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PHLP eNews

October 2014

PHLP & APPRISE Work Together to Get Essential Diabetic Testing Supplies Covered

For someone living with diabetes, having the right supplies to monitor blood sugar is crucial to well-being and safety.

"Lisa" is a 23-year-old living in Fayette County who is a
dual eligible (a person who has both Medicaid and Medicare). She tests five times a day to manage her diabetes. Typically the supplies for testing are covered by her Medicare and Medicaid insurances. However, in July, when she went to pick up her testing supplies at the pharmacy, she owed a $200 copay! Lisa’s monthly income of $743 made that co-payment impossible, and her insurance should have made the co-pay for those services much smaller. 

Lisa’s family contacted
APPRISE, who referred Lisa to PHLP. We discovered Lisa was enrolled in a Medicare plan with a high deductible that had not been met, so the Medicare plan was not paying anything toward the test strips. In addition, the pharmacy was not using the correct codes when it billed Medicaid, so Medicaid was not paying as her secondary insurance. We persuaded the pharmacy to call the state Medicaid Pharmacy Unit to get an override so Medicaid would pay for the diabetic testing supplies while Lisa was still in her Medicare plan’s deductible period.

After PHLP’s intervention, Lisa was able to get her diabetic testing supplies for a small co-pay of $1. She and her family were thrilled and thankful. PHLP referred Lisa back to APPRISE, who then helped her to find a Medicare plan that better met her needs given her limited income and dual-eligible status. 

To help clients like Lisa, consider donating to PHLP today.

Donate to PHLP

Meet PHLP's Fall Interns, Cana & Holly

Cana Noel is a student at Temple University Beasley School of Law. She joined PHLP this summer as a Martin Luther King, Jr. Intern with support from Equal Justice America.

In her experience working with callers to PHLP’s Helpline, Cana encountered Pennsylvanians forced to choose between paying for groceries and using the money for life sustaining prescriptions. She reflects, "How do you choose between the things that matter the most in life: food, water, electricity, medicine?" Although it proved challenging, she was able to secure health care coverage for a family who had been faced with this question each month, a story she recounts

Cana is continuing her work with PHLP through the fall, following her desire to use what she learned this summer "to be a strong advocate for vulnerable communities in need of health coverage."

Cana with PHLP’s Executive Director, Laval Miller-Wilson, at the MLK Reception

Holly Dennehy is a student at the Drexel University School of Law, where she is working on a health law concentration. Holly is working at PHLP this fall through the Drexel University Co-Op program. She most enjoys the direct service aspect of her work at PHLP. Holly has a special interest in how health law impacts the LGBT community. She draws from experience as a McCleary Law Fellow at the Human Rights Campaign and her work as a research volunteer at the Mazzoni Center. Holly decided to pursue a career in law to make life better for individuals and improve society, and she sees PHLP as accomplishing both.

PHLP Offers Medicare 2015 Webinars

October 15 to December 7 is when all people with Medicare can change their Medicare health plan and prescription drug coverage for 2015. PHLP is offering free webinar trainings to educate providers, advocates and other professionals who work with dual eligibles (people who have both Medicare and Medicaid) and other low-income Medicare beneficiaries about upcoming changes to Medicare and other programs in 2015. 

Each webinar will cover the following topics:
  • Medicare Part D plans and costs in 2015
  • Programs that help Medicare beneficiaries with their costs
  • Helping Medicare beneficiaries in times of transition, including becoming a dual eligible or losing their dual eligible status
  • Medicare and the Health Care Marketplace
To register for a webinar, please click one of the links below: Space is limited- register today! Please share this announcement with others who may be interested in participating in one of the webinars.

What We're Reading

Congressional Leaders Ask Governor Corbett for Input on CHIP’s Future, Summer 2014

Earlier this year, leaders of the House Energy and Commerce and the Senate Finance committees (the two committees with jurisdiction over the Children’s Health Insurance Program) asked governors for their input on the federal-state program. Pennsylvania’s response is due October 31, 2014.     
State Standards for Access to Care in Medicaid Managed Care, Office of Inspector General, U.S. Department of Health & Human Services, September 2014

A new report on the (lack of) state and federal oversight of Medicaid managed care provider networks. Most states, including Pennsylvania, rely on self-reporting by managed care plans on the adequacy of their networks. Three states—Ohio, Georgia, and New York—conduct secret shopper surveys to evaluate adherence to state provider network standards. Our colleagues at the National Health Law Program have advocated for stronger network standards and more robust network adequacy oversight. This includes recently released recommendations for modernizing Medicaid's managed care regulations on network adequacy.
In States That Don’t Expand Medicaid, Who Gets New Coverage Assistance Under the ACA and Who Doesn’t?, RWJF & Urban Institute, October 2014

This study found state officials’ decisions against expansion adversely affect already disadvantaged residents.

*Inclusion in "What We're Reading" does not imply endorsement and views expressed here do not necessarily represent the views of PHLP

New PHLP Publication

Do You Need Health Insurance?, A New One-Page Fact Sheet

Pennsylvania’s Medicaid program is expanding coverage to almost all low-income adults. We prepared a low literacy, one-page description for populations who might qualify for free or low-cost coverage. Consumer advocates are welcome to distribute to clients.  

Upcoming Event

"Delivering Quality Health Care Today - Challenges, Opportunities and the Law" - Matthew J. Ryan Law and Public Policy Forum, Villanova University School of Law, November 14, 2014
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