David Gates, PHLP Policy Director and Senior Attorney, discusses Medicaid programs for individuals with developmental disabilities, including waivers, wraparound services, and recent cuts to the Medicaid program. See the full interview on BCTV’s program The ARC: Building Bridges in the Community.
PHLP is updating our archive of resources for consumers, advocates, and providers! The following revised and updated publications are now available in our “resources & publications” section:
The Department of Public Welfare (DPW) has been instructed to require certain families to pay copays for services provided under Medical Assistance to children with disabilities whose family income is more than 200% of the federal poverty level.
PHLP conducted a survey detailing the impact that copays would have on families (a summary of results is available here). PHLP has also partnered with other organizations to develop recommendations to DPW on how to implement copays. To read these recommendations and learn about how you can make a difference, check out our Action Alert.
As part of the 2011-12 state budget, the Pennsylvania Department of Public Welfare was directed to impose co-payments for Medicaid services on children with special health care needs whose family income is more than 200% of the federal poverty guidelines. PHLP and several partners (Disability Rights Network, Mental Health Association in PA, the PA Chapter of the American Academy of Pediatrics, Pennsylvania Partnerships for Childrenand PA Community Providers Association) are working to ensure that this imposition does not place too great a financial and administrative burden on families.
As part of that effort, PHLP surveyed 948 families about what services they use, what out-of-pocket expenses they pay, and how Medicaid services support their children in school.
Highlights of the responses are:
933 families said that Medicaid pays for their child’s primary care.
763 families said that Medicaid pays for their child’s specialty care.
758 families said that Medicaid pays for their child’s prescriptions with almost half saying they filled prescriptions once a month.
625 families said that Medicaid pays for their child’s diagnostic tests and 405 families said that Medicaid pays for their child’s diagnostic x-rays and other radiology.
325 families said that Medicaid pays for their child’s physical therapy, 514 families said that Medicaid pays for their child’s speech therapy, and 449 families said that Medicaid pays for their child’s occupational therapy.
272 families said that Medicaid pays for outpatient behavioral health, 407 families have wraparound services and 261 families said that Medicaid pays for other behavioral therapies/psychiatrist/psychologist services.
212 families pay for primary care, 258 families pay for specialty care, 242 families pay for medications with 34.3% paying between $100 and $200 a month.
143 families pay for diagnostic tests with 48.3% paying between $100 and $200.
71 families are paying for outpatient behavioral health with 42.3% paying between $100 and $200 per visit.
Under a grant from the William Penn Foundation, PHLP convened a group of advocates to develop principles regarding children and health care reform. Now, PHLP and our partners are asking organizations to sign on in support of these principles, to ensure that children do not lose ground as Pennsylvania implements the many changes of the health care reform law.
This diverse new collaborative will develop best practices for health care enrollment and will work to educate Americans about the new opportunities they will have to secure affordable health care coverage.
A new, nonprofit organization, “Enroll America,” was launched earlier this month by an unprecedented collaboration of key, diverse national groups representing virtually all stakeholders in America’s health care system. The organization will be dedicated to securing health coverage enrollment for tens of millions of uninsured people.
Groups participating in the new collaboration include the Pennsylvania Health Law Project and range from companies and associations representing the hospital, insurance, and pharmaceutical industries to organizations representing physicians, community health centers, free clinics, health care consumers, and people with major illnesses and disabilities.
Enroll America’s mission is to maximize enrollment in new health coverage opportunities that become available in 2014. But many of the strategies can be used now to improve enrollment and renewal in Medicaid and CHIP even before 2014.
The organization will focus on two primary goals: First, it has established a Best Practices Institute to promote better understanding of ways to make the health care enrollment process simple, streamlined, and seamless. The Best Practices Institute will work through Enroll America’s partners to encourage states to adopt these best practices. Second, Enroll America plans to organize a massive public information and advertising campaign in 2013 and 2014 to ensure that Americans know about the new opportunities they will have to secure affordable health coverage.
For more information, visit Enroll America’s web site at www.enrollamerica.org.
On September 30th, DPW will reduce dental benefits for consumers on fee-for-service Medical Assistance. For more details, see our factsheet.
As part of the Pennsylvania State Budget for 2011-2012, the Department of Public Welfare will begin charging co-payments for some Medicaid services. Children with disabilities covered by Medicaid in the PH-95 category (sometimes called “loophole”) whose family income is more than 200% of the federal poverty guidelines (or about $45,000 a year for a family of four) are likely to see new co-pays. At this point DPW is still deciding how to implement the co-payments.
