PA's Medicaid expansion could make it cheaper for enrollees to get exchange coverage

A proposed expansion of Pennsylvania's Medicaid program under the Affordable Care Act (ACA) by Gov. Tom Corbett has created a quandary--many thousands of the state's residents would pay higher premiums if they stayed in Medicaid than if they obtained coverage through the state's health insurance exchange, the Philadelphia Inquirer reported.

Monthly premiums for potential  Medicaid enrollees would start at 50 percent of the federal poverty level, even though monthly incomes for a single person at that floor would be less than $500, according to the Inquirer.

Iowa made a similar proposal to charge premiums to enrollees with incomes below the federal poverty level, but the Centers for Medicare & Medicaid Services rejected it. Iowans enrolled in Medicaid would only pay for coverage if their income was at or above the poverty level, according to the Inquirer.

Based on analysis by the Inquirer, low-income Pennsylvanians could obtain coverage without a monthly premium from the state's health insurance exchange, although they could face thousands of dollars a year in out-of-pocket costs.

And aside from paying premiums of at least $13 a month, enrollees that miss three consecutive payments would be terminated from Medicaid in Pennsylvania, according to Corbett's proposal.

"Maybe they are working and their car breaks down and the only way they can get to work is to fix the car," said Richard Weishaupt, a senior attorney at Community Legal Services of Philadelphia, told the Inquirer. "The choice is then to fix the car and keep working," or potentially risk their job by paying the premium.

About two dozen states have agreed to relax Medicaid income eligibility under the ACA, with Pennsylvania and several others still debating the issue. Some 20 states have refused to expand the program outright.

Corbett, a Republican, has made a public-private proposal to expand Medicaid coverage to about 500,000 Pennsylvanians. However, because of delays in crafting a plan the state won't implement it until 2015 at the earliest.

Public hearings on Corbett's proposal will be held in the coming weeks.

To learn more:
- read the Philadelphia Inquirer article