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Pennsylvania Health Law Project: Helping People in Need Get the Health Care They Deserve
Client Spotlight: Preserving In-School Pediatric Care for the Medically Frail

Five-year-old Kyler lives with seizure disorder, autism, and developmental delays. Every day he attends school and relies on his private duty nurse, who ensures that he receives his medications and is kept safe during his near-daily seizures. Kyler’s seizures are so severe and frequent that he often requires immediate emergency medical attention that only his nurse can provide. Without that nurse, it would not be safe for Kyler to attend school. So when his Medicaid Managed Care Plan (Insurer) terminated Kyler’s nursing care, even though there was no improvement in Kyler’s medical condition, his mother contacted PHLP.
 
To challenge the Insurer’s denial, PHLP gathered strong supporting documentation from Kyler’s doctors and nurses demonstrating his need for in-school nursing. At trial, PHLP called experts who testified that nursing services remained medically necessary for Kyler, and his condition did not warrant their termination.  The Judge agreed and ordered the Insurer to continue supports during the school day. 
 
Since trial, Kyler is still doing well in school. His mom told PHLP, “Your work on this case will never be forgotten and always be appreciated!  I cannot thank you and your team for your hard work and dedication!” PHLP staff feels privileged to do this work, and are committed to fighting for children like Kyler. 


Securing Health Coverage for Immigrants: Resources Available!

Securing health care coverage is daunting, but there are additional barriers facing immigrants. 

"Nina," a pregnant woman who is a lawfully present immigrant in Pennsylvania, was in a bind after she received conflicting information about her eligibility for health insurance.  She was told by the Pennsylvania Department of Public Welfare (DPW) that she was not eligible for Medicaid due to her immigration status.  However, the Federal Health Insurance Marketplace told her that she did not qualify for “private” coverage on the Marketplace because she was eligible for Medicaid.  Nina was unsure how to get the care she needed.  She was stuck with contradictory information and denied through both paths to coverage!

Women’s Law Project in Pittsburgh reached out to PHLP on Nina’s behalf. Our staff quickly realized that DPW incorrectly found Nina ineligible for Medicaid, and PHLP helped Nina appeal the denial – successfully! Our friends at Women’s Law Project say they “can’t thank [PHLP] enough; you were the only people who understood the complexities of the way Medicaid works (or doesn’t work) for immigrants.”

Nina is excited and optimistic about her pregnancy, now that she knows she has access to the medical care she needs. PHLP was glad to have provided guidance to help her secure care.

The following resources provide more guidance on immigrants accessing health care:
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What We're Reading

Alternative Medicaid Expansion Models: Exploring State Options, Center for Health Care Strategies, February 2014

The Uninsured at the Starting Line: Findings from the 2013 Kaiser Survey of Low-Income Americans and the ACA, Kaiser Family Foundation, February 2014

The ACA and Recent Section 1115 Medicaid Demonstration Waivers, Kaiser Family Foundation, February 2014

Mental Health Parity and Addiction Equity Act of 2008: Final Regulations and Federal Guidance, National Health Law Program, January 31, 2014

Opting Out Of Medicaid Expansion: The Health and Financial Impacts, Health Affairs Blog, January 30, 2014

Study: Many Will Die if Medicaid is Not Expanded, The Morning Call, January 30, 2014

U.S. Gives Pennsylvania Until 2015 to Move Poorest Children into Medicaid Under Obamacare, The Morning Call, January 22, 2014

Mind the Gap: Low-Income Women in Dire Need of Health Insurance, National Women’s Law Center, January 2014

Minimizing Care Gaps for Individuals Churning between the Marketplace and Medicaid: Key Considerations for States, Center for Health Care Strategies, January 2014

Spotlight on Advocacy

We helped develop this chart on the severe Medicaid benefits cuts in the Executive Budget in coordination with Community Legal Services. See the next edition of our Health Law PA News for more analysis on the Executive Budget.

What We're Following

Webinar #1: Innovative Strategies for Using Medicaid State Plan and Waiver Options to Promote Integrated Employment of PWD, Thursday, February 20, 2014, 2pm-4pm

Webinar #2: Implications of HCBS Final Rule on Non-Residential Settings - The Impact of New HCBS Guidance on Employment & Day Services, Thursday, February 27, 2014, 2pm-4pm
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The Pennsylvania Health Law Project is a nationally recognized expert and consultant on access to health care for low-income consumers, the elderly, and persons with disabilities. PHLP engages in direct advocacy on behalf of individual consumers while working on the kinds of health policy changes that promise the most to the Pennsylvanians in greatest need.
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