The Pennsylvania House of Representatives used amendments to change an adoption
bill (HB59) and propose harmful changes to Medical Assistance that would cut benefits and reduce
enrollment in the program. This amended version of HB59 narrowly passed the House with only 11 extra
votes on July 11, 2017. The Senate further amended and passed HB59 on July 27, 2017. It now returns to
the House for a final vote. Click here to sign on to a letter opposing these changes.

HB59 would weaken Medicaid by: 1) imposing new bureaucratic work requirements for non-disabled,
non-elderly, non-pregnant adults (but not exempting people with serious conditions like cancer or MS,
or those in active drug and alcohol treatment or those who are homeless); 2) fast-tracking cuts to “nonessential”
benefits, like dental, vision, mental health and behavioral health clinic based services, and
hospice care; and 3) paving the way for additional cuts in the future.

Fifty eight percent of Medicaid Expansion enrollees are already working, and 3 in 4 have at least one fulltime
worker in the home, so adding new work requirements is simply a way to reduce enrollment by
tripping people up with new layers of red tape. These changes will result in people losing the benefits
and care that keeps them healthy enough to work.


• Pennsylvanians need Medicaid to stay healthy and keep working. Making it harder for people to
keep their coverage by piling on new layers of red tape is self-defeating if the goal is a healthy
• Beefing up the state bureaucracy and putting more work on already overburdened county
assistance offices wastes critical state and federal resources.
• Lawmakers need to remember the costly mistakes made the last time Pennsylvania attempted
to impose work requirements and cut benefits under Healthy PA: people faced long,
unnecessary delays and lost access to care while the state faced a huge administrative backlog
that affected everyone covered by Medicaid, not just those subject to new requirements.
• The benefits Medical Assistance covers are included for a reason: to keep people healthy and
allow them to live independently. Cutting benefits takes away the freedom to live well and
• Cutting benefits and creating more barriers to care will sink the Commonwealth’s efforts to fight
the worst opioid crisis our state has ever faced. HB59 does not exempt the more than 200,000
Pennsylvanians battling substance use disorders from the work requirement, which means
people in treatment for opioid addiction will be forced to jump through new hoops to keep their

• Work requirements are likely to cut around 10% of Medicaid Expansion enrollees (more than
74,000 individuals), including older individuals who have been downsized, people in treatment
for substance use disorders or mental health issues, people with chronic debilitating conditions
not yet qualified for disability, college students, homeless individuals, and others who have
significant barriers to employment.
+ Nearly 1 in 3 of those losing coverage would likely be between 45 and 64, often people
who are sicker or face more barriers to work.
+ More than 1 in 4 of those losing coverage are unable to work because they are caring
for children or an elderly family member.

• Implementing work requirements alone would roughly increase our total Medical Assistance
administrative costs by 13%. Since the requirements apply to only Medicaid Expansion
enrollees, those administrative costs would increase by roughly 50%. Adding employment and
training, major IT changes, or complex benefit designs resulting from benefit cuts or tiered
benefits would further increase these costs by hundreds of millions of dollars.
• Budgets this year for IT, county assistance office operations, and benefit administration are cut
by 11.1% ($52.1 million) over last year. With fewer resources, caseloads would significantly
increase due to added verification and screening that would be required for 708,821 enrollees.
• In only four months of Healthy PA, estimates show that 1 in 5 enrollees received the wrong
benefits plan, locking them out of needed services like behavioral health treatment and medical
transportation. This lock-out has a negative effect on health outcomes and increases costs.
Comprehensive Benefits Keep People Healthy & Ready to Work
• Optional benefits that could be cut include: dental, vision, podiatry, hospice, and chiropractic
care. Home and community based services and case management services are optional.
• Some mental health and substance use disorder services are also “nonessential.” These include
services provided at psychiatric clinics, drug and alcohol outpatient clinics, methadone
maintenance clinics, mental health crisis services, family based mental health services, mobile
mental health treatment, and peer support services.
• Under Healthy PA, waiver requests to limit access to health centers, family planning providers,
and nonemergency medical transportation were submitted.
• Pharmacy benefits; physical and occupational therapies; speech, hearing, and language disorder
services; prosthetics, and some diagnostic, screening, preventive services might also be waived.
• Access to comprehensive coverage helps people maintain their health and maintain their
employment. When medical conditions that then go untreated, worsening health becomes a
barrier to employment and can lead to preventable disabilities.

People on Medicaid Work
• Estimates based on Census data show that nearly 3 in 4 enrolled on Medicaid Expansion already
have at least one full time worker in their household.
• Recent DHS data confirms that of individuals:

+ 58% of newly eligible Medicaid Expansion enrollees are working;
+ 51% of non-elderly traditional Medicaid enrollees are working, including 18% of those in
the long-term disability category; and
+ Of those not working, according to a national study by the Kaiser Family Foundation:

  •  35% have a serious illness or disability
  •  28% are caring for other family members, often children or elderly members
  •  18% are in school
  •  8% are retired
    Work Requirements Don’t Work
    • Working Pennsylvanians make our economy strong and ensure the success of our businesses
    and communities. Work gives people the dignity and needed income. People have plenty of
    incentives to work. People want to work because they value work, not because it is mandated.
    • Work requirements do not create long-term incentives for work. Any initial uptick in work is
    usually from temporary, part-time jobs or volunteer service. Sustainable employment requires a
    serious intervention separate from the bureaucratic hoops Medicaid usually imposes.
    • Cutting people off from Medicaid who are not working reduces the likelihood they will find
    employment in the future when their health becomes an issue.
    • Without additional funding for childcare and transportation (which have not increased over the
    past year), common barriers for low income individuals seeking employment will essentially lock
    them out of getting covered.
    • Several studies show that Medicaid expansion has had no negative impact on workforce
    participation, meaning no negative effect on employment rates, rate of job switches, or
    reduction in worker hours. Some initial data shows that it helped job development.
    Barriers to Care and Reduced Benefits Negatively Impact Vulnerable Populations
    • Those enrolled in Medicaid Expansion have higher health needs than the general population.
    Coverage allows them to manage these conditions, stay healthy, and be able to work. A
    prerequisite prevents them from doing that. A state report on Medicaid Expansion shows:
    o 31% of the newly eligible enrollees were diagnosed with and/or treated for a substance
    use disorder and/or mental health condition;
    o Half of those treated for a substance use disorder were treated for opioid-related
    o Overall, Medicaid Expansion enrollees have a higher prevalence of the most common
    chronic conditions, including cardiovascular, central nervous system, gastrointestinal,
    metabolic, skeletal, skin, and pulmonary conditions, along with diabetes type 2,
    substance use disorders and HIV/AIDS; and
    o 3% of the newly eligible enrollees are homeless.
    • People with complex physical and behavioral health needs often need to prioritize treatment
    and gaining stability in their health over work in order to be a better place in the future when
    they can concentrate on work. Forcing them to first seek work puts the cart before the horse.
    • Work requirements force some individuals who can work periodically to seek disability status in
    order to maintain their coverage. This then lowers the payments Pennsylvania would receive
    toward paying for their coverage.

Work Requirements Shift Dollars away from Healthcare and onto Bureaucracy
• With 700,000 adults enrolled in Pennsylvania’s Medicaid, tracking hours worked, managing
exemptions, and overseeing work activities would be a costly and time-consuming.
• Because they do not increase labor force participation, work requirements waste already limited
state resources, shifting state workers away from administering health care benefits efficiently.