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State's Medicaid plans poised for overhaul

HARRISBURG — Gov. Tom Corbett’s administration is telling hundreds of thousands of adult Medicaid enrollees that their benefits will change as part of an overhaul of the medical coverage plans beginning Jan. 1.

Notices were mailed last week, and adult enrollees will go into one of two plans that best fit their needs, according to a spokeswoman for the Department of Public Welfare.

However, precise changes were unavailable because the department does not have the federal government’s OK yet, spokeswoman Kait Gilliis said today.

“They are working with us,” she said.

The overhaul in medical plans under the traditional Medicaid program — which already insures many nursing home residents, childless adults with no income and some low-income parents — is separate from the vast, federally funded expansion of Medicaid eligibility set to take effect in Pennsylvania on Jan. 1.

Changes to coverage under the traditional Medicaid program will simplify the current lineup of 14 plans to two, and save money by better tailoring benefits to the needs of each enrollee, the Corbett administration says. Benefits for children under 21 do not change.

The plans include a “high risk” one for people with chronic health problems and more generous benefits, and a “low risk” one for healthier people who do not need as much medical care.

Every Medicaid enrollee who is in a nursing home, 65 or older, pregnant, mentally or physically disabled or dealing with a chronic medical condition or substance abuse will go into the high-risk plan, according to the Department of Public Welfare.

But many working-age adults who already are on Medicaid will go into the low-risk program, which will limit the reimbursement for many services.

Democratic Gov.-elect Tom Wolf, who takes office Jan. 20 after beating Corbett in last week’s election, opposes the changes because he views them as a reduction of benefits for the poor.

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