HARRISBURG — Some 90,000 Pennsylvania women are at risk of losing access to the free family planning and women’s health-care coverage they now receive through a special Medicaid program.
But they may be able to gain the coverage right back by applying for broader private coverage through the state’s revamped Medicaid program, or through the federal government’s health insurance marketplace.
SelectPlan for Women — essentially a limited-benefit category of Medicaid — offers services such as birth control, breast exams, Pap smears (a screening test for cervical cancer) and other women’s health-related services at no cost, according to its website. Women age 18-44 with income below 214 percent of the federal poverty guidelines who have no private insurance, and no Medicaid insurance, are eligible.
Those who have limited health plans that do not include family planning benefits also may be eligible.
The website gives no indication the program will be ending at year’s end, but women’s advocates say they have been told to prepare for the program’s termination. On Thursday, the Corbett administration said “no final decisions have been made.”
“The Corbett administration will not let any of these women in Pennsylvania go without access to health-care coverage — we will ensure that,” said Kait Gillis, a spokeswoman for the state Department of Welfare, in an email. “We are still in conversations working through some of the issues [and] we are coordinating with the federal government on any outstanding health-care waivers, including SelectPlan.”
SelectPlan is not a full health insurance plan with a comprehensive range of benefits; some of those losing coverage will be eligible to reapply for new, full health-care plans under Gov. Tom Corbett’s “Healthy PA” Medicaid overhaul. Others, who make more than 138 percent of the federal poverty level, will be able to apply for full benefits plans through the Affordable Care Act’s online health insurance exchanges.
In both cases, women will be able to receive tax subsidies toward their monthly premiums, and for women making less than the federal poverty limit, they won’t have to pay any monthly premiums to gain Healthy PA Medicaid-style coverage.
But they might have to pay copays, and will have limits on their visits and usage. With the SelectPlan, there are no visit limits, no premiums and no co-pays, making it a valuable safety net for women.
“SelectPlan has been very important for low-income women who can’t get family planning care any other way,” said Sue Frietsche, senior staff attorney at the Women’s Law Project in Pittsburgh.
The federal Medicaid waiver for the plan will expire Dec. 31.
Several advocacy groups have said the state’s Department of Public Welfare should continue to offer SelectPlan to women who are not eligible for coverage under the new Healthy PA, and should additionally automatically transition eligible women into Healthy PA, to ensure continued access to care.
“Why let people’s benefits expire?” Ms. Frietsche said.
Making women reapply for new coverage means additional administrative costs for the state, and a likely loss of coverage for patients in the meantime, according to a briefing prepared by the left-leaning Pennsylvania Budget and Policy Center, Community Legal Services of Philadelphia, and the Pennsylvania Health Access Network. The groups also worry that the women will be lost in the shuffle in a time of bureaucratic chaos, as the state is also going to be trying to enroll hundreds of thousands of newly insured people into the Healthy PA program, which takes effect Jan. 1.
The state is automatically moving other groups of people from other categories of Medicaid coverage to the new coverage but is not doing the same for SelectPlan women, the groups say.
Furthermore, since many of the women in SelectPlan initially applied for full Medicaid, or may have children in Medicaid or another assistance program, the state probably has the information it needs to transition them.
“DPW has a lot of information from these women,” such as their income and household size, said Laval Miller-Wilson, executive director of the Pennsylvania Health Law Project.
Healthy PA is the governor’s alternative to a straight-up expansion of the Medicaid program; federal regulators have approved portions of the plan that would allow several hundred thousand uninsured Pennsylvanians to purchase private insurance with a federal subsidy.
It remains to be seen if it will ever become reality, however. The governor’s opponent in the Nov. 4 election, Democrat Tom Wolf, who is leading in the polls, has made it clear he favors a traditional Medicaid expansion, as permitted under the federal Affordable Care Act. But if he were to win, by the time he takes office hundreds of thousands of Pennsylvanians may have already applied for private coverage through the Healthy PA program, making it hard to immediately undo.