HARRISBURG (AP) - Gov. Tom Corbett on Wednesday began seeking federal approval for his plan to bring billions of federal Medicaid expansion dollars to Pennsylvania to cover a half-million working poor residents through private health plans, although advocates for the poor and uninsured called it bureaucratic and punitive.
The Corbett administration submitted the plan to the U.S. Centers for Medicare and Medicaid Services, which has given at least partial approval to proposals by other states, including Arkansas and Iowa, which sought some similar modifications to the Medicaid expansion envisioned by the 2010 federal health care law.
Corbett's public welfare secretary, Beverly Mackereth, said the administration is backing off certain elements that have been criticized as barriers to coverage, although not enough to mollify every critic of a draft plan with a long list of conditions the administration issued in December.
In any case, any new coverage is expected to wait until January 2015, when Mackereth has said the administration will have the technology and staff to handle the new program.
Meanwhile, the Republican governor is running for a second four-year term this year and may have to sustain criticism until then that he did not move quickly enough to draw down the federal Medicaid expansion dollars when they became available Jan. 1.
Corbett, a critic of Medicaid who calls the five-decade-old program inefficient and bloated, refuses to expand Medicaid coverage. Instead, he wants to use the Medicaid expansion dollars to purchase private insurance policies for about 500,000 newly eligible adults, an idea pioneered by Arkansas.
Mackereth said Wednesday that the administration is still contacting insurers and trying to figure out how the program of subsidizing private coverage plans will work. For the time being, a quirk in how a U.S. Supreme Court decision affected the federal health care law's rollout means that some of the 500,000 - those whose annual income is $11,500 or more - can seek coverage that is subsidized by tax credits through insurance marketplaces created by the law.
The Pennsylvania Association of Community Health Centers and the Pennsylvania Medical Society said Wednesday that they supported the proposal.
The revised plan would relax usage limits on certain medical services that it wants to require for able-bodied adults in the existing Medicaid program.
It also would ensure that rural health centers and federally qualified community health centers are automatically enrolled under the insurance plans subsidized by the Medicaid dollars. The previous draft had forced them to negotiate with the insurers, but Mackereth said the administration is putting an emphasis on providing access to primary care.
The administration said it also is backing off most demands that enrollees complete work-search requirements and pay premiums instead of co-pays in the first year as a condition of getting coverage, although advocates for the poor and uninsured warned that those elements remained troublesome.
For instance, the work-search and premium requirements carry as a punishment "lockout" periods during which people cannot get coverage if they fail to meet the requirements.
"So you better not get sick during that time," said Richard Weishaupt, a lawyer with Community Legal Services of Philadelphia, a public interest law center that advocates for the poor. "No state has ever gotten a waiver to do the lockouts."