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December 2016 eNews
Health Law PA News

Click here for the November-December 2016 Health Law PA News.
  • Community HealthChoices Delayed as Protesting Health Plans Appeal
  • Medicare Announces 2017 Part A and Part B Costs
  • Pennsylvania Long-Term Care Council Formed
  • Resource Limits to Qualify for Extra Help and Medicare Savings Programs in 2017 Announced
  • OLTL Waiver Application Help Now Available
  • Help for People Who Mistakenly Missed the Transition from Marketplace to Medicare
  • New Outreach Effort to Enroll Eligible Children into Medicaid or CHIP
  • Human Services Block Grants Now Available Statewide
  • Public Comment Opportunity-Consolidated and PFDS Waiver Renewals
  • Comments on OLTL Waiver Amendments Due December 21st
  • Happy Holidays from PHLP
As 2016 draws to a close, PHLP thanks everyone whose support helped us secure health care for almost 5,000 low-income persons and those who are otherwise vulnerable or disenfranchised.  We’ve obtained health coverage for the uninsured, restored skilled nursing care for developmentally disabled children and adults, and advised low-income seniors confused about Medicare enrollment. The services we obtain for our clients are important to their well-being, and provide peace of mind: the kind of peace we wish for anyone who needs medical care. It is a privilege to do this work.

Please consider us when you are making any year-end contributions to charitable organizations and help us continue to advocate for the most vulnerable Pennsylvanians. Your support makes our work possible. Donations can be made by mail or by using our secure online form.

We wish you good health, and hope you will continue to stand for healthcare access in the New Year!

 

Medicare Miscommunication Leaves Senior Unaware of Financial Options

For Pennsylvania’s senior residents, agency miscommunications can further confuse the healthcare process. Such was the case for Elsie Rose, a 92-year-old, low income resident receiving home and community-based waiver services to avoid admission to a nursing home.  A social worker from the senior high rise where Miss Elsie lives contacted PHLP’s Helpline in May 2016 on her behalf.  Miss Elsie’s daughter had recently applied for the Medicare Part B premium and was denied. Confused, they turned to PHLP.

When the County Assistance Office reviewed Miss Elsie for financial eligibility for the waiver program in 2010, they appropriately reviewed her for other possible benefits as well.  During the review, she was also found eligible for the state to pay her monthly Medicare Part B premium of $104.90; however, there was a breakdown in communications between the state and the Social Security Administration, so Miss Elsie continued to pay the Part B premium from her Social Security for the next 6 years!  

After six months of relentless advocacy by PHLP with top officials at the Department of Human Services and the Social Security Administration to unravel this case, we were successful in getting Miss Elsie a check for $8,025 that she was owed. Her social worker called it “a bureaucratic miracle”! Miss Elsie and her family were deeply appreciative of PHLP’s persistence in resolving her case.

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What We're Reading

Medicaid under ACA changes lives of gun-violence victims, Sarah Varney, Philadelphia Inquirer

“The same states that have opted to expand Medicaid suffer high numbers of firearm injuries, including Pennsylvania. The law is profoundly changing how gunshot victims in these states heal from grievous injuries by guaranteeing access to specialists, physical therapy, nursing-home care, antibiotics, wound supplies, and wheelchairs, according to dozens of interviews with trauma surgeons, rehabilitation specialists, anti-violence groups, and shooting victims.

Physicians and officials at Philadelphia hospitals pointed out that under federal law, trauma patients always have received lifesaving care without consideration to insurance status. Hospital social workers work to qualify patients for insurance or aid from groups such as the Pennsylvania Victims Compensation Assistance Program, noted Einstein Health spokeswoman Judy Horwitz.

But after the initial trauma is resolved, Medicaid expansion has made it easier to ensure needed follow-up care.”


Webinar on Aging in Place for Older Adults Shares Promising Models, Carol Regan, Community Catalyst, December 12, 2016

“On December 1, Community Catalyst hosted the third webinar in its series on Health and Housing – “Aging in Place: Housing and Health Integration for Low-Income and Chronically Ill Seniors.” Two resources are now available – both a recording of the full webinar and the slides presented. The three presenters shared various state and local examples of innovative and successful practices to integrate support for safe and continuous housing with well-coordinated home-based care and services for vulnerable older adults with complex and chronic conditions.”

 
How High-Need Patients Experience Health Care in the United States, The Commonwealth Fund

“The health care system is currently failing to meet the complex needs of these patients. High-need patients have greater unmet behavioral health and social issues than do other adults and require greater support to help manage their complex medical and nonmedical requirements. Results indicate that with better access to care and good patient–provider communication, high-need patients are less likely to delay essential care and less likely to go to the emergency department for nonurgent care, and thus less likely to accrue avoidable costs. For health systems to improve outcomes and lower costs, they must assess patients’ comprehensive needs, increase access to care, and improve how they communicate with patients.”

 
Why Obamacare enrollees voted for Trump, Sarah Kliff, Vox, December 13, 2016

“Many expressed frustration that Obamacare plans cost way too much, that premiums and deductibles had spiraled out of control. And part of their anger was wrapped up in the idea that other people were getting even better, even cheaper benefits — and those other people did not deserve the help.

There was a persistent belief that Trump would fix these problems and make Obamacare work better. I kept hearing informed voters, who had watched the election closely, say they did hear the promise of repeal but simply felt Trump couldn’t repeal a law that had done so much good for them. In fact, some of the people I talked to hope that one of the more divisive pieces of the law — Medicaid expansion — might become even more robust, offering more of the working poor a chance at the same coverage the very poor receive.”

 
COBRA, Retiree Plans, VA Benefits Don’t Alleviate Need To Sign Up For Medicare, Susan Jaffe, Kaiser Health News, December 14, 2016

Thousands of seniors unwittingly make similar mistakes every year, believing that because they have some type of health insurance, they don’t have to worry about signing up for Medicare Part B. Generally, insurance other than that provided by a current employer will not exempt them from Medicare’s strict enrollment requirements. Seniors’ advocates and some members of Congress want to fix the problem, backed by a broad, unlikely group of unions, health insurers, patient organizations, health care providers and even eight former Medicare administrators.

Medicare’s Part B enrollment rules haven’t changed since the program was created in 1965. Seniors can enroll only when they first become eligible — usually three months before and after the month they turn 65 — or when their job-based insurance ends. If they miss this opportunity, they have to wait until the months of January through March to enroll and then coverage only begins July 1. Most won’t be allowed to buy any other health insurance policy during that time.


Many Parents With Job-Based Coverage Still Turn To Medicaid, CHIP To Insure Kids, Michelle Andrews, Kaiser Health News, December 9, 2016

“Over the course of the study, nearly all the families in which a parent was offered coverage accepted it for the parent, and about three-quarters of children in the sample were covered by their parents’ employer-sponsored plan, on average.
But the proportion of kids who lacked employer-sponsored coverage even though at least one parent had it grew from 22.5 percent in 2008 to 25 percent in 2013, the study found. Likewise, the percentage of children who were on Medicaid or CHIP even though at least one parent had coverage through an employer increased 3.1 percentage points, to 15.2 percent, over the course of the study.”
 
Helping People in Need Get the Health Care They Deserve.
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