Pennsylvania Health Law Project: Helping People in Need Get the Health Care They Deserve

Helping Vulnerable Pennsylvanians Understand Health Coverage

Applying for Medical Assistance can be a challenge. PHLP takes the time to guide our clients as needed throughout the process, providing much-needed moral support as well as legal advice. Last August, Edward, a 57-year-old Philadelphian, called PHLP to ask about options for health insurance. PHLP determined that he qualified for Medical Assistance and sent him application materials.
In November, Edward called PHLP again. This time, he was having chest pains and worried that something was really wrong. He hadn’t submitted the Medical Assistance application PHLP sent him, and because he had no insurance, he was afraid that going to the Emergency Department would leave him with large medical bills he could not pay.
Recognizing the severity of his symptoms, PHLP advised Edward to go to the Emergency Department immediately. We also explained that the hospital could help him apply for Medical Assistance or Charity Care to assist with the bills. He immediately called an ambulance to take him to the hospital, where he was diagnosed with unstable angina, a condition that can lead to a heart attack if not treated, and admitted for four days.
Upon his release, Edward applied for Medical Assistance, but his application was denied. He called PHLP again and we helped him persuade the local County Assistance Office to reverse the denial and approve Edward for Medical Assistance. Unfortunately his struggles were not over because the coverage began on the day after his hospital admission, leaving him with tens of thousands of dollars in hospital and ambulance bills. PHLP worked with him and the County Assistance Office to change the start date, making sure that all his medical bills were covered.
Edward learned firsthand that obtaining Medical Assistance is difficult and requires support. He called us recently to say PHLP “was a big help, giving me the advice and moral support I really needed to proceed with this because I had no idea what to do. I would have been lost without PHLP.”

PHLP Co-Authors White Paper on Eligibility, Enrollment & Renewal in Pennsylvania's Medicaid and CHIP

This month, the Federal Department of Health and Human Services released final rules for health insurance exchanges and Medicaid that will take effect under the Affordable Care Act (ACA) on January 1, 2014. These rules establish requirements regarding eligibility and enrollment processes that will allow people to obtain health coverage that is most appropriate to their financial and health needs and maximizes reliance on electronic databases and other technology. PHLP and Community Legal Services co-authored a white paper on the revisions necessary to Pennsylvania’s administration of Medicaid and CHIP. 

PHLP Co-Authors Comments on Insurance Department's Proposed Plan for Health Insurance Exchange 

The Affordable Care Act provides each state with an unprecedented opportunity to re-shape the health care system to fit its own unique needs and insurance marketplace. Last month, the Pennsylvania Department of Insurance released conceptual draft legislation for a state-operated exchange. 

The proposed bill would establish multiple private exchanges,a model very different from other states which have proposed no more than two exchanges operated by either state government or a quasi-government authority. Any private entity meeting the exchange criteria would be certified, and be permitted to sell qualified health insurance plans and other types of insurance including auto and home-owners. 

PHLP is concerned about the multiple exchange approach and with Community Legal Services co-authored comments critical of the proposed model. We appreciated the Department’s desire to create an Exchange unique for Pennsylvania, but discouraged the use of multiple Exchanges. A summary of the Department’s proposal, our comments, and the Department’s conceptual draft can be found here.
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PHLP In The News

PA Changes Worry Home-Care Providers and Clients, Philadelphia Inquirer, March 18, 2012

What We're Reading

The Health Reform Law's Medicaid Expansion: A Guide to the Supreme Court Arguments, Kaiser Family Foundation, March 2012

Medicaid Managed Care: Key Data, Trends, and Issues, Kaiser Family Foundation, February 2012

The Role of the Basic Health Program in the Coverage Continuum: Opportunities, Risks, and Considerations for States, Kaiser Family Foundation, March 2012
Integrating Care for Dual Eligibles in New York: Issues and Options, New York State Health Foundation, March 2012

Louisiana Breaks New Ground: The Nation’s First Use of Automatic Enrollment through Express Lane Eligibility, Urban Institute, March 2012

Spotlight on the ACA

Later this month, the U.S. Supreme Court will examine the constitutionality of the Affordable Care Act. Read more on our website

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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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