On top of that, the proposal that Corbett calls fiscally responsible also contains a long list of requests for the federal government to waive rules that would otherwise apply to the health care coverage that a state Medicaid program must provide.
"I read a lot of waivers and I have never seen such a long list of waiver requests," said Joan Alker, the executive director of Georgetown University's Center for Children and Families in Washington, D.C.
The proposal was unveiled Friday morning. It adds crucial details to the broad outlines of a proposal Corbett announced in September to extend coverage to half-a-million people and it kicks off what could be a long process of public review and negotiations with the federal government.
Under President Barack Obama's signature health care law, the federal government promises to foot the lion's share of the bill for any state that broadens its Medicaid eligibility guidelines to cover more low-income adults starting Jan. 1.
Medicaid traditionally covers the poor and disabled, including children and their parents, pregnant women and the elderly in nursing homes. The Medicaid expansion would primarily benefit healthier adults who work in low-wage jobs, and the conditions that Corbett wants target that group.
Corbett, a critic of Medicaid who calls the program bloated and unsustainable, maintains that his proposal encourages personal responsibility and healthy behavior, better matches benefits to a person's health needs and makes Medicaid more like a private insurance plan.
The proposal "is well thought out for the future of Pennsylvania's health care system, and not just a quick fix," the Corbett administration said in a statement Friday.
To begin with, Corbett, a Republican, wants to use Medicaid expansion dollars to buy private insurance policies for the newly eligible, rather than cover them under the traditional Medicaid program, an idea pioneered by Arkansas.
Corbett wants to eliminate all co-pays but one in favor of a new premium structure that requires many able-bodied, working-age enrollees to pay a monthly premium to keep the coverage or risk losing it for up to nine months. Those premiums can be reduced if the enrollee pays on time and completes an annual health risk assessment and physical, but the administration also wants the ability to change or expand that list.
A health screening questionnaire would determine whether someone has any complex medical conditions, and the state would determine whether a person is a high risk, and thus eligible for a broader benefits package, or low risk, and subject to a narrower benefits package.
Corbett also wants to require the able-bodied who are working under 20 hours a week to meet certain work-search goals, including engaging in 12 job-searching activities each month. Someone who fails to meet the benchmark would lose the coverage.
It creates an awful lot of paperwork demands and red tape that will prevent people from being able to get and keep their medical insurance, said Richard Weishaupt, a lawyer with Community Legal Services of Philadelphia, a public interest law center that advocates for the poor.
"What are you going to do if someone is behind on their premium and they get hit by a car or they have a schizophrenic episode?" Weishaupt said. "So they don't have any coverage and they're going to run up a $20,000 bill and the hospital is going to eat that?"
Alker, of Georgetown's Center for Children and Families, called the proposal enormously complicated and far more punitive toward potential enrollees than Arkansas' program.
"This proposal is irresponsible," Alker said. "The federal government cannot approve it."