Pennsylvania Submits Healthy PA Waiver to U.S. Dept. of Health & Human Services

HARRISBURG – Gov. Tom Corbett has submitted Pennsylvania’s plan to the U.S. Department of Health and Human Services to reform the state’s Medicaid program and to provide increased access to quality affordable health care for more than 500,000 uninsured Pennsylvanians. By this formal step, Pennsylvania is seeking federal approval to implement the Healthy Pennsylvania plan.

The Healthy Pennsylvania Medicaid modernization plan includes two critical parts: reforming the current Medicaid program and offering a private coverage option for uninsured Pennsylvanians.

Healthy Pennsylvania is vital to providing a much needed safety net for the people that need it most. However, we want to make sure Medicaid remains a transitional benefit,” Corbett said. “We are working towards a health care delivery model that best meets the needs of all Pennsylvanians, and this plan is a step in that direction.  Pennsylvania is seeking approval on an expedited basis so we can move forward.”

The proposed plan, anticipated to begin in January 2015, encourages personal responsibility, provides benefits that match individuals’ health care needs and promotes healthy behaviors.

Currently, one in six Pennsylvanians receive Medicaid benefits and the costs of the Medicaid program account for 27 percent of the commonwealth’s entire general fund budget. These costs continue to grow by hundreds of millions of dollars each year.

“As we developed this plan, we traveled the commonwealth, listening to what people really needed from their health care coverage. The plan that Governor Corbett is proposing is a strong reflection of the over 1,000 comments received,” said Department of Public Welfare (DPW) Secretary Beverly Mackereth.

The submitted plan includes numerous modifications based on feedback DPW received during seven statewide hearings, two webinars and submitted comments. Some of the changes include modifying cost sharing criteria, providing coverage for the period between the presumptive eligibility application date and the effective date of the private coverage option coverage, and including locally-based federally qualified health centers in plan networks under the private coverage option.

The proposed Medicaid modernization plan focuses on Governor Tom Corbett’s three key priorities under the HealthyPennsylvania plan: improving access, ensuring quality and providing affordability.

The proposed plan will:

  • Increase access to private market health insurance through the Healthy Pennsylvania Private Coverage Option for Pennsylvanians 21 years of age or older, but under 65 years of age, with incomes less than 133 percent of the Federal Poverty Level ($15,282 in a household of one);
  • Modify the existing Medicaid benefit designs to be consistent with the private health insurance market to assure long term sustainability of the program and provide a safety net when individuals are in their greatest need; and
  • Promote healthy behaviors and increased independence through cost sharing and encouraging employment.

“Health care is not ‘one-size-fits-all’. The Healthy Pennsylvania plan is focused on what is best for Pennsylvania – and delivers quality options for people in their greatest time of need,” said Mackereth. “We look forward to working with the federal government to deliver a high quality and fiscally sustainable option for Pennsylvania.”

For more information about Governor Corbett’s entire Healthy Pennsylvania plan, visit For more information about the Healthy Pennsylvania Medicaid modernization plan, visit

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