HARRISBURG, Pa. - Gov. Tom Corbett has won approval for elements of a federally funded health care expansion his administration spent more than a year developing, but he is facing an uphill battle for a second term and some parts of the plan may not survive if Democrat Tom Wolf beats him in November's election.

Following approval Thursday by the U.S. Department of Health and Human Services, the Corbett administration is now tasked with setting up a system for more than a half-million more low-income Pennsylvanians to get federally funded health insurance through a private insurer.

The system it creates will be distinct from the existing managed care system that serves many of Pennsylvania's 2.2 million Medicaid enrollees through private insurers. The insurance plans under the new system will be different, and insurers that participate can impose premiums on enrollees who earn above the poverty level, about $11,670 a year for a single, childless adult.

But advocates for the poor said Friday that certain elements are punitive or complex - even though federal officials rejected the Republican governor's bid to undo some Medicaid rules to give private insurers more control over coverage and enrollment. And Wolf, who supported an expansion of Medicaid, is not saying whether he would keep Corbett's plan.

"It would be very doable for another governor to come in and do something different because this is not that different from current Medicaid managed care and the feds would be fine and happy with that," said Joan Alker, executive director of Georgetown University's Center for Children and Families, who has closely followed states' Medicaid expansion plans.


A campaign spokesman said that Wolf supports the broadest expansion of Medicaid and that Thursday's agreement between the federal government and the Corbett administration does not change Wolf's position on coverage for low-income residents.

Enrollment in the plan, named Healthy Pennsylvania, is expected to begin Dec. 1 with coverage to start Jan. 1. With the agreement, Pennsylvania joins 26 other states and Washington, D.C., in opting for the Medicaid-funded expanded coverage under the 2010 federal health care law.

Advocates for the poor said the creation of a new, private Medicaid system separate from the existing one ensures bureaucratic red-tape for people who must switch from one to the other because of a change, for instance, in income or family circumstances.

"In just a few months, we're going to build an entirely distinct system and there's real worries about how the systems are going to talk to each other," said Kristen Dama, a lawyer with Community Legal Services, a Philadelphia public interest law center that helps the poor get access to services.

Also, the imposition of premiums, which could begin in 2016, could be a hardship for the low-wage workers who have to pay them, advocates say.

"Paying $25 a month when your income level is down at about ... $1,000 a month can be pretty tough," said George Hoover, a former Insurance Department and Public Welfare Department official who now works for the Harrisburg-based nonprofit Pennsylvania Partnerships for Children.