So long, Healthy PA. Hello again, HealthChoices.
Monday marked the beginning of Pennsylvania’s transition from one version of Medicaid expansion under the Affordable Care Act to another.
“The changes put in place today will make it easier for hundreds of thousands of Pennsylvanians to get access to the health care they need,” Gov. Tom Wolf said, announcing the change.
SouthEast Lancaster Health Services has helped residents with 405 Healthy PA applications from January 1 through April 22, according to Helen Jones, director of social work there.
Processing the applications took up to 75 days, she said, but once enrolled in the program people were generally happy, although some specialists don’t accept Healthy PA plans. With the transition now taking place, she said, “We are looking forward to better access to specialist care for our patients.”
Here’s what you need to know about the switch.
1. Which plan goes with which governor.
States became eligible to expand Medicaid under the ACA in January 2014. Former Gov. Tom Corbett enacted Healthy PA in January of this year, and Wolf set the switch to HealthChoices in motion shortly after being inaugurated.
2. Who’s in the first wave.
All new applicants and all people who were on Pennsylvania’s Medicaid plan before Healthy PA’s debut are being enrolled in HealthChoices, which will take effect June 1.
3. Who’s in the second wave.
Everyone else who’s currently enrolled in Healthy PA will be notified in July of their pending transition to HealthChoices, which will be effective by Sept. 1.
4. What HealthChoices is.
It’s the system of managed care programs through which Pennsylvania’s Medicaid program has been administered for decades, according to DHS spokeswoman Kait Gillis. The name’s old, but the benefit package under Wolf’s plan is new, she said.
5. Who has a choice.
People in Healthy PA’s Private Coverage Option — the plan for the newly eligible — will be given a choice of managed care providers through which to receive HealthChoices. If they don’t choose, they will be automatically placed in one.
6. Who will be automatically transferred.
Everybody, except those in the PCO plan, will be automatically transferred to a HealthChoices plan.
7. How is HealthChoices different from Healthy PA?
It has a single benefit package for adults; Healthy PA had three different ones. Unlike some or all of Healthy PA plans, benefits in the HealthChoices plan include dental treatment, transportation to medical appointments, dialysis and some behavioral health care.
8. How does the Affordable Care Act factor into this?
The law authorized expansion of Medicaid eligibility to everyone below 138 percent of the federal poverty guidelines, with the federal government funding 100 percent of coverage for all newly eligible adults from 2014 through 2016, then phasing down to 90 percent by 2020.