Pennsylvania Gov. Tom Corbett has softened his rhetoric while he awaits a federal decision on his request to link a work requirement to benefits under the Medicaid expansion. It's an issue that has flared up in his hotly contested re-election campaign.
The request comes in the form of a waiver that the Republican governor has requested as part of his bid to receive additional federal funds for Medicaid, the state-federal program for the poor and disabled.
The federal government's public comment period ended April 11.
If approved, Pennsylvania would be the first state to include the work requirement for Medicaid. According to federal regulations, a decision by the U.S. Centers for Medicare and Medicaid Services could come as early as Monday, but Corbett's office says that won't happen.
Points of debate in Corbett's 124-page plan, dubbed Healthy PA, include questions over premium rates and plans to waive both retroactive eligibility and Medicaid's appeals process, which advocates for the poor contend would violate the law.
"The governor has told me and the rest of the negotiating team that it is very important to bring the issue of work-related criteria to resolution," Jennifer Branstetter, Corbett's policy director, said in a telephone interview. "If you take that away, it breaks the plan as a whole. The whole premise is to help individuals break a cycle of poverty."
She noted that while both sides would like an agreement soon, the governor also has made it clear to "get it right."
The Affordable Care Act expands Medicaid expansion to all adults below 138 percent of the federal poverty level, or an additional 454,000 people in Pennsylvania, according to the Kaiser Family Foundation.
Corbett's plan seeks to build on modifications, or "waivers," President Barack Obama's administration has granted in states such as Arkansas and Iowa that allow use of federal Medicaid money to purchase private plans.
Having originally pushed a mandatory work requirement, Corbett now is proposing a one-year voluntary pilot program that would offer lower premiums to those who participate and seeks separate coverage limits to help reduce expenses for the state. To date, CMS has balked at cost-sharing plans that place undue burdens on low-income recipients.
CMS officials declined to comment on ongoing negotiations. But the agency made clear based on past applications that it does not feel bound by any specific timetable. As recently as February, CMS granted New York a separate Medicaid waiver that took two years to decide.
"CMS remains in close contact with the state during and following the waiver application public comment period and continues to provide technical assistance before making a decision," Emma Sandoe, a CMS spokeswoman, said in a statement.
Corbett has softened his tone from earlier this month, when he suggested that he was reaching a "breaking point" over the Obama administration's apparent resistance.
Democratic gubernatorial challenger Allyson Schwartz released an ad this past week that touts her support of the federal health care law and criticizes Corbett's stance on Medicaid, saying he failed "to take the Medicaid money" to help low-income Pennsylvanians.
The ad was striking in that most Democrats in competitive races have steered clear of embracing the Affordable Care Act.
Schwartz, a U.S. House representative, is seeking to differentiate herself from three primary challengers. All four Democratic candidates have expressed support for a full expansion of Medicaid without any modifications.
Corbett is a conservative highly critical of the federal health overhaul law. His proposed Medicaid expansion would not take effect until January, providing some wiggle room for continued talks. Less frequently, CMS has rejected a state's proposed changes outright if negotiations break down.
"Gov. Corbett would love to reach agreement," said G. Terry Madonna, a pollster and public affairs professor at Franklin & Marshall College, noting that Schwartz's ad lays down the markers for a line of attack in the general election. Corbett, rated by independent analysts as the nation's most vulnerable GOP gubernatorial incumbent because of low favorability in polls, faces token opposition in the GOP primary.
If CMS approves Corbett's plan in its present form, it's an immediate boost to a governor who can point to Healthy PA as a welfare-to-work model for other Republican-leaning or politically divided states weighing waiver requests such as Utah, New Hampshire, Virginia and Tennessee.
But "if the Obama administration denies Corbett's plan flat out, it immediately becomes one of the top issues in the gubernatorial campaign," Madonna said, as needy Pennsylvanians may find themselves without coverage.
Polling conducted last October by Franklin & Marshall College showed strong support in Pennsylvania for some kind of Medicaid expansion.
About half the states so far have opted to take the ACA's Medicaid expansion dollars, including those led by Republican Govs. John Kasich in Ohio and Chris Christie in New Jersey.