On February 19, Pennsylvania Governor Tom Corbett submitted his Healthy Pennsylvania Medicaid Waiver proposal to Health and Human Services (HHS) Secretary Sebelius. While the proposal affirms Pennsylvania’s commitment to ensuring access to coverage for all children who are eligible for Medicaid, 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. 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.

Pennsylvania’s proposal to impose premiums and work requirements for former foster youth contradicts 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, 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.

Just yesterday, 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 is that former foster youth would not be exempt.

While it is encouraging to see that the Governor has backed down from his original proposal to tie work search requirements to Medicaid eligibility, his modified proposal doesn’t go far enough. Medicaid is not a job training program and any attempts to tie eligibility for this health program to work requirements or incentives or any other type of related initiative should not be approved. If approved, HHS is sending a message that it will entertain state attempts to link Medicaid to job training and employment and paves a slippery slope for states looking to restrict program eligibility. And, let’s not forget that the proposal still includes premiums and co-payments for Medicaid.

CMS should send a clear message to all states that premiums, work requirements and other attempts to place additional eligibility restrictions on the new mandatory category of former foster youth will not be approved.

Corbett Medicaid Letter 2014-03-05.pdf