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March 19, 2014Alerts

Alert for the Disability Community: Healthy Pennsylvania Comments Due April 11

The Department of Public Welfare is proposing “Healthy PA,” which is a plan to:

(1) Cut benefits for adults on Medicaid (Medical Assistance), and
(2) Provide private insurance coverage for certain uninsured adults, without the rights and protections of Medicaid.

The final Healthy PA proposal, which was submitted to the federal Centers for Medicare and Medicaid Services (CMS) on February 19, 2014 can be found here.

Healthy PA would negatively impact people with disabilities, and so it is very important for people with disabilities to submit comments.

Comments are due by April 11, 2014 at 6:00 AM.  Comments on the “Healthy Pennsylvania Private Coverage Option Demonstration” can be submitted online or emailed to –

Comments may also be mailed to:  Megan Stacy, Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Mailstop: S2-01-16, Baltimore, Maryland 21244.  Every comment matters.
Big changes are being proposed that include:

  • Medicaid benefits cuts for adults ages 21 to 64.  For example, durable medical equipment and medical supplies would each be limited to either $1000 or $2500 a year.  This does not cover a new power wheelchair or many speech-generating devices.  Outpatient mental health visits would be limited to either 30 visits or 60 visits a year.  Radiology, laboratory work, inpatient acute and psychiatric hospitalization, and other services would be limited as well.
  • Coverage for uninsured adults, with incomes up to 133% of the federal poverty level, through private insurance. This would be called the Private Coverage Option.  For people in the Private Coverage Option, there would be no Fair Hearings for coverage denials, no Medicaid transportation or other Medicaid wrap-around benefits, very limited ability to get out-of-network services, and no Medicaid medical necessity requirement.  Appeals of service denials, for example, would be made to the private insurance company providing the health insurance.
  • The Medical Assistance for Workers with Disabilities (MAWD) program would be eliminated.
  • People in Medicaid and in the Private Option who have incomes above 100% of the federal poverty level would have to pay monthly premiums beginning January 1, 2016.  100% of federal poverty level is $972.50 income per month for an individual or $1,987.50 income per month for a family of four.  Failure to pay premiums would result in increasing periods of ineligibility for Medicaid or the Private Coverage Option (i.e., three months for the first failure to pay, six months for the second, and nine months for the third).

For more information, go to DRN’s overview of Healthy PA. 

Contact: Kelly Whitcraft, DRN Policy Coordinator, at or 800-692-7443, extension 323.

Thank you,

Disability Rights Network of Pennsylvania
Philadelphia, Harrisburg, Pittsburgh