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Work Requirements For 'Able-bodied' Medicaid Recipients And More From Human Services Budget Hearings

Gov. Tom Wolf
Department of Human Services Secretary Teresa Miller

Department of Human Services Secretary Teresa Miller and other officials fielded dozens of questions from lawmakers during two days of budget hearings this week.

While those questions covered a wide range of topics, here are three issues from the hearings likely to come up throughout the legislative session:

Work requirements for people getting assistance

Republican state Sen. David Argall of Schuylkill County plans to introduce a proposal requiring "able-bodied" people on Medicaid to get jobs. Similar bills passed the GOP-controlled Legislature in 2018 and 2017 and were vetoed by Democratic Gov. Tom Wolf.

While Argall's plan targets Medicaid, he questioned DHS' handling of the federal Supplemental Nutrition Assistance Program (SNAP), which helps people to buy groceries. DHS has gotten waivers for 63 counties to opt out of work requirements for "able-bodied adults without dependents," Argall noted.

The work requirement waivers are authorized by the federal government based on criteria such as a county's employment opportunities, Miller said. About one in 10 of the 1.8 million Pennsylvanians that receive SNAP are considered able-bodied. Miller stressed that most people on SNAP are children, elderly or disabled, and that those considered to be able-bodied often face additional challenges to regular employment.

Raising wages for care workers

Wolf wants to raise the minimum wage, first to $12 an hour, and eventually to $15. If some version of his plan gets through the legislature, DHS has a plan to inject $74.2 million in federal funds for child care providers to bring them up to that pay rate.

The department will also add $45 million in state and federal money for direct care workers serving the elderly and people with physical disabilities.

GOP state Rep. Fred Keller of Union County questioned the department's assertion that the state would save $36 million in general fund dollars even after providing for the rate increases.

"Really, the people who pay taxes fund these things," Keller said.

Democratic state Rep. Matthew Bradford of Montgomery County said fewer people would need public assistance if employers didn't pay people "an unconscionably low wage."

Looking into pharmacy benefit managers

For every prescription filled, a company processes the payment between the pharmacy and the insurer -- taking a cut for each transaction.

Following a December report by auditor general Eugene DePasquale, Republican Sen. Lisa Baker of Luzerne County introduced legislation to tighten regulations on the companies, also known as PBMs. 

DHS doesn't regulate pharmacy benefit managers, Miller noted. However, beginning this year, DHS is requiring managed care organizations to provide information on pricing -- including what a pharmacy benefit manager charges -- so that the department can target a practice known as "spread pricing," where PBMs reimburse the pharmacy one amount for a medication, charge Medicaid or the insurer a higher price for the same drug, and keep the difference.