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Read this month's Health Law PA News and PHLP's comments on Community HealthChoices
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PHLP eNews

January 2016

Health Law PA News
 

Click here for the January 2016 Health Law PA News.

This month's edition includes the following articles:
  • Governor Approves Stopgap Budget for FY 2015-2016
  • Budget Address Scheduled for February 9th
  • Community HealthChoices Update
  • A Reminder Regarding the MATP Escort Policy
  • Attention Parents of Children with Autism Spectrum Disorder Who Have PA Medicaid!
  • Marketplace Open Enrollment Ends January 31, 2016
  • Medicare Advantage Disenrollment Period Ends February 14th!
  • Medicare Sanctions Cigna-Health Spring Plans
  • Two Opportunities for Comments Related to HCBS Waiver Programs

PHLP Comments on Community HealthChoices; Highlights Threat Facing 18- to 21-Year-Olds


As reported in January’s Health Law PA News, Community HealthChoices is the name of Pennsylvania’s plan to require dual eligibles (those on Medicare and Medicaid), as well as all adults on waivers administered by the Office of Long Term Living, to be enrolled in managed care plans for their Medicaid and any long term care services they receive. In December and January, PHLP submitted detailed comments and recommendations. This included writing on behalf of more than 35 organizations and individuals to request that the Department of Human Services (DHS) reconsider its decision to raise the minimum age of eligibility for Community HealthChoices from 18 to 21 for young adults with significant physical disabilities—e.g., muscular dystrophy, cerebral palsy, spina bifida, and spinal cord injury; disabilities that significantly limit mobility. 
 
PHLP’s statement details the services that keep these young adults in their homes and communities and out of institutional care—e.g., respite, home modifications and residential habilitation. Denying 18-, 19-, and 20-year-olds these essential supports will place them at serious risk of institutionalization. 
 
It also contradicts basic principles of adolescent development. As youth move into adulthood around the age of eighteen (often on completion of high school), their choices and challenges shift to decisions about post-secondary education or vocational training, entry into and transitions within the labor market, moving out of the family home, and sometimes marriage. These are positive milestones, but the Department’s current approach will delay, at a critical time, this transition to adulthood. Unaltered, Community HealthChoices will isolate young adults with disabilities, unnecessarily blocking their path to becoming independent and productive.

PHLP in the News


Philadelphia Family Prevails in Court, Forcing Insurer to Pay for Autism Services in School, Newsworks, January 22, 2016

Elder Law: Healthcare Options for the Elderly and Disabled, Pittsburgh Post-Gazette, January 25, 2016

Pennsylvania Court Rules Insurers Must Cover School-Based Applied Behavioral Analysis Under Autism Treatment Mandate (membership required), Open Minds, January 4, 2016



 

What We're Reading


Supportive Housing for Chronically Homeless Medicaid Enrollees: State Strategies, Center for Health Care Strategies, January 2016

People who experience chronic homelessness often also struggle with serious mental illness, substance use disorders, physical and mental disabilities, and chronic medical conditions. These individuals, many of whom are eligible for Medicaid, are more likely to frequently visit emergency departments and, as a result, often have high annual health care expenditures. Medicaid prohibits directly paying for housing, but this brief details circumstances under which Medicaid can fund housing-related services, and outlines eight key strategies and practical action steps to help states advance supportive housing options. The Wolf administration is expected to release soon a supportive housing plan that includes some of these strategies.


The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey, January 2016

A major survey of Americans struggling with medical bills finds that, even among the insured, illness and injury can reshape a family's financial health. 

In the new poll, conducted by The New York Times and the Kaiser Family Foundation, roughly 20 percent of people under age 65 with health insurance nonetheless reported having problems paying their medical bills over the last year. By comparison, 53 percent of people without insurance said the same.

These financial vulnerabilities reflect the high costs of health care in the United States, the most expensive place in the world to get sick. They also highlight a substantial shift in the nature of health insurance. Since the late 1990s, insurance plans have begun asking their customers to pay an increasingly greater share of their bills out of pocket through rising deductibles and co-payments. The Affordable Care Act, signed by President Obama in 2010, protected many Americans from very high health costs by requiring insurance plans to be more comprehensive, but at the same time it allowed or even encouraged increased in deductibles.


Both The 'Private Option' and Traditional Medicaid Expansions Improved Access to Care for Low-Income Adults, Health Affairs, January 2016

Under the Affordable Care Act, thirty states and the District of Columbia have expanded eligibility for Medicaid, with several states using Medicaid funds to purchase private insurance. Despite vigorous debate over the use of private insurance versus traditional Medicaid to provide coverage to low-income adults, there is little evidence on the relative merits of the two approaches. This article compared the first-year impacts of traditional Medicaid expansion in Kentucky, the private option in Arkansas, and non-expansion in Texas. It found the uninsured rate declined by 14 percentage points in the two expansion states, compared to the non-expansion state. In the expansion states, again compared to the non-expansion state, skipping medications because of cost and trouble paying medical bills declined significantly, and the share of individuals with chronic conditions who obtained regular care increased. Other than coverage type and trouble paying medical bills (which decreased more in Kentucky than in Arkansas), there were no significant differences between Kentucky's traditional Medicaid expansion and Arkansas' private option, which suggests that both approaches improved access among low-income adults.
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