HARRISBURG, Pa. (AP) -- Gov. Tom Corbett's top human services aide said Wednesday that she will meet with a federal official as she explores how to expand Medicaid coverage to hundreds of thousands of adults in a way that her boss, the federal government and state lawmakers can all agree on.
Beverly Mackereth, the acting secretary for the Pennsylvania Department of Public Welfare, said a department consultant is reviewing Medicaid expansion models in an effort to find ways to satisfy concerns over its cost.
An expansion of Medicaid, the federal-state health care program for the poor, is one of the hallmarks of the 2010 landmark federal health care law, though Corbett and some other governors are refusing to go along with an expansion for now in part because of concerns over how it will be funded.
A decision on a possible model will be based on the quality of the program, not just cost, Mackereth added.
"We want to look at the whole package," Mackereth said in an interview after a Senate committee approved her nomination to the post. "It's not just about the dollars."
Among the ideas Mackereth's department has explored are a Medicaid work requirement, cost sharing with enrollees and subsidies for plans offered by private insurers. They also are considering scaling back optional coverage provided by Pennsylvania's Medicaid program, such as chiropractic care, podiatry and funeral director services, Mackereth said.
However, federal officials have discouraged a work requirement, maintained that cost-sharing be minimal and insisted that private plans not cost more than Medicaid coverage while offering coverage identical to traditional Medicaid, Corbett administration officials say.
Next week, Mackereth plans to travel to Baltimore to meet with Cindy Mann, a top federal official in charge of the Medicaid program.
Corbett, a Republican, is under pressure to embrace the expansion from Democratic lawmakers, labor unions, hospital executives, advocates for the poor, and even some Republican lawmakers in the GOP-controlled Legislature.
Corbett administration officials are trying harder to publicly stress their pursuit of a Medicaid expansion that they say will be affordable, while they blame the federal government for being inflexible. In the meantime, Democratic lawmakers accuse Corbett of dragging his feet.
"To delay a decision is to deny access to health care," Rep. Joseph Markosek, D-Allegheny, told House colleagues during floor debate Wednesday on a GOP-sponsored budget proposal that does not include a Medicaid expansion.
An expansion is designed to provide federally funded health care coverage to hundreds of thousands, primarily uninsured adults, beginning next year. The Legislature's nonpartisan fiscal analysts have agreed with the conclusions of studies sponsored by health care groups that an infusion of billions of federal health care dollars would boost Pennsylvania's finances by hundreds of millions of dollars a year.
Overall, about half the states are planning to expand their Medicaid programs, while about a dozen are undecided. Nine of Corbett's fellow Republican governors have said they support an expansion.
However, Corbett administration officials maintain that key questions about an expansion remain unresolved, such as the state's ability to continue collecting a gross receipts tax Pennsylvania imposes on Medicaid payments to the private insurers that manage coverage.
In any case, Mackereth has said the state would be unable to carry out an expansion before 2015 because of the necessary preparations, including hiring 2,000 more caseworkers.
On Wednesday, she acknowledged criticism that delaying any expansion beyond Jan. 1 would mean that Pennsylvania misses out on federal health care dollars, but she also insisted that expanding right away would be premature without more information and that there will be no state budget windfall in the next 12 months.