A Brighter Future for an Allegheny County Woman with a Lung Mass
Not having health insurance means delayed treatment and care for too many Pennsylvanians. For many conditions quick diagnosis is critical, and delayed care endangers one’s well-being.
“Nicole,” a 53-year-old living in Allegheny County, was delaying doctor’s appointments because she was uninsured. She had a lung mass for the past year but had not sought treatment. Nicole ended up seeing a doctor who was concerned that the lung mass was cancerous and urged immediate surgical care and treatment; care and treatment, however, that Nicole could not afford.
Fortunately, a hospital social worker who works with Nicole and her disabled adult daughter contacted PHLP. Nicole had recently applied for Medicaid, and we notified the family about the policy to expedite Medicaid applications when someone has a medical emergency. Nicole’s doctor wrote a letter detailing that her condition required urgent care and PHLP submitted the letter to the County Assistance Office (CAO) with the request to have the application expedited. The CAO acted quickly and approved Nicole for coverage that same day!
Nicole was so relieved to have coverage that she cried joyfully while on the phone with the PHLP staff person who told her that she had been approved for Medicaid. Nicole no longer has to live with the uncertainty of being uninsured and can seek diagnosis and treatment.
PHLP Helps Create Pilot Programs to Enroll Prisoners in Medicaid Prior to Release
People reentering the community from Pennsylvania’s prisons and jails are some of the state’s most vulnerable. While stabilized by prison health services, most do not have health insurance or a good connection to care in the community, and they are disproportionately afflicted with behavioral and physical illnesses compared to the non-incarcerated. Some reentering individuals are eligible to purchase insurance through the Health Insurance Marketplace
, but most fall into the coverage gap: not eligible for Pennsylvania’s Medicaid program under current rules, and not eligible for Marketplace coverage because their income is too low.
In the expectation that Medicaid will be expanded, PHLP’s Project Fellow Maureen Barden has helped create pilot programs through which several county jails in southeastern Pennsylvania are working with their local County Assistance Offices (CAOs) to enroll people in Medicaid while they are still incarcerated. This means that their coverage will take effect the day they are released. Most people who now qualify have a behavioral and/or physical health condition that disables them from working.
Once Medicaid is expanded, whether through Governor Corbett’s proposed Healthy PA program or other means, many more people leaving custody will qualify. Correctional institutions already enrolling eligible individuals in Medicaid will be able to build on the processes and relationships established through their pilot programs and offer reentering individuals access to health care coverage that takes effect as soon as they leave custody. Based on experiences in other states
, this has the potential to benefit communities by reducing recidivism, as well as benefiting reentering individuals themselves.
PHLP Project Fellow Maureen Barden is assisting counties in creating pilot programs and planning for Medicaid expansion. Contact her for assistance at email@example.com.