Improving Health Care Coverage for People with Disabilities in Southwest Pennsylvania
PHLP is grateful for the support to ensure that persons with disabilities access needed health care coverage and services.
Support this year from FISA Foundation
and other donors has allowed us to provide advice, assistance, and representation to over 300 adults with disabilities in Southwestern PA, their family members or their advocates. This represents a 70% increase in direct services to this population from the previous year.
PHLP helped with the following types of problems:
Medicaid denials or terminations
Problems with Medicaid’s six prescription per month limit,
Problems for Medicaid recipients accessing dental care as a result of new dental limits,
Problems accessing prescription drugs for dual eligibles
Accessing home and community based services,
Understanding coverage and how to access services
Uninsured individuals with disabilities seeking affordable coverage
The client story below is a good example of our efforts:
“Robert,” a man in his late forties living in a rural area of Southwestern Pennsylvania, was referred to PHLP in November 2011 by his local County Assistance Office (CAO) after being denied for a Home and Community Based Services Waiver program for not meeting the level of care required to qualify.
Robert has Cerebral Palsy and uses leg braces and a walker for mobility. He requires ongoing assistance with activities of daily living such as bathing and dressing.
Robert was living with family members, but their house was not accessible. He was seeking the Waiver to live independently in an apartment better suited to his needs.
On the advice of PHLP, Robert filed an appeal. PHLP represented him at his fair hearing and negotiated a settlement for a new level of care assessment. The new assessment determined that Robert did
meet the level of care required to qualify for Waiver services and he was approved for the Attendant Care Waiver program.
By mid-June 2012, he had moved into his own apartment and was receiving support services. It was a long process, but in the end, Robert was able to receive the help needed to live independently in his own apartment!
We are proud of our accomplishments, and the support we’ve received, working with and on behalf of people with disabilities.
Co-pays for Some Families of Children with Disabilities to Start This Fall: Comments due Sept. 10
Some families of children with disabilities (children in the PH-95 Medicaid category) will start paying Medical Assistance copays this fall. The copays will apply to families with income above 200% of the federal poverty level. Not all services will be subject to the copays. DPW still has to make some important decisions regarding how the copays will be implemented. Concerned families have until September 10th to submit comments to DPW. For more information, click here
Client Spotlight: Helping Vulnerable Youth in Luzerne County
“Carly” was a 19-year-old resident of Luzerne County and four months pregnant when she called PHLP. Carly was panicked: she needed prenatal care because her chronic kidney disease increased the chance of a health problem for her baby, and the Department of Public Welfare’s County Assistance Office (DPW) had denied her application for Medicaid/Medical Assistance (MA).
Carly fully expected to receive MA when she applied, but when she called DPW, a worker in the county office explained that because Carly lived with her fiancé and his mother, the mother’s income had been included, putting Carly over the income limit.
PHLP contacted DPW on Carly’s behalf and advised them that non-spouse, non-guardian income should not be counted. Moreover, because Carly had been in the foster care system she was eligible for a different living status.
DPW agreed to enroll Carly in MA immediately, without going through lengthy appeal process. Thanks to PHLP, Carly is now receiving the medical care she needs to keep herself and her baby healthy.