Cutting 90,000 Pennsylvania Women from the SelectPlan for Women Program Is Bad Policy

                     Close the Gap Campaign

Prepared jointly by the Pennsylvania Budget and Policy Center, Community Legal Services of Philadelphia, and the Pennsylvania Health Access Network as part of the work of the Close the Gap Campaign, to ensure that states accept the federal dollars set aside to extend Medicaid to low-income adults, and that Medicaid expansion waivers do not undermine the goal of providing comprehensive coverage with minimal burdens on potential enrollees.

Sharon Ward
Director
Pennsylvania Budget and Policy Center
(717) 255-7156
ward@pennbpc.org

Kristen M. Dama
Staff Attorney
Community Legal Services of Philadelphia
(215) 981-3782
kdama@clsphila.org

Antoinette Kraus
Director
Pennsylvania Health Access Network
(267) 971-1680
akraus@pahealthaccess.org

Download the Report

Media Coverage: Pittsburgh Post-Gazette, October 24, 2014
"Thousands of PA women could lose some health coverage"

Read the Report:

The Department of Public Welfare (DPW) will end family planning coverage for almost 90,000 low income women currently enrolled in SelectPlan for Women, most of whom will be eligible for comprehensive health care coverage through Healthy Pennsylvania. Rather than ending the SelectPlan waiver, DPW should transition eligible SelectPlan enrollees into Healthy Pennsylvania and continue to offer SelectPlan as a choice for women who are not Medicaid expansion-eligible.

SelectPlan for Women is a special category of Medicaid that provides family planning and gynecological coverage for women earning up to 214% of the federal poverty line. SelectPlan is offered under a federal Medicaid waiver, which will expire on December 31, 2014.

The majority of women in SelectPlan will be eligible for the new Medicaid expansion program, and DPW should automatically move them to the new program with full coverage effective January 1, 2015. Instead, DPW is planning to end their SelectPlan coverage and send them a letter telling them they must reapply to obtain coverage. While some of the women in SelectPlan will be over-income for the new Medicaid expansion program (Medicaid expansion covers people up to 138% of the federal poverty line), most of the women in SelectPlan are at the lower end of the income scale and will be eligible for Medicaid expansion.

Cutting off coverage for these 90,000 women and making them reapply means that these women will not only not have the broader coverage for which they will qualify, but they will also lose their only insurance for family planning and gynecological care.

This plan is bad policy because:

Many of the women in SelectPlan originally applied for full Medicaid coverage but were not eligible under pre-Medicaid expansion rules. With income limits of just 38% of poverty for parents (and lower for single adults), most applicants only qualified for SelectPlan coverage. Now that Medicaid will be expanding on January 1, 2015, parents and single adults with income up to 138% of the federal poverty line will be eligible for full health coverage.

DPW already has the needed information to find these women eligible under the new rules, and to move them automatically, to the new coverage. DPW has the information from their applications for Medicaid that resulted in SelectPlan coverage, and in addition, many of them have children who are getting Medicaid, or are getting SNAP (formerly called Food Stamps) from DPW.

DPW is automatically moving other groups of people from other categories of Medicaid (General Assistance-related Medical Assistance) to the new coverage, but is not doing the same for women who were in SelectPlan.

Automatically enrolling eligible women, rather than making them reapply, will substantially reduce the administrative burden on DPW. Beginning in December 2014, DPW will have to process four or five hundred thousand new applications for people who will be newly eligible under Medicaid expansion. Automatically enrolling those for whom DPW can electronically verify income will reduce administrative costs and ensure that women do not lose coverage during this expected enrollment crush.

In 2015 and 2016, the costs of covering the women who were in SelectPlan through Medicaid Expansion will be fully paid by the federal government. Pennsylvania will not have to pay any of the costs of their coverage. The only costs Pennsylvania will incur will be a portion of the administrative costs of enrolling them. Why is DPW adding to administrative costs by making women apply from scratch?

Social service agencies and family planning clinics will have to assist many of these women through the reapplication process, at the same time they will be trying to help other individuals apply for Medicaid expansion.

Women will lose coverage. Many women will have difficulty understanding what they need to do to reapply, and the barriers and burdens of having to go through an unnecessary reapplication—particularly for low-income workers who cannot take time off from work and may not have easy access to technology—will result in lost paperwork and a gap in coverage.

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