The broad outlines of the plan resemble elements of waivers granted to other Republican-led states. For example, the Pennsylvania waiver allows the state to provide premium assistance to its expansion population to shop for private plans on an exchange. Arkansas and Iowa adopted similar models. Other states, including Iowa, have similarly received permission to charge premiums for certain beneficiaries.
“HHS has stuck to the lines that they've previously drawn in other states,” said Leonardo Cuello, director of health reform for the National Health Law Program. Corbett initially intended to require that beneficiaries be employed or looking for work to keep their benefits. That request was dropped.
However, Cuello and other advocates still have concerns about some of the concessions the CMS made to the state. Most troubling, he said, is that the CMS expressed willingness to allow the state to impose limits on benefits at a later date.
Pennsylvania asked for permission to limit the number of times a beneficiary could go to a doctor, be hospitalized or receive certain tests. The CMS said it would consider those requests pending data from the state showing the changes would not harm enrollees. “That is very, very scary,” Cuello said.
And even though Iowa got approval to charge premiums, the waiver capped the amount at $10 a month. Pennsylvania's waiver means low-income residents may have to pay as much as $30 a month, depending on how much they earn.
Follow Virgil Dickson on Twitter: @MHVDickson