Unscrambling Autism Laws
PA Requires Insurers to Pay to Treat Autism, But Challenges Abound For Families
(PHOTO CREDIT: Matthew Hall for The Philadelphia Inquirer)
Earlier this month, the Health Section of the Philadelphia Inquirer profiled
the efforts of a Southeast Pennsylvania family (the Burkes) to get effective treatment for their child with autism. The Burkes and PHLP Senior Attorney David Gates spoke extensively to reporter Rachel Zamzow about the challenges. The result: one of the most compelling articles we’ve ever seen!
Earlier this year, PHLP represented the Burkes in Pennsylvania’s Supreme Court about the rights of families to have courts decide their appeals against insurance companies that deny them in-school autism treatment. The outcome could affect 10,000 families. A decision is expected before year’s end.
PHLP assists individuals and families, like the Burkes, free of charge. To learn more about how to support PHLP’s work, click here
MAWD Saved! Advocacy Efforts Prevail
Last month, Department of Public Welfare (DPW) Secretary Beverly Mackereth announced that DPW has shelved the planned elimination of the Medical Assistance for Workers with Disabilities (MAWD) program. Readers may recall the program was scheduled to end effective Jan. 1, 2015.
MAWD provides health coverage to over 34,000 working Pennsylvanians with disabilities who don’t qualify for other categories of Medical Assistance, usually due to their earnings. It provides an important incentive for people with disabilities to work and still keep their Medical Assistance coverage. It allows individuals with disabilities to work without fear of losing their critically important health insurance coverage, including personal assistance services and other supports they need to get and keep a job and remain in the community.
PHLP worked closely with numerous organizations and persons on MAWD to highlight how eliminating this program would have a devastating effect. Our advocacy efforts included drafting and coordinating comments to state and federal officials by many disability organizations and the Consumer Subcommittee of the Medical Assistance Advisory Committee, assisting affected individuals in drafting their own comments, and providing information to stakeholders.
PHLP applauds the decision by Secretary Mackereth and the Corbett Administration to continue the MAWD program. MAWD provides vital health coverage and community supports for working Pennsylvanians with disabilities.
Preserving Dignity for a Senior Couple Coping with Tragedy
When you learn that someone you love has a life-threatening illness, there may be overwhelming moments of helplessness in dealing with many matters, including health coverage and services. PHLP supports families with legal help. A husband, whose wife recently passed away, appreciated our assistance and permitted us to share that story.
Deborah Drenning, a 64-year-old Bedford County resident, passed away in early December 2013. She had been diagnosed with malignant breast cancer only eight days earlier, when she was hospitalized on Thanksgiving Day. Because of the severity of her illness, her local hospital immediately transferred her to UPMC Altoona hospital. Doctors there confirmed a diagnosis of breast cancer and informed the family that the tumor had spread to her brain and spinal cord, liver, and lungs. Mrs. Drenning had been unaware of the cancer; after she experienced pain and fell twice during the summer, she had been misdiagnosed with a pinched nerve. The Drennings had no health insurance, and rather than seeking care for her illness, in her husband’s words “she more or less kept it to herself.”
She would have turned 65 and qualified for Medicare in another four months.
Ms. Drenning’s husband turned to PHLP after the welfare office denied the application for Medical Assistance to cover his wife’s hospital stay. The resulting hospital and physician bills exceeded $70,000. The welfare office cited Mr. Drenning’s carpenters union pension in stating the family was over the applicable $3,000 resource limit. Mr. Drenning could not make any withdrawals from his modest pension without significant penalty for another two years. PHLP assisted the family with the appeal, arguing successfully that Ms. Drenning’s diagnosis of breast cancer allowed the welfare office to authorize a category of coverage that has no resource limit. Expressing his gratitude, Mr. Drenning stated that “what you people did was phenomenal.”