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PHLP eNews

October 2015

Health Law PA News

Beginning with this month's newsletter, we are combining our eNews (updates about PHLP's work) and our Health Law PA News (monthly updates on policies and practices affecting consumers). Those of you who used to receive the Health Law PA News as a separate email will now be able to access the PDF newsletter through a link in this box.

Click here for the October 2015 Health Law PA News.

Client Spotlight: Restoring Health Insurance Coverage for a Senior Seeking Treatment for Cancer and Cardiac Arrest

At 70 years old, in poor health, and losing his insurance, Michael Belford admitted he was scared. He contacted PHLP in July after he learned his Medicaid was being stopped. He had had a heart attack three days earlier. Doctors at the hospital put three stints in his heart. He also had lymphoma, a cancer in his blood cells, for which his doctors wanted to start treatment as soon as possible.   

Despite his age, Mr. Belford could not enroll in Medicare Part B for another year, until July of 2016. He had been released from prison in May, and because he had not paid his Medicare Part B premium during the four years that he was incarcerated and had no income, Social Security had stopped his Medicare benefit. He now had to wait over a year to be allowed to re-enroll in Medicare Part B.

Losing Medicaid would mean his lymphoma would go untreated, at least for the next year. It would also mean any cardiac rehab or other follow-up care for his heart attack would have to be paid out of pocket. Mr. Belford’s only income was his Social Security of $1,400 a month, but that amount put him over the income limit for Medicaid.

PHLP contacted Mr. Belford’s welfare office and argued that, when he first applied, the welfare office should have put him in a category of Medicaid – the Medicare “Buy-In” category – that would have triggered immediate Medicare Part B coverage, bypassing the one year wait period he was otherwise facing. Though it would still stop his Medicaid coverage going forward, a welfare administrator agreed that the office made a mistake and should retroactively turn on the Medicare “Buy-In” category. By virtue of the welfare office authorizing the “Buy-In” category, even for a short retroactive period, his Medicare Part B was turned on.

He would have to pay the normal monthly premium of $105 for it, but three weeks after contacting PHLP, Mr. Belford had Medicare Part B coverage. He’d be able to get treatment for his lymphoma without worry about his coverage stopping. For that he was immensely grateful.

To help clients like Mr. Belford, consider a donation today.

Donate to PHLP

Upcoming Webinar on Coverage for Dual Eligibles

PHLP is offering a free webinar to educate providers, advocates and other professionals who work with dual eligibles (people who have both Medicare and Medicaid) and other low-income Medicare beneficiaries about upcoming Medicare in 2016.

The webinar will be held October 29th from 10 am-noon and will cover the following topics:
  • Medicare Part D plans and costs in 2016
  • Programs that help Medicare beneficiaries with their costs
  • Helping Medicare beneficiaries in times of transition, including becoming a dual eligible or losing their dual eligible status
To register for the webinar, please click here. Space is limited, so register today! Please share this announcement with others who may be interested in the webinar.

What We're Reading

Mobile Health and Patient Engagement in the Safety Net: A Survey of Community Health Centers and Clinics, The Commonwealth Fund, May 2015.

Researchers conducted an online survey of community health centers and clinics to assess if and how health care providers in the safety net use cell phones to support patient engagement. The findings indicate that the use of cell phones in patient care is at an early stage of deployment across the safety net.

Briefs in Commonwealth of Pennsylvania, v. UPMC & Highmark Health (Nonprofit Corp), PA Supreme Court, October 2015.

This month the Pennsylvania Supreme Court heard arguments in a lawsuit the state brought against the two largest participants in the western Pennsylvania health care market (UPMC and Highmark), whose ongoing battle against each other endangers the welfare of tens of thousands of seniors enrolled in Medicare Advantage plans. A decision from the Court is expected soon.

The Connection Between Health and Housing: The Evidence and Policy Landscape, Alliance for Health Reform, October 2015.

Summarizes various studies exploring the link between housing and the health of people and communities.

Pennsylvania Data in the 2014 State and County Uninsurance Estimates, The State Health Access Data Center (SHADAC), September 2015.

Recently released federal data shows fewer Pennsylvanians are going without health insurance as the Affordable Care Act helps push more coverage into financially struggling communities. About 8.5% of Pennsylvania's population was uninsured in 2014, down from 9.7%, or roughly 1.2 million people, in 2013. Lower-income families accounted for much of the shift, buying subsidized policies through a health insurance marketplace. An expansion of Medicaid in Pennsylvania in 2015 should reduce those uninsured numbers. The estimates are based upon data collected through the US Census' American Community Survey (ACS), an annual survey of sample households that data on a variety of population characteristics, including health insurance coverage.

Vital Signs: Core Metrics for Health and Health Care Progress, Institute of Medicine of the National Academies, April 2015.

This report was a big part of the recent Consumer Voices for Coverage conference. How we measure quality in health care is a hard question to answer. What we measure, how we measure it, what matters most to consumers-- these are questions raised by this IOM report.

Visualizing Health Policy: Medicaid and Medicare at 50

Infographic from the Kaiser Family Foundation and the JAMA Network (full image can be found at
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