Read this month's Health Law PA News and check out a preview of our Deskbook for Family Court Judges in this edition!
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PHLP eNews

December 2015

Health Law PA News

Click here for the December 2015 Health Law PA News.

This month's edition includes the following articles:
  • Community HealthChoices News
  • DHS Extends Its Waiver Enrollment Contract; Moving Forward With Certain Changes
  • Supreme Court Rules In Highmark And UPMC Dispute
  • Reminder About Part D Plan Transition Requirements
  • PA CHIP Reauthorized
  • Medicaid Expansion Enrollment Hits 500,000
  • Open Enrollment In The Marketplace Continues
  • Pennsylvania To Expand Pilot Program For Pregnant Women With Substance Abuse Disorders
  • Comments To Proposed Autism Waiver Changes Due January 11th
  • DHS To Hold Family Input Session On Medical Necessity Guidelines For ABA
With 2016 upon us, we take a moment to express our appreciation for your support during an incredibly busy year that featured the launch of Medicaid Expansion in Pennsylvania (that has now enrolled over 500,000) and the start of developing a system of managed long term services and supports, known as Community Health Choices. We thank our partners, funders, board members, and supporters! Your commitment to our shared work and vision is invaluable. We also thank our clients. We could not have achieved so much without the continual input from individuals we serve every day. Your stories and your life experiences drive us to do better.

In 2016, PHLP remains committed to: 
  • Providing high quality legal assistance to as many individuals as possible to help them overcome barriers to accessing coverage and health care services
  • Sharing information about policies and practices so that others can be informed to assist Pennsylvanians in need
  • Influencing policies and practices that maximize health coverage and access to care, hold providers and insurers accountable, and achieve better health outcomes and reduce health disparities
Please consider us when you make any year-end contributions to charitable organizations and help us continue to advocate for the most vulnerable Pennsylvanians, and keep stakeholders updated, as our Commonwealth continues to make historic decisions about health law. Donations can be made by mail or by using our secure online form.

We look forward to continued partnership and a productive and successful 2016. PHLP wishes you and your family a happy holiday season and good health in the New Year!

Client Spotlight: The Gift of Sight

This year “Luke” was admitted to the emergency room after he had experienced sudden vision loss. Doctors told Luke that he had a retinal detachment, a serious eye condition where the retina separates from the tissue surrounding it, and that unless he received surgery immediately, he would lose his vision completely.

Luke was the sole provider for his wife and young child, and he worried that he would have to give up his job delivering pizza if he was no longer able to see well enough to drive. Furthermore, because of his precarious immigration status, Luke worried that he would not be eligible for Medicaid to help pay for his hospital bills.

When Luke and his family walked into our office, distraught over their inability to pay the cost of his surgery, PHLP stepped in. We helped Luke file an application for Emergency Medical Assistance and spoke to the local county assistance office on his behalf. Luke’s application was processed quickly and he was able to go in for surgery.

A few weeks later, PHLP received an emotional message from Luke thanking PHLP for all our help. He also hand-delivered a box of pizza to the PHLP’s Philadelphia office – a testament to the fact that his vision has been saved and he can now continue to provide for his family.

To help clients like Luke, consider a donation to PHLP today.

Donate to PHLP

PHLP Releases Deskbook on the Affordable Care Act for Judges

Family Courts are in a unique position to ensure that children and their parents have access to health insurance. Often, courts will ask whether a child has health insurance, but the inquiry should not stop there. Does the coverage meet the child’s needs? Are there issues or high costs associated with that coverage? Does the child have special health care needs? Is their coverage addressing those needs? Most importantly, how will a decision the court is going to make change the child’s access to health coverage?
The Deskbook (click link for preview) provides clear descriptions of Pennsylvania’s two largest insurance programs for low-income families: Medicaid (called Medical Assistance in Pennsylvania) and the Children’s Health Insurance Program (CHIP). It also describes health insurance coverage that can be purchased on the Health Insurance Marketplace with significant financial assistance. The Appendix contains useful resources for courts and litigants, including a glossary of health insurance terms. This Deskbook will also be useful to practitioners, particularly legal services providers, working with litigants in Family Court.

The development of the Deskbook was supported by a grant from U.S. Department of Health and Human (HHS) to identify and enroll children eligible for Medicaid and CHIP through the Connecting Kids to Coverage Outreach and Enrollment program. 

If you are interested in purchasing a copy of the Deskbook (print or digital), please email

PHLP in the News

Here's Why PA Shouldn't Tinker with an Important Healthcare Program for Seniors: Another View, PennLive Op-Ed, December 1, 2015.


What We're Reading

Certification of Comparability of Pediatric Coverage Offered by Qualified Health Plans, Centers for Medicare & Medicaid Services, November 25, 2015.

The federal government (HHS) released the long-awaited Children's Health Insurance Program "Comparability" report. The Affordable Care Act required HHS to compare the benefits and cost-sharing of CHIP with Qualified Health Plans (QHPs) to determine if QHPs are at least comparable to CHIP. Only if the Secretary certifies QHPs as comparable could states move children out of CHIP and into QHPs (if a state experienced a CHIP funding shortfall). The report finds that no QHPs
not a single one in any state are comparable to CHIP. CHIP offers families lower premiums and cost-sharing and more comprehensive benefits than QHPs. Here's a link to a blog from Georgetown's Center for Children and Families providing more information. CHIP is currently funded through 2017 although the program is authorized until 2019.

Low-Wage PA Nursing Home Workers Rely on Public Assistance, Keystone Research Center, November 2015.

A report from the Keystone Research Center finds thousands of workers in nursing homes across Pennsylvania need food stamps and Medicaid to make ends meet. The Center estimates that nearly 15,000 nursing home workers need public assistance to supplement their wages.

Leveraging the Affordable Care Act to Enroll Justice-Involved Populations in Medicaid: State and Local Efforts, Health Affairs, December 2015.

This report examined sixty-four programs operating in jails, prisons, or community probation and parole systems that enroll criminal justice-involved populations in health insurance, particularly Medicaid. Many state and county corrections departments have launched programs that incorporate Medicaid enrollment in discharge planning. Four practices have facilitated the Medicaid enrollment process: suspending instead of terminating Medicaid benefits upon incarceration, presuming that an individual is eligible for Medicaid before the process is completed, allowing enrollment during incarceration, and accepting alternative forms of identification for enrollment.

Access to Care in a Medicaid Managed Care World (VIDEO), The American Journal of Managed Care, November 2015.

Access to care for Medicaid has been a longstanding issue, and it remains a complex one because there are a variety of ways to measure access. In November, the federal government released a final proposed rule requiring state Medicaid agencies to monitor access to care for beneficiaries. This is six minutes of video of three experts discussing Medicaid managed care and access to care in particular.
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