After months of touting the concepts, Pennsylvania Gov. Tom Corbett's administration released a full draft of its Medicaid plan Friday. If implemented, the plan could affect up to half a million low-income, uninsured Pennsylvanians, according to government estimates.

The plan would draw down generous matching funds to expand eligibility for coverage, with certain caveats. It's unclear how soon the plan would actually take effect, however, or whether U.S officials will even approve it.

As part of the federal health law, states have the option, starting in January, to expand Medicaid to more adults, with the federal government picking up most of the tab. Only about half of states so far have planned to do that. After delaying a decision for about a year, Corbett said earlier this fall he'll seek federal funds to do something different.

"We need a medical insurance program that's designed for Pennsylvania," Corbett told a crowd at St. Christopher's Hospital for Children in North Philadelphia in October. "One size does not fit all."

Healthy Pennsylvania, as Corbett calls it, would essentially use those federal expansion funds to help subsidize people purchasing their own private coverage. The proposal is no sure bet because the federal government has to approve it. That process kicked up a notch Friday, with the Corbett administration's release of the 97-page application it plans to send to Washington for final approval. 

Job search, income-based premiums part of plan

Some of the most contentious parts of the plan, as outlined by Corbett earlier, include income-based premiums and a job-search requirement for people working fewer than 20 hours a week.

"We do understand that it's something that has not been requested by other states," said State Department of Public Welfare Secretary Bev Mackereth. "However, in our discussions around this, the federal government recognized that we believe that it is extremely important. We'd like the federal government to consider allowing Pennsylvania to shape our structure for Medicaid and health insurance."

Those elements aren't likely to sit well with federal reviewers, according to Mark Duggan, a former health economist with the Obama administration and professor at Penn's Wharton School. Even so, he thinks the plan stands a good chance.

"States are different," said Duggan. "Ideologically, they're different. They're different in terms of the details of their [Medicaid] program. So I think the administration is trying to be flexible to allow some states to tailor some parts of the Affordable Care Act to some circumstances of their state."

Duggan points to the federal government's recent approval of Arkansas' alternative Medicaid plan. He says the success of Pennsylvania's application may depend on the plan's costs, the workings of the state's private insurance market and the impact of those special provisions on recipients.

As proponents and skeptics of Healthy PA alike delve into the application's details, at least some health advocates have expressed concerns over "new and burdensome paperwork requirements" and changes in coverage for current enrollees.

Uncertain timeframe

While many states will start tapping those expansion funds in January, Corbett's schedule has Pennsylvania's expansion starting a full year after that, in 2015. But state Medicaid director, Leesa Allen, would like to see an earlier start.

"I think the timeframe is really dependent on what we're able to accomplish with our federal partners over the course of the next several months and how swiftly they can move to an approval," said Allen. "And then how comfortable we are that we can be prepared to implement as we have identified in the proposal."

The application must undergo a one month public comment period in Pennsylvania, then another one-month federal comment period, during which the application could change.

A hearing is slated in Philadelphia Jan. 3 from 10 a.m. to 1 p.m. at the Pennsylvania Convention Center.