This post also appears on the State Policy Advocacy and Reform Center (SPARC) blog. 

Just yesterday, Healthy Pennsylvania, Pennsylvania’s alternative to a traditional Medicaid expansion for low-income adults, was approved by the Department of Health and Human Services (HHS). While many would agree that a traditional expansion would have been better than this demonstration, Healthy Pennsylvania will provide the opportunity for many low-income adults, including parents, to gain coverage under Medicaid for the first time. This is important as we know that when parents are insured, there is a greater likelihood that their uninsured children (who are currently eligible) will also become insured. The proposed program has not been without controversy.

You may recall that earlier this year, Pennsylvania Governor Tom Corbett submitted his Healthy Pennsylvania Medicaid Waiver proposal to HHS Secretary Sebelius. Several of the provisions of the proposal were problematic for former foster youth in the state. Specifically, the proposal asked for approval for the State to require work search activities and premium payment for non-exempt former foster care participants 21 years of age or older but under 26 years of age. A number of us countered that conditioning receipt of Medicaid coverage on compliance with job search and premium payments is not only counter to current law and regulations, but would place an enormous burden on Pennsylvania’s most vulnerable youth and would lead directly to the loss of coverage for a large proportion of these high-need young adults. We further argued that Pennsylvania’s proposal to impose premiums and work requirements for former foster youth contradicted legislative intent, which is to afford parity to and provide health coverage for former foster youth as provided to young adults 18-26 who are on their parents plans. Also, we argued that coverage for former foster youth is a new mandatory Medicaid coverage category. The Medicaid Act does not permit states to impose work search requirements, and mandatory coverage categories are typically exempt from premiums entirely, particularly with regard to youth. You can view our comments here.

In March, Governor Corbett sent a letter to Secretary Sebelius, with a modified proposal for job training. His new initiative, Encouraging Employment, is a voluntary, one-year pilot program to encourage participation in job training and work opportunities that would be offered to those applying for Medicaid or the Private Coverage Option. It is not tied to program eligibility, and those who participate in it will have lower premiums and cost sharing as incentives. Children, elderly, pregnant women and individuals with disabilities would be exempt from this program, as was the case under the proposed 1115 waiver. Our understanding was that former foster youth would not be exempt.

The newly approved Healthy Pennsylvania has removed several concerning provisions. Importantly, we are pleased to see the federal government rejected a provision of the proposal that would have required former foster youth to meet certain work requirements at age 21 and required some foster youth who age out of care to begin paying monthly Medicaid premiums in 2016. When the ACA required states to allow former foster youth to remain on Medicaid until age 26,  it intended to equalize insurance coverage among young adults, placing youth aging out of foster care on par with their peers who are able to stay on their parents’ insurance until age 26. This provision enables former foster youth to use this time in their lives similarly to that of their peers outside of “the system”– exploring educational and professional opportunities, many of which do not often come with insurance coverage. Foster youth are an unfortunately unique population who have been abused or neglected and who often have a range of unique physical and mental health needs, physical disabilities and developmental delays, far greater than other high-risk populations. We should not be creating more barriers to coverage for these youth, so rejecting this unprecedented proposal and removing additional eligibility restrictions to the new mandatory coverage category for former foster youth is good news for young people who are exiting foster care as they head into adulthood.

A big thanks to our Pennsylvania partner, Pennsylvania Partnerships for Children for leading efforts to urge HHS to reject these and other onerous requirements, and for their update on the recent Healthy Pennsylvania approval package.