Pennsylvania Health Law Project
PHLP Protects Poor and Disabled Medicaid Beneficiaries from State Medicaid Cuts

In its efforts to balance its FY 2011-12 state budget, Pennsylvania has chosen to curb spending on Medicaid, a joint state-federal program that provides health insurance for the poor and disabled.  Even with already announced benefit changes—limiting pharmacy and dental benefits for adults, and co-payments for transportation to medically necessary treatment—the Department of Public Welfare (DPW) still needs to reduce Medicaid spending by $200 million of unspecified reductions.  PHLP is concerned budgetary pressures and DPW’s extraordinary new authority to make sweeping changes without legislative approval or the normal administrative rule-making process will result in hurried decisions that harm the most vulnerable Pennsylvanians.
Recent advocacy by PHLP attorneys Fran Chervenak and Kyle Fisher, counsel for the Consumer Subcommittee of the Medical Assistance Advisory Committee, persuaded DPW to 1) delay implementation of some cuts to ensure Medicaid consumers receive adequate and low-literacy appropriate notice of the pharmacy and dental changes and 2) expand its exceptions policy.  The exceptions policy would permit a pharmaceutical or dental benefit to continue if eliminating it would jeopardize a consumer’s life or result in a serious deterioration of health.  The August edition of PHLP’s newsletter describes the effective date of these changes and details the exceptions process.  Earlier this month, PHLP trained legal services about these changes and how they can file successful appeals.  PHLP will offer at least one additional training session for legal services advocates on October 6th.  To register for the training, email
PHLP will continue to press state officials to engage consumers and their advocates in Medicaid policy development and program administration.  PHLP believes that in hard budgetary times Pennsylvania s
hould not cut Medicaid.  Failing that, PHLP will insist that any changes meet federal and state rules and be implemented in ways that minimize the burden on the people who can least bear it. 
Pennsylvania Court Protects Rights of Children with Autism:  Orders Independence Blue Cross to Pay for Therapy

John and Suzanne Burke know how important it is for their seven-year-old son to receive applied behavioral analysis therapy, which medical professionals say is vital to their son’s social acclimation and devel
opment. So when Independence Blue Cross (IBC) refused to pay for Tony’s therapy, the Burkes called PHLP.     
The Burkes were represented by Senior Attorney David Gates.  At issue was a 2008 Pennsylvania law called Act 62, the Autism Coverage Law, which requires private health insurers to pay for diagnoses and treatment of autism for children and adolescents.  IBC argued that since the therapist worked at school, the law didn’t apply to them.
A state court decided Independence Blue Cross, like all private insurers, was legally required to pay for needed services and treatment for autism.  To read more click here.  To read the court decision click here.

PHLP assists families and individuals free of charge and did not receive attorney’s fees for this case.  To learn more about how to support PHLP’s work, click here

What We're Reading:
Exchange 101

Explaining Health Care Reform: Questions About Health Insurance Exchanges
, Kaiser Family Foundation, April 2010

Why We Need a Health Insurance Exchange
, Families USA,  June 2011

Insurance Exchanges: Why New York Needs Active Purchasing, Health Care for All New York, June 2011

For more about exchanges, visit our new exchange resource page

PHLP in The News

Study Finds Barriers to Special Care for Children With Public Insurance Access to Medicaid Limited, Marie McCullough, Philadelphia Inquirer, 6/16/11

Status Report: Planning for State Health Exchanges, Taunya English, WHYY’s Newsworks, 7/13/11

Highmark set to raise low-income plan rates, Bill Toland, Pittsburgh Post Gazette, 7/22/11 

UPMC, Highmark health care fight an adman's delight, Bill Toland, Pittsburgh Post Gazette, 8/15/11

Spotlight on Advocacy

PHLP Co-Authors Principles for Children’s Coverage Under Federal Health Reform. Read more.

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