Protecting Medicaid Coverage in Wrongful Terminations
Having health insurance is important because coverage gets people timely medical care and improves their lives. For persons with chronic health conditions it is essential, so imagine the shock of suddenly losing health coverage for unexplained reasons.
That’s exactly what happened to “Gerald”, a 52-year-old Montgomery County resident who was at a pharmacy to fill his monthly prescriptions when his pharmacist told him that he and his wife had been disenrolled from Medicaid.
The couple was shocked. Gerald needed medication to control his diabetes and asthma, and his wife needed blood pressure medication; without them their health would become worse, yet they could not afford the full price of these medicines without insurance.
The couple had not received any notice of termination from the Department of Public Welfare (DPW), and they had received no additional income or resources that would disqualify them from coverage. When Gerald called his local County Assistance Office (CAO), even his caseworker did not know why the insurance ended and actually asked Gerald if he terminated the coverage himself!
Gerald filed an immediate appeal to continue benefits until their dispute was resolved by a judge. That should have worked, but the benefits did not continue. Gerald then called PHLP for help.
Because the CAO did not provide Gerald advance notice of the benefit change, PHLP persuaded the CAO to restore health coverage while Gerald's appeal was pending. PHLP also counseled Gerald on the upcoming appeal.
It seems overwhelmed DPW caseworkers have been unable to keep up with the paperwork, so benefits get stopped and Pennsylvanians lose coverage, even though many families do everything required to continue Medicaid coverage. Families in these situations should call PHLP for assistance.
PHLP Conducting Trainings about HealthChoices Expansion
DPW is expanding HealthChoices (mandatory managed care for most Medicaid consumers) across the Commonwealth in phases. The next phase of expansion is the creation of a New West HealthChoices Zone comprised of 13 counties in northwestern Pennsylvania: Cameron, Clarion, Clearield, Crawford, Elk, Erie, Forest, Jefferson, McKean, Mercer, Potter, Venango, and Warren.
This is an important change for Medicaid recipients in these counties, impacting how they access health care services and providers. Consumers, family members and professionals need to know:
How coverage will change after October 1st
Managed Care Plan choices available
What to think about before choosing a plan
What to do if a plan isn’t meeting someone’s needs
PHLP is conducting free trainings about these changes. Click here
to learn more.
What the Supreme Court Decision on the ACA Means for Pennsylvania
Last month’s Supreme Court decision to uphold the Affordable Care Act (ACA) brought clarity to the future of health care reform and its implementation. PHLP prepared two short briefing papers on the ruling and its implications. One is a general update
; the second is an FAQ
about the impact of the decision on Medicaid.
In the weeks and months ahead, we will provide more details on how the ruling, and future guidance from the federal government, impacts Pennsylvanians.