Medicaid expansion was a major part of the Affordable Care Act (ACA) when it was first approved. It’s goal was—and is—to decrease the healthcare coverage gap and provide access to care for those who wouldn’t otherwise have it. While some states immediately implemented Medicaid expansion, others took a little longer to adopt it. One of those states is Pennsylvania.
Current State of Medicaid in Pennsylvania
Pennsylvania adopted Medicaid expansion on January 1, 2015, though the process to implement it took about a year longer than it did in other states (expansion began in 2014). At first, legislators wanted to approve it with a waiver and some customized regulations. But after a year of working through the process and following changes in leadership, the state completely adopted Medicaid expansion without any amendments or waivers. Just seven months later, 439,000 Pennsylvanians had reportedly enrolled. By spring 2017, a total of 719,000 Pennsylvanians had joined, and in October 2019, just over 800,000 people were reported to be in the Medicaid expansion group. This made for a 43 percent reduction in the uninsured rate between 2013 and 2017.
The fact that Pennsylvania has fully adopted Medicaid expansion means that anyone with a household income up to 138 percent of the federal poverty line (FPL) can be eligible for coverage. This has resulted in significant Children’s Health Insurance Program (CHIP) enrollment. It also provides for pregnant women, unmarried individuals without access to care and individuals with chronic needs and disabilities.
The Work Requirements Battle
In 2018, the Pennsylvania government proposed legislation that would require non-exempt Medicaid enrollees (i.e. those with the ability to work or get an education) to work at least 20 hours a week or complete at least 12 job-training activities per week. However, this legislation was eventually vetoed. Part of the reason for the debate over work requirements in Pennsylvania and in other states is that such regulations are difficult to implement and enforce, and even if people follow them, they may end up losing coverage. In some cases, people may lose coverage because they start making too much money as a result of being required to work, even though they may not receive employer-provided healthcare. In other cases, the methods of reporting work credits are difficult to understand and are therefore not completed properly.
Pennsylvania may in the future attempt to pass another work requirement, but uncertainty still exists about whether it would be ratified. However, it’s important to note that as of October 2019, 60 percent of adult Medicaid enrollees are working anyway.
How DECO Can Help
At DECO, we specialize in determining eligibility and keeping track of the changes in government programs. If the patients in your healthcare organization could potentially receive Medicaid funding (or any other form of coverage), but are not yet enrolled, we can help them undergo the process, gaining financial security and the ability to pay for their care. This results in higher reimbursement rates for healthcare organizations, which in turn promotes a healthy revenue cycle. We work on the front lines with clinical staff doing this and many other tasks that can streamline efficiency in the healthcare system. If your organization wants to learn more about how increased Medicaid enrollment can help improve its financial well-being and that of its patients, contact us today!
