Pennsylvania Medicaid Expansion Waiver

The Patient Protection and Affordable Care Act expanded Medicaid coverage to non-elderly adults with incomes at or below 138 percent of the federal poverty level who were not previously eligible for the program. After the U.S. Supreme Court ruling in June 2012 effectively made Medicaid expansion optional, a number of states have pursued alternative approaches to extending coverage to these previously ineligible adults. Pennsylvania originally expanded through a Section 1115 research and demonstration waiver, but transitioned from the waiver to a traditional Medicaid expansion effective September 1, 2015. This fact sheet summarizes the main design features of Pennsylvania’s now inactive expansion waiver, including covered benefits, required premiums and cost sharing, whether the waiver used a premium assistance program, and how services were delivered (i.e. by fee for service or managed care).