Department of Public Welfare Secretary Beverly D. Mackereth and many of her deputy directors got an earful during the latest in a string of statewide public hearings to both explain and receive input on reforming the state’s Medicaid program.
While some who spoke at the Monday, Jan. 6 hearing said the current system is fine, they lamented the state’s decision to follow a different path from the one outlined in The Affordable Care Act that 23 other states modeled their new programs on.
“I think Pennsylvania has a very good Medicaid program,” Mackereth said. “But we have a financially-unsustainable system and that’s what we need to talk about.”
Some of the 20 people who got their three minutes of allocated public speaking time took their opportunity to support the plan but more raised concerns about the way the the state’s proposed Medicaid program is currently written.
Mackereth said these meetings, which have been held in Philadelphia, Pittsburgh and Erie so far with additional ones scheduled in Altoona and Harrisburg, are taking place so that issues can be addressed and changes can be made before the state submits its final plan to the federal Centers for Medicare and Medicaid Services for approval.
“This is our opportunity to hear from you,” Mackereth said. “There are a lot of misconceptions out there about this plan.” One of them, she said, is that “people think what we’re putting out there is final. It is not.”
By holding these hearings, she added, the public can better understand the plan’s reality and facts. But she also said the public has raised issues the state didn’t envision and those matters will lead to changes in the final plan.
The overriding theme of the need for a new Medicaid system in Pennsylvania is that the state’s population continues to get older and changes need to be made to insure the plan is financially healthy enough to make sure the state’s future senior citizen population has adequate access to health care.
We need to create a “sustainable Medicaid program, not just for next year or the year after but 10 years down the road and 10 years after that. … We have to insure we can deal with that population, which we’ll all be part of one day.”
Mackereth said that Pennsylvania has the nation’s fourth highest number of senior citizens. And recent census data shows the number of children in the state continues to drop while the number of elderly residents is climbing.
She noted that Medicaid, the federal and state medical insurance program for the poor, is used by about one out of every six — or 2.2 million — state residents. And it’s costly with more than a quarter of the state’s budget allocated to the program. Medicaid costs $20 billion a year in state and federal funding, Mackereth said.
The Healthy PA Plan that includes the Medicaid changes, floated by Gov. Tom Corbett, eliminates most co-pays in Medicaid, replacing them with premiums up to $25 per month for individuals and $35 per month per household depending on income guidelines for adults between ages 21 and 65. No premiums would be owed by those under 21 or older than 65.
Recipients older than 65 would also be exempted from the requirement that Medicaid recipients working fewer than 20 hours a week show proof that they are searching for a better job. That provision seemed to get a lot of attention from those who took to the podium Monday inside the Taylor and Dalton meeting rooms at the Hilton Scranton and Conference Center
These changes and the state’s scurrying to create its own plan is a result of a provision in The Affordable Care Act that created an increase in the number of people eligible for Medicaid. The changes were to kick in Jan. 1.
A Supreme Court ruling permitted states to opt out of the mandated expansion but they must submit an alternate plan that meets satisfactory approval from the federal government. Pennsylvania was one of 27 states that did not accept the original federal plan and opted out while it creates its own acceptable plan that still meets the federal mandates.
After Mackereth offered a 45-minute PowerPoint presentation on the plan, the challenges facing the state and the way the changes would work, it was the public’s turn to be heard. Statements were permitted but no questions were allowed. With only three minutes to speak — and a countdown clock displayed on the big screen — the orators had to get their point across quickly. Some were cut off mid-sentence with a polite “thank you” from the moderator.
Almost all of the speakers represented a health care or community organization such as Geisinger, Genesis, Dress for Success Lackawanna and the Wilkes University School of Pharmacy. Most wanted state officials to make sure they understood that some populations need to be advocated for including the mentally or developmentally challenged and seniors receiving home health care or in assisted living facilities.
Michael Wylie, with Genesis HealthCare, which operates The Willowbrook and Abington Manor in Clarks Summit, said he believes the plan is a good one that balances costs while continuing to provide quality health care to the state’s sickest and most frail.
Others, however, had concerns.
Mary Lou Knabel, a vice president of home care services with Allied Services, said the job search requirement “might be challenging for some adults with developmental disabilities” especially those living in rural areas where access to transportation may be difficult.