MA Enrollment

Governed by federal regulations, Pennsylvania is required to cover a set of mandated services for specific groups of individuals to qualify for federal matching payments.

There were many changes with Medical Assistance enrollment and categories of aid in Fiscal Year (FY) 2014/2015, primarily driven by the Affordable Care Act (ACA) or commonly known as Obamacare. These changes were also a result of changes in administration and different approaches to ACA taken by our two different Governors.  A goal of ACA is to ensure that every United States citizen has affordable access to healthcare coverage. One way of accomplishing this goal was to change Medical Assistance enrollment guidelines so that more citizens would qualify for Medical Assistance healthcare coverage.

Under Governor Tom Corbett’s leadership, the Department of Human Services (DHS) implemented the Section 1115 Demonstration Waiver, known as Healthy PA as a new path toward healthcare transformation.  To qualify for healthcare coverage, individuals were required to participate in a health screening and based on the completed screening would be classified as either medically frail or not medically frail. Newly eligible individuals determined to be medically frail would receive coverage through the existing Medical Assistance managed care program (HealthChoices).  All other individuals were enrolled in a Private Coverage Option (PCO) plan.

When Tom Wolf was elected Governor of Pennsylvania on January 1, 2015, he and his leadership team set a new course that required a transition from the Healthy PA program to a traditional form of Medicaid expansion under DHS’ HealthChoices program. The goals included covering Pennsylvanians without service disruption, minimizing consumer confusion, and ensuring access to care. This change took a multi-phase approach which eliminated the health screening and PCO in the spring/summer of 2015 and transitioned all recipients to the existing Medical Assistance managed care program (HealthChoices).