Sep 14, 2013 4 min read

HARRISBURG – Gov. Tom Corbett will start a three-day tour Monday to lay out his plans to improve health care and reveal the conditions under which he would accept additional Medicaid dollars under the sweeping federal health care law designed to provide insurance to more working poor.

A key condition for Corbett will be an idea being explored by some other states – using the Medicaid dollars to buy private insurance policies instead of expanding government rolls – where Republicans are wary of expanding traditional Medicaid coverage.

The announcement arrives after months of Corbett aides pressing the U.S. Department of Health and Human Services to accept the governor’s terms to join the Medicaid expansion, a major element of President Barack Obama’s signature 2010 law.

Corbett, a Republican who sued unsuccessfully to overturn the federal law, is a critic of Medicaid, saying it is bloated and costly, and his aides insist that the forthcoming proposal will not amount to an expansion of Medicaid’s enrollment.

“Gov. Corbett does not support growing an entitlement program as he has been very clear about the need for reform,” spokeswoman Lynn Lawson said Friday. Lawson did not give details about the forthcoming plan or reveal where Corbett will stop on the tour.

But three people who are familiar with the plan said Corbett’s conditions to accept the money reflect ideas that administration officials have publicly discussed in recent months. The people spoke on condition of anonymity because they did not want to be named revealing details of his plan before Corbett announces it.

For states that participate in the Medicaid expansion, the extra federal money becomes available Jan. 1.

However, it is not yet clear whether the U.S. Department of Health and Human Services will agree to Corbett’s conditions, and the Corbett administration has yet to submit an official request for approval. In addition, Corbett’s public welfare secretary, Beverly Mackereth, has said previously that the administration will probably need until 2015 to negotiate and prepare for a Medicaid expansion plan.

The conditions Corbett will lay out include allowing Pennsylvania to use the new federal Medicaid dollars to help adults who are eligible under the expanding income guidelines to buy private health insurance on the online exchanges that open Jan. 1, the people familiar with the plan said.

Corbett also wants to require the enrollees to share the cost, for instance by paying a premium that is a percentage of their income, they said.

But first, Corbett will insist that the Obama administration approve changes to Pennsylvania’s existing Medicaid program for working-age adults, they said. For instance, he wants to require working-age adults already on Medicaid – including pregnant women, parents and people with disabling conditions – to pay a premium and the able-bodied and unemployed among them to search for work, they said.

Besides Medicaid, Corbett will take on the issues of children’s health care and access to physicians.

He will propose improvements to the Children’s Health Insurance Program, including eliminating a six-month waiting period before a child can get coverage, as a way to close the gap of an estimated 150,000 children in Pennsylvania who lack health care. And he will also propose new ways to persuade medical school graduates to practice in areas of Pennsylvania that are in need of more family doctors, they said.

Corbett, who is unpopular in public opinion polls as his 2014 re-election campaign gears up, is heavily criticized by Democrats and advocates for the poor for his health care policies. Since he became governor in 2011, enrollment in both Medicaid and the Children’s Health Insurance Program has shrunk, while he shut down a state-subsidized health care program called adultBasic for about 40,000 lower-income adults.

Meanwhile, he is being pushed to embrace a Medicaid expansion by a broad coalition of Democratic lawmakers, labor unions, hospital executives, advocates for the poor, the NAACP, the AARP and some Republicans in the GOP-controlled Legislature. His biggest critics say he has dragged his feet on the issue for too long.

The U.S. Supreme Court’s June 2012 decision to uphold the law also decided that the federal government couldn’t force states to expand their Medicaid programs, and instead left the decision up to each state.

Republican lawmakers in Arkansas first raised the idea of a private option to Medicaid – using the federal Medicaid expansion funds to pay for private health insurance coverage – and sent a proposal to the Obama administration earlier this month. Many Republican-leaning states are now watching the outcome.

Hang-ups include who will pay the difference if private insurance policies are more expensive than Medicaid coverage and how those private plans will reflect Medicaid guarantees of certain benefits and limits on cost-sharing, said Matt Salo of the National Association of Medicaid Directors in Washington, D.C.