Client Spotlight: PHLP Maintains Health Care Benefits for a Low Income Elderly Couple
“Sara”, a 64-year-old woman living in Allegheny County, contacted PHLP concerned that she and her husband, “James”, age 69, could not afford their health care costs.
Sara and James had been “dual eligibles,” receiving health coverage through Medicare and Medicaid, but a few months ago their income had risen above the Medicaid limit. Having Medicare alone left them responsible for 20 percent of their medical bills, which were significant due to James’ history of multiple strokes and his recent diagnosis of Huntington’s Disease, a neurodegenerative genetic disorder that affects muscle coordination.
PHLP quickly stepped in, assessed the situation and informed Sara and James of their options. Because their income had increased only slightly, we determined that Sara and James were still eligible for the Medicare Buy-In Program, which helped them pay their Part B premiums, as well as the Part D Low Income Subsidy (LIS), which helped them cover their prescription drug costs.
PHLP also noted that James’s health was declining and he increasingly needed help with dressing and bathing and other daily supports to continue to live at home. Their son had been helping with James’s care but a recent injury limited his ability to continue providing that type of assistance. PHLP referred Sara to the Area Agency on Aging to have James evaluated for the PDA (Aging) waiver which would bring him needed in-home services and would also bring him Medicaid benefits again as a “dual eligible”. The program is open to Pennsylvanians 60 years of age or older who are determined to be nursing facility clinically eligible and who meet specific financial requirements.
James’ application was approved, providing him full Medicaid coverage as well as the support services he needed. The additional coverage provided much-needed peace of mind for Sara and James, and is enabling James to continue living at home and in his own community.
Note: Readers may recall that recent editions of PHLP’s Senior Health News included a series of articles reviewing what happens when someone becomes a dual eligible and what, if any, actions they need to take. All three articles have been compiled into a single volume, “Dual Eligibility in Pennsylvania”.
PHLP released a pamphlet and accompanying graphic about Medicaid and CHIP eligibility requirements. The chart is not intended to be comprehensive, but is intended to help individuals and parents understand Medicaid and CHIP application paths. It is one of many publications available on our website that organizations can use and distribute to their own clients.
New Chart to Help You Determine Medicaid and CHIP Eligibility
PHLP Briefs County Commissioners on Medicaid Expansion
This month, PHLP staff attorney Kyle Fisher presented to members of the County Commissioners Association of Pennsylvania
(CCAP), about the financial and programmatic benefits of expanding Medicaid for the Commonwealth and its 67 counties. The U.S. Supreme Court upheld the constitutionality of the Affordable Care Act and made expanding Medicaid a state option. PHLP’s presentation detailed specific benefits for counties if Pennsylvania amends its Medicaid State Plan and enacts a budget for fiscal year 2014 that appropriates the billions of dollars in additional federal Medicaid funding that would flow from this decision.
Other presenters included Matthew O’Donnell from Governor Corbett’s Administration who addressed some of the administration’s reservations about expansion, and Charles Ingoglia from the National Council for Community Behavioral Healthcare
, who provided perspective about the impact on behavioral health programs.
PHLP Leads Training on Affordable Care Act Navigator Program
This month, PHLP led a presentation on the role of navigators in the new insurance marketplace created by the Affordable Care Act (ACA). Enrollment in this new marketplace, sometimes referred to as the “Exchange”, begins October 1, 2013. Pennsylvania’s Exchange will be operated by the federal government.
PHLP Special Project’s Director Ann Bacharach provided an overview of the proposed “Navigator” program, which must raise awareness about health coverage, and provide information on how to apply and enroll. PHLP then facilitated a discussion on how Pennsylvania can make the best use of available federal funds for navigators. At the end, a coalition was formed to identify and support potential entities to lead the Navigator program.
To learn more about the Navigator program and the coalition’s efforts contact Ann Bacharach.