PHLP eNews

June 2016

Health Law PA News

Click here for the June 2016 Health Law PA News.This month's edition includes the following articles:
  • DHS Sanctions MAXIMUS and Urges Quick Fixes to HCBS Enrollment Problems
  • Easing the Transition from Marketplace to Medicare
  • Federal Funding for Medicare State Health Insurance Programs in Jeopardy
  • Pennsylvania Parity Implementation Coalition Supports State Legislation
  • Recent Lawsuit Settlement Should Increase Access to ABA Services
  • Bill Proposes Suspending Medicaid for Individuals Entering Corrections System

A Senior About to Lose Medicaid Benefits From PHLP’s Quick & Creative Advocacy

Linda’s approaching 60th birthday should have been a cause for celebration. Instead, as she lay in a nursing home recuperating from a dangerous bout of pneumonia, she received an unpleasant early birthday present: a termination letter from Medicaid. When Linda turned 60, she would begin receiving Social Security survivor benefits on behalf of her late husband, making her “income-ineligible” for Medicaid.

One year earlier, PHLP had helped Linda get coverage as part of the Medicaid expansion to address her numerous health problems, including bipolar disorder and diabetes. Prior to that, she had been uninsured for over seven years since her husband’s death. Now, with less than ten days to go until Linda’s Medicaid was terminated and she became uninsured again, her daughter Jennifer called PHLP for help.

PHLP staff helped Jennifer file a timely appeal to continue Linda’s Medicaid benefits. Meanwhile, given Linda’s profoundly poor health, PHLP realized she was also a good candidate for the Aging Waiver, which allows older adults to receive skilled care and personal care assistance in their homes instead of going into a nursing home. PHLP staff connected Jennifer with the enrollment broker to begin the lengthy waiver application process.

In spite of her pending appeal, Linda’s Medicaid was cut off at the end of the month, leaving her without coverage and stalling her application for the Aging Waiver. PHLP staff immediately contacted the local County Assistance Office to correct the due process violation and to offer a creative solution: resolve the pending appeal by enrolling Linda in the Medical Assistance for Workers with Disabilities (MAWD) program. Although MAWD has a modest work requirement, this requirement is flexible: even though Linda was extremely ill, she could meet the work requirement by babysitting her granddaughter just once a week, as long as she was being paid. More importantly, having MAWD would ensure Linda had medical coverage even if she wasn’t approved for the Aging Waiver. The county office accepted this proposal, and quickly got Linda enrolled in MAWD.

Thanks to the quick and creative advocacy by PHLP staff, the lapse in Linda’s coverage lasted only a few days. Linda is still waiting to hear if she has been approved for the Aging Waiver. In the meantime, having secure coverage through MAWD will allow Linda to focus on more important things during her 60th year: staying well and spending time with her granddaughter.


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PHLP Awarded Two-Year Federal Grant to Increase Health Coverage for Children Involved in Juvenile Justice

This month, the Centers for Medicare & Medicaid Services (CMS) announced awards to help 38 community organizations in 27 states enroll eligible children in Medicaid and the Children’s Health Insurance Program (CHIP) as part of the Connecting Kids to Coverage campaign. PHLP was one of the two Pennsylvania non-profits to receive the two-year grant.
PHLP will partner with Pennsylvania Health Access Network (PHAN), the state’s largest health navigator, to enroll and retain children and their parents in Medicaid and CHIP. The project will focus on families disconnected from mainstream services due to involvement in child welfare, juvenile justice, or school discipline problems, challenged by immigration or language barriers. PHLP and PHAN will work with county-based family courts and supportive agencies including legal aid organizations, alternative education sites and school districts, immigrant-serving organizations and community colleges to provide direct application assistance and educate residents in 12 Pennsylvania counties.


What We're Reading

Here's Why It's So Difficult To Solve Soaring Drug Prices, Los Angeles Times, June 1, 2016
Sovaldi (sofosbuvir) was released in December 2013 at the cost of $1,000 per pill, or $84,000 for a course of treatment. This is a shocking price, and scrutiny was entirely justified. The conclusion of Michael Hiltzik’s column caught our attention,

“Plainly, the solution to this problem is to spread the cost for the drugs society-wide.… [T]he best option is obvious: make hepatitis C sufferers eligible for Medicare. This would effectively spread the cost over all federal taxpayers. As Allan Joseph observed on the Incidental Economist healthcare blog, there’s precedent for this in the treatment of end-stage renal failure patients, whose dialysis costs are ruinous. But it would require congressional action — these days a major obstacle.”

Why Do Health Costs Keep Rising? These People Know, New York Times, June 6, 2016
“The Geisinger Health Plan, run by one of the nation’s top-rated health care organizations, foresees medical costs increasing next year by 7.5 percent for people buying insurance under the Affordable Care Act.

So when Geisinger requested a rate increase of 40 percent for 2017, consumer advocates were amazed….
Geisinger is not alone. The Pennsylvania Insurance Department says insurers have proposed premium increases averaging 23.6 percent for individual coverage for 2017.”

Medicaid/CHIP Managed Care Regulations: Improving Consumer Information, Georgetown University Center for Children and Families (CCF) and the National Health Law Program (NHeLP), June 2016
CCF and NHeLP have teamed up to analyze the recently finalized Medicaid and CHIP managed care regulations. This paper is the second in the series, and it describes how the new rules improve consumer information.

Penn Senior Kriya Patel to Help Incarcerated Women Access Health Care, Penn News, April 7, 2016

A graduating University of Pennsylvania senior is launching a 1-year project to help women at Riverside Correctional Facility enroll in Medicaid following their release. The project, which is supported by a $150,000 President’s Engagement Prize from the University, aims to enroll over 4,000 women in Medicaid.
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