Sep 4, 2014 3 min read

HARRISBURG – Before hundreds of thousands of Pennsylvanians can enroll in a new federally funded Medicaid plan, lots of work must be done and important questions must be answered about the health coverage.

The federal government last week approved elements of the health care expansion that Corbett’s administration spent more than a year developing. With the agreement, Pennsylvania joined 26 other states and Washington, D.C., in opting for a Medicaid expansion under the 2010 federal health care law.

Now the state and participating health insurers must get the system ready to go in 87 days, when enrollment begins Dec. 1. Coverage is to take effect Jan. 1 for the new enrollees, expected to be primarily single, childless working adults who make up to 133 percent of the federal poverty level, or about $15,500 a year.

“We feel pretty confident at this point that we’ll be able to move forward with enrollment on Dec. 1 and coverage on Jan. 1,” said Lisa Allen, executive director of Pennsylvania’s Medicaid program.

In some ways, the new system is using parts that are already in place, like the state’s Compass website or the county welfare offices. The insurers that will administer the new coverage plans are largely the same insurers that administer benefits to three-quarters of the 2.2 million people already on Pennsylvania’s Medicaid program. The new system also will use the same private contractor to help enrollees select a plan.

But insurers must assemble new provider networks since the benefits under the new coverage plans and the geographic regions in which the plans operate will be different. A new screening system also must be created, in which the sickest Medicaid enrollees are identified and diverted into a program with broader benefits. The electronic application system must be updated to process the newly eligible applicants.

Antoinette Kraus, executive director of the Pennsylvania Healthcare Access Network, which advocates for the poor, said a straightforward expansion of the existing Medicaid system would have been far less cumbersome or complicated. As a result, she questions whether everything will be ready Dec. 1.

“It’s going to be complicated and for folks doing enrollment, it’s going to be a lot for folks to understand how to walk people through the entire process,” Kraus said.

Allen said the insurers – nine are approved to offer a plan under “Healthy PA” – have the information they need to assemble provider networks and coverage plans. But insurers said they still need crucial information from both the state and federal government.

That includes the exact benefits the state will require in the coverage plans and how much insurers will be paid, said Michael Rosenstein, who represents the eight private insurers that are managing the care of 1.6 million Medicaid enrollees in Pennsylvania’s current system.

“There are a lot of questions that remain unanswered,” Rosenstein said.

Insurers also will need to update their computer systems and add staff.

A spokeswoman for Geisinger Health Plan, which is affiliated with Geisinger Health System, said it expects to enroll 55,000 more people under Pennsylvania’s Medicaid expansion. It currently serves 470,000 people in five states, she said.

The federal government could eventually pump more than $3 billion into Pennsylvania to support the coverage, according to an estimate by the Independent Fiscal Office, a nonpartisan agency of the state Legislature.