HARRISBURG - The Corbett administration seeks to broaden the scope of Medicaid expansion talks with Washington, but expressed disappointment at the lack of progress so far with federal officials.
The administration wants to cover such issues as having new recipients obtain their coverage through health insurance exchanges, requiring some form of co-payments and job training on their part, and reconsidering the types of benefits that would be offered.
Gov. Tom Corbett has yet to decide whether to expand Medicaid health coverage to include hundreds of thousands of low-income adult Pennsylvanians under terms of the 2010 federal Affordable Health Care Act.
Democratic lawmakers are pushing to include Medicaid expansion as part of the next state budget as a way to draw large sums of federal aid to underwrite coverage for the uninsured, boost the health care sector of Pennsylvania's economy and free up state dollars for other purposes.
While the June 30 state budget passage deadline looms, two top Corbett administration officials said they are not necessarily looking at that deadline because they want to make major changes to Medicaid as part of any expansion.
The Medicaid program covers more than 2 million low-income Pennsylvanians, including children and adults with dependent children, pregnant women, the elderly, the disabled and medically needy.
The administration isn't seeking changes that would affect services provided to the elderly and disabled, said Corbett policy director Jennifer Branstetter.
"There is no date for when a decision has to be made for Pennsylvania," she added.
The expansion talks started in April with a meeting between Mr. Corbett and federal Department of Health and Human Services Secretary Kathleen Sebelius.
Ms. Branstetter and Todd Shamash, Corbett deputy chief of staff, said federal officials are being too rigid in their approach.
"We are not seeing much of a wink and nod out of Washington yet," said Ms. Branstetter.
The administration has broached the idea of having those newly eligible medical assistance recipients obtain their coverage through the state health insurance exchanges being set up under ACA, said Ms. Branstetter and Mr. Shamash. These exchanges are intended as a regulated marketplace where individuals and small businesses can purchase private health insurance from insurers.
It would be an alternative to expanding the traditional medical assistance programs under the state Department of Public Welfare which cost more to run each year, they added.
Arkansas is advancing a private-option plan, where the state would use federal money to buy private insurance for low-income residents.
Other issues raised by the Corbett administration include whether the federal government will keep its funding commitments and the fate of the state Children's Health Insurance Program and a state gross receipts tax on Medicaid managed care plans if Pennsylvania opts in.
The Corbett administration is still discussing concepts while HHS is asking states to submit specific plans that can be reviewed and then negotiated, said Senate Democratic Appropriations Chairman Vincent Hughes, D-7, Philadelphia.
"Some people believe this is a stall tactic to get beyond June 30," he added.
The idea of a copay costing a couple dollars is something that could get consideration, but not a copay on a scale of $200, said Mr. Hughes.
Pennsylvania must redesign its health care system under ACA regardless of whether it expands Medicaid, said the Pennsylvania Budget and Policy Center, which supports expansion.
"There is no reason that the expansion could not take effect in 2014 if policymakers allocate the federal dollars in the 2013-14 budget," the center said.
"Medicaid expansion should be abandoned because it would dump more of the poor into a system that's already failing them" said the Commonwealth Foundation, which opposes the idea.
Contact the writer: rswift@timesshamrock.com