"This is a chance for us to listen," DPW Secretary Beverly Mackereth said. "I want to make sure we hear what they have to say. There may be things we haven't thought of."
In hearings in Pittsburgh and Erie, those testifying raised issues with the requirements that recipients pay monthly premiums and engage in work search - mandates that advocates for the poor say are punitive.
But Mackereth said the premiums could be as low as $6.50 a month for those who meet health goals such as losing weight or quitting smoking.
Had Pennsylvania expanded Medicaid rolls - as two dozen other states have - hundreds of thousands of uninsured residents would have been eligible to receive coverage Wednesday. Mackereth said that with Medicaid reimbursement rates declining, the state budget would not be able to sustain the increased costs over time. The federal government pays 100 percent of the costs for the first three years, but states will have to fund 10 percent after that.
The federal Department of Health and Human Services approved similar "private option" waivers for Arkansas and Iowa, which also will require a premium. Pennsylvania would be the first state to require able-bodied adults to participate in a job search or training program to receive both private and Medicaid coverage.
Following the conclusion of the hearings and comment period, the state will submit its final waiver proposal. There is no deadline for the government to act on the waiver, making it unclear when low-income Pennsylvanians would be able to receive health coverage.
The waiver process can take up to 18 months for final approval. State officials said they will seek expedited approval but could not project when the Pennsylvania program might begin.
"We are working as fast as we can," Mackereth said. "This is the beginning of a negotiation."
A spokeswoman for a coalition representing 100 groups supporting comprehensive health coverage for all - including faith organizations, unions, and disability rights groups - remains unconvinced that "HealthyPA," which makes sweeping changes to benefits in the existing Medicaid program as well, will help those who need it most.
"There is concern about reductions in benefits in the existing Medicaid program, such as doctor visits and increased equipment costs," said Amelia Abromaitis, spokeswoman for Cover the Commonwealth. "A majority of beneficiaries are already working at jobs that don't provide insurance, so the delay is of most concern for those people 'in the gap' who aren't seeing any light at end of the tunnel. With traditional Medicaid, folks would be seeing coverage now."