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

Helping Pennsylvanians Adjust to Recent Medicaid Changes

Kenneth Appleby is a 56-year-old man living in Potter County. To keep his emphysema, depression, and other health conditions under control, he takes a number of medications every month, so he was worried about how Pennsylvania's new six-prescriptions-per-month policy in Medical Assistance would affect him.

Last month, Kenneth got bronchitis and his doctor prescribed an antibiotic, but the pharmacist denied the medicine because it was over the monthly limit. 

Knowing that he needed the antibiotic to avoid life-threatening complications with his emphysema, Kenneth called PHLP. PHLP explained how his doctor could request a benefit limit exception for the antibiotic, and how Kenneth could obtain a five-day emergency supply at the pharmacy while he waited for the exception to be approved. PHLP also emailed him educational materials about the six-prescriptions-per-month limit.

Better informed, Kenneth was able to educate his doctor and his pharmacist about the new policies, including the emergency supply and the benefit limit exception process. He was relieved to get the antibiotic he needed, and grateful PHLP was there to help.  

Helping Eligible Pennsylvanians Maintain Medicaid

Over 100,000 individuals in Pennsylvania have lost their Medicaid (Medical Assistance) since July 2011. PHLP and Community Legal Services believe that many of these case closures were done improperly. To help us decide how to advocate on behalf of those who have lost their Medicaid, we are looking for stories of individuals who have Medicaid cases that were:
  1. Closed sometime between July 2011 and the present
  2. Closed for noncompliance with the redetermination process (meaning that the individual allegedly did not return their redetermination/re-evaluation/SAR paperwork)
Even if the individual has since reapplied or appealed and has received Medicaid again, we are still interested in hearing about the case.
 
If you are willing to share your story (or the story of your clients/patients, if you work for an agency or medical office), please contact Ann Bacharach at PHLP (abacharach@phlp.org). We will not use anyone’s name without express permission. If you don’t feel comfortable providing your name or the name of your client/patient, please tell us as much information as possible. 

State Budget Proposal: Governor’s Cuts Would Affect Most Vulnerable

In his proposal for Pennsylvania’s 2012-2013 budget, Governor Corbett announced deep cuts to General Assistance (GA) programs that serve the state’s neediest, most vulnerable residents. The Governor’s budget calls for eliminating GA cash assistance entirely and slashing funding of GA-related Medical Assistance by as much as two-thirds.

Read more at our website. 
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PHLP in the News

More pain expected in Corbett's budget proposal, Pittsburgh Post-Gazette, 2/5/12
 
What We're Reading

Even Critics of Safety Net Increasingly Depend On It, New York Times, 2/11/12

Medicaid Rolls Rose Even as PA Disqualified Many, New Calculation Shows, Philadelphia Inquirer, 1/26/12

 
Building a Relationship between Medicaid, the Exchange, and the Individual Insurance Market, National Academy of Social Insurance, January 2012

Strategies for Building Seamless Health Systems for Low-Income Populations, Center for Health Care Strategies, Inc., February 2012

Health Reform Hits Main Street: Spanish Version, Kaiser Family Foundation, February 2012
  
Integrating Care for Dual Eligibles: What Do Consumers Want?, Alliance for Health Reform, December 2011 
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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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