Pennsylvania Health Law Project: Helping People in Need Get the Health Care They Deserve
Helping Young Adults Access Mental Health Treatment

Late last year, PHLP received a call from “Mary”, a 25-year-old woman living in Allegheny County. Mary was on her father’s health insurance as a dependent, but as her 26th birthday approached, she knew she would lose that coverage, and her part-time job would not provide health insurance.

Mary has bipolar disorder and relies on her insurance to cover psychologist and psychiatrist visits, as well as several medications to manage her condition. She was concerned that a lapse in coverage would impact her treatment. PHLP spoke with Mary about her options, and advised her about Medical Assistance for Workers with Disabilities (MAWD), which lets Pennsylvanians with disabilities work and keep their full medical coverage.

A few months later, Mary called back – she had been denied MAWD. PHLP stepped in to appeal the denial. PHLP worked with Mary to gather the necessary documentation of her diagnoses, her treatment plan, and the medications she needed. With that additional information, state officials approved Mary’s application and activated her coverage. She has access to the health care she needs to continue working and manage her bipolar disorder. 

PHLP Defends the Rights of Children with Autism in Pennsylvania's Supreme Court 

What rights do parents of children with autism have to challenge insurance companies? Earlier this month, PHLP argued in the Pennsylvania Supreme Court (Burke v. Independence Blue Cross) that families should have a court decide their appeals. The outcome could affect 10,000 families seeking in-school autism treatment. 

John and Suzanne Burke knew how important it was for their seven-year-old son to receive applied behavioral analysis therapy, which medical professionals say is vital to their son’s social acclimation and development. So when Independence Blue Cross (IBC) refused to pay for Tony’s therapy, the Burkes called PHLP.

The Burkes were represented by Senior PHLP Attorney David Gates. At issue was a Pennsylvania law called Act 62, the Autism Insurance Law, which requires private health insurers to pay for diagnoses and treatment of autism for children and adolescents. IBC argued that since the therapist worked at school, the law didn’t apply to them. A state trial court decided Independence Blue Cross, like all private insurers, was legally required to pay for needed services and treatment for autism, including those provided in school. To read the trial court decision, click here

IBC appealed to Superior Court which held that the Burkes never had the right to appeal to courts. PHLP appealed to the Supreme Court on the Burkes' behalf and the high court agreed to hear their appeal. To hear PHLP’s and IBC’s Supreme Court argument, click here. A decision is expected before year’s end.  

Note: PHLP assists families and individuals free of charge and did not receive attorney’s fees for this case. To learn more about how to support PHLP’s work, click here.

Learn How Children with Special Health Care Needs Can Get Home and Community Based Services

Join the PEAL Center and PHLP for in-person trainings about home and community based service programs (also known as “HCBS waivers”) in Harrisburg (May 20th) and Allentown (May 27th).  

Waivers are the most common funding sources for non-educational services and supports for children and adolescents with special health care needs and disabilities. Services include skilled nursing; home health aides; and occupational, physical therapy and speech therapies.  

Learn who can qualify, what’s covered and what to do if coverage is denied. 

To learn more, click here. Interpretación en español se brindará en Allentown. Spanish Interpretation available in Allentown.

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What We're Reading & Watching
A powerful consumer story about a Pennsylvania woman who got insurance coverage after spending 2 years uninsured, CBS News
Pennsylvania’s Request for Applications for Pennsylvania-Licensed Health Insurance Entities to Submit Proposals for Medicaid Expansion Population, May 2014
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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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