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Pennsylvania Health Law Project: Helping People in Need Get the Health Care They Deserve

Appeal Victory: PHLP Helps 13-Year-Old Retain Crucial In-Home Care

Last month, PHLP won an administrative appeal that kept needed services in place for a 13-year-old boy, Joseph, with numerous complex health needs including epilepsy, speech and language delays, fine and gross motor delays, and pervasive developmental delay. Due to his cognitive and development delays, Joseph functions at the level of an 18 to 24 month old.  

Because of his multiple medical and behavioral needs, Joseph requires constant one-on-one supervision. For tasks such as preparing his medications, reinserting his feeding tube, and changing his diaper (which he fights), he requires two-on-one care. Joseph’s parents are able to provide most of his care; however, because of the intensive nature of care required, his Medical Assistance plan paid for a home health aide to assist his mother during the hours when Joseph was not at school and his father was at work.
 
When the Medical Assistance managed care plan notified Joseph’s family that they were reducing the hours of home health aide services, Joseph’s mother worried that she wouldn’t be able to safely care for Joseph by herself. She knew she would have to appeal the reduction, and she called PHLP.

PHLP advised Joseph’s parents on how to proceed with the appeal process, explaining what evidence the Medical Assistance plan would need and how to present their case most effectively. When the first appeal was denied, a PHLP attorney stepped in to represent the family at their next appeal, helping Joseph’s parents and doctors most persuasively present his case.  

The managed care plan reversed their decision, granting Joseph the extra hours of care on non-school weekdays, and adding an additional hour of care on school days. Joseph’s parents are relieved that they will continue to have the support they need to care for their son and keep him safe at home. 

PHLP: Training the Next Generation of Health Advocates

Each semester, PHLP’s Philadelphia office welcomes three to five interns from local law, public health ,and social work schools such as Temple, Drexel, Penn, and Rutgers-Camden. This program allows exceptionally qualified students to learn about health advocacy in Pennsylvania and contribute to PHLP’s work.

During the course of their internship, students learn about Pennsylvania’s publicly funded health programs and their eligibility and appeal processes. After an initial training and under close supervision, many interns assist staff in responding to Helpline calls and handling cases. Legal interns may also assist staff in conducting legal research and drafting memos and factsheets. By working collaboratively with experienced staff, our interns expand PHLP’s capacity to serve our clients while also gaining crucial advocacy skills.

Orlando Smith is a PHLP intern from the Temple School of Social Work. His work at PHLP, he says, “represents an opportunity for me to gain valuable skills in advocacy, a core value of social work, and exposure to understanding policy initiatives. PHLP is an ideal learning ground for me to become a skilled advocate and leader in upholding the rights of others.”

PHLP is proud to be training the next generation of health care justice leaders.  For more information about our internships, visit our website.

PHLP in the News 

New Medicaid rules hamper patient transportation, Pittsburgh Post-Gazette, 1/8/12 

Cuts to legal aid harm the justice system, Harrisburg Patriot-News, 1/12/12

What We're Reading

Since August, 88,000 Pennsylvanians have lost Medicaid benefits, Philadelphia Inquirer, 1/17/12

Project puts records in the patients' hands
, New York Times, 1/9/12


Medicaid Reform: Policy Brief, Robert Wood Johnson Foundation, 1/12/12

Inside National Health Reform, John McDonough, University of California Press

Balancing coverage affordability and continuity under a basic health program option
, New England Journal of Medicine, 12/15/11


Medicaid's role for women across the lifespan: current issues and the impact of the Affordable Care Act, Kaiser Family Foundation, January 2012

Insurance Exchange Planning, Pennsylvania Insurance Department, November 2011

Spotlight on Advocacy

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane."

- Dr. Martin Luther King, Jr. in a speech to the Medical Committee for Human Rights, 1966
Support our work!

The Pennsylvania Health Law Project is a nationally recognized expert and consultant on access to health care for low-income consumers, the elderly, and persons with disabilities. PHLP engages in direct advocacy on behalf of individual consumers while working on the kinds of health policy changes that promise the most to the Pennsylvanians in greatest need.
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