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PHLP eNews

March 2016

Health Law PA News

Click here for the March 2016 Health Law PA News.

This month's Health Law PA News includes the following articles:
  • DHS Issues Community HealthChoices RFP
  • Maximus to Handle Aging Waiver Enrollments Starting April 1st
  • DHS Launches Information and Referral Tool for Home and Community Based Services
  • DHS Issues RFP for Home Modification Brokers
  • DHS Clarifies Policy Regarding Medicaid Eligibility for Pregnant Women Who Are Immigrants
  • State Agencies Step Up Efforts to Enforce Autism Insurance Law

Client Spotlight: Ensuring Access to Care for a High Risk Pregnancy

Three years ago the “Sato” family lost a child to ectopic pregnancy. Newly expecting again, they feared a similar result when Riko had unexpected vaginal bleeding. The doctor at the emergency room wanted them to return to the hospital in two days for an ultrasound and blood work, but the Satos lacked health insurance and could not afford the $400 follow-up visit. 

Desperate to get the care needed to maintain the health of their unborn child, the Satos turned to PHLP for help. They had been denied Medicaid a month before and submitted a new application when they were at the hospital earlier in the week. However, their calls to the county welfare office, to explain the urgency of their situation, went unanswered. 

PHLP intervened and learned that the family’s application had been transferred from Montgomery County to Butler County as part of an arrangement to spread case volume among counties. An administrator at Butler County explained that Medicaid couldn’t be authorized because they lacked information on Riko’s immigration status and because they appeared “over-income” due to Riko’s husband’s work as a drug and alcohol treatment counselor. 

Communicating quickly with the family, PHLP resolved the immigration status issue by providing the welfare office a copy of Riko’s Lawful Permanent Resident card (“green card”). 
Discovering that the Satos cared for Riko’s 18 year old step-daughter, PHLP counseled them to claim her as a dependent. Because many Medicaid programs now follow tax rules, this increased their household size for Medicaid eligibility purposes and made Riko “income-eligible.” PHLP faxed a statement declaring the Satos’ intent to claim the step daughter as tax dependent to the welfare office. 

With PHLP’s intervention, Riko had Medicaid coverage authorized the same day she had contacted PHLP. She was able to get the follow up care she needed for her high risk pregnancy the very next day.

This is just one example of PHLP's work protecting the rights of vulnerable Pennsylvanians. To help clients like Riko, consider a donation to PHLP today.

Donate to PHLP

PHLP Releases Report, "Impact of the Affordable Care Act on Pennsylvanians with Disabilities"

This report to the Pennsylvania Developmental Disabilities Council highlights Pennsylvania’s successes, challenges and unfinished business with the implementation of the Affordable Care Act. Specific to persons with disabilities and chronic health conditions, the report focuses on three critical areas of the ACA: Medicaid expansion; the Marketplace; and long term services and supports. The intent of the report is to educate persons with disabilities, family members, advocates and policy makers about the work done on the ACA and the continued opportunities for health system transformations.

The report can be found on the PHLP website at: 

Questions about the report can be directed to Janice Meinert at

This report was funded by a grant from the Pennsylvania Developmental Disabilities Council.

What We're Reading

Why States Should Suspend Medicaid for People During Incarceration, Families USA, March 8, 2016

With a majority of states expanding Medicaid, many more people stand to gain health coverage, including those recently released from jail or prison. States are re-evaluating their policies regarding Medicaid for incarcerated residents. Families USA takes a closer look at what states have accomplished so far to get a better idea of how this has played out across states. They found that 34 states (including Pennsylvania) and the District of Columbia now have some form of policy to suspend Medicaid for people in prison or jail.

State Wage Hike Intensifies Staffing Challenge for Health Care Providers, POLITICO New York, March 15, 2016

This story from NY caught our attention. Now that NY Governor Cuomo hiked the minimum wage to $15 per hour, Medicaid health care providers are finding it increasingly difficult to find staff when retail stores and fast food restaurants are offering higher hourly wages. Raising wages is an arduous task for Medicaid providers that rely primarily on state funding. Those who care for the aged, sick, and disabled must provide for medical, hygienic, and emotional needs of patients. Given the choice between this type of work and other, less demanding work that pays better, workers often choose the latter.

Report to Congress on Medicaid and CHIP, Medicaid and CHIP Payment and Access Commission (MACPAC), March 2016

This report desribes the critical importance of Medicaid in the lives of so many low-income Americans. What caught our attention is the chapter on integration of behavioral and physical health. It's well documented that a disproportionately large number of Medicaid beneficiaries have a behavioral health diagnosis. The MACPAC report details the problems these beneficiaries encounter: siloed behavioral and physical health services lead to beneficiaries having multiples providers in multiple locations which, too often, results in declining health and soaring Medicaid costs. States are actively pursuing new programs to address these problems, but as MACPAC points out, the evidence base for this sort of integration is still in development.
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