Several organizations including PA Health Law Project, PA Chapter of the American Academy of Pediatrics, Disabilities Rights Network and the Mental Health Association of PA would like to show DPW what families spend out-of-pocket now and what the impact of co-payments might look like.
If you have a child or youth under 21 with a disability or other special health care need, you can help us by completing the survey through the link below. The survey does not collect any information that can be used to identify individual families. We will only share summaries of the information we collect with DPW.
Thank you for your help and for your time. If you have any questions, please contact Ann Bacharach, Special Projects Director, PHLP 215-625-3596 x101 or firstname.lastname@example.org.
The Health Insurance Exchange(s) under the Patient Protection and Affordable Care Act (PPACA) will be a critical mechanism for obtaining coverage as well as for shaping the health insurance market both inside and outside the Exchange. To learn more about exchanges, visit PHLP’s new Exchange resource page.
Many, many decisions that will affect the Exchange functions need to be made by Pennsylvania. Will the Exchange operate one Exchange for individuals and one for small business or combine the two? Will the Exchange be an active purchaser, leveraging the Exchange market to support affordable, high quality care or simply be a listing of available products? To help consumers and advocates understand these issues, PHLP has been reading a large number of publications written by national and state experts, in order to compile a resource page of our top recommendations.
Under a grant from the William Penn Foundation, PHLP convened a group of advocates to develop principles regarding children and health care reform. Together, PHLP, Community Legal Services (CLS), the Pennsylvania Chapter of the American Academy of Pediatrics (PAAAP), Pennsylvania Partnerships for Children (PPC), and Public Citizens for Children and Youth (PCCY) have worked to highlight Pennsylvania’s gains in coverage, access, and quality for children and to outline important steps to protect those gains and at the same time optimize the opportunities for further improvements under the Affordable Care Act. The principles can be found here and have already proven to be useful. PCCY, CLS, and PA AAP have referenced the principles in their testimony to the Department of Insurance at the Exchange forums in Pittsburgh and Philadelphia and PHLP and PPC will do the same later this month in Harrisburg.
In a case of first impression, a Court of Common Pleas (Philadelphia County) ordered a health insurance carrier, Independence Blue Cross (IBC), to pay for services to treat children with autism spectrum disorder. The case, Burke v. IBC, was brought by the Pennsylvania Health Law Project to force the insurance industry to abide by Pennsylvania’s Autism Coverage Law (also known as Act 62), which requires many private health insurance companies to cover diagnoses and treatment of autism for children and adolescents. Read the decision Read PHLP’s 7/22/11 press release
On June 30, the General Assembly enacted significant changes to the statute known as the Public Welfare Code, 62 P.S. § 101 – 1503, which governs many of Department of Public Welfare’s programs, including Medicaid (also known as Medical Assistance). These were signed into law by the Governor on June 30 as Act 22 of 2011. These changes grant DPW the authority to make significant changes to Medical Assistance benefits and provider reimbursement rates without the usual oversight by the General Assembly or the Independent Regulatory Review Commission. In the past, when expenditures, especially for Medical Assistance, exceeded the amount appropriated in the budget, the Governor would ask for one or more “supplemental appropriations” to fund the additional costs. Act 22 makes clear that DPW will have to “live” within the budget as passed on June 30, without any supplemental appropriations later in the year. DPW may move money around within its various line items but cannot exceed the aggregate amount appropriate to DPW in the budget. Act 22 mandates DPW to make a variety of changes, including Medical Assistance, to keep costs within the amounts appropriated in the budget for this fiscal year. Learn more about the changes here.
On June 30, the General Assembly enacted significant changes to the statute known as the Public Welfare Code, 62 P.S. § 101 – 1503, which governs many of Department of Public Welfare’s programs, including Medical Assistance. These were signed into law by the Governor on June 30 as Act 22 of 2011. These changes grant DPW the authority to make significant changes to Medical Assistance benefits and provider reimbursement rates without the usual oversight by the General Assembly or the Independent Regulatory Review Commission. Among the changes made is the express grant of authority to DPW to charge copays, including copayments for services to some children under 18 with disabilities that are covered under Medical Assistance. DPW will be able to require providers to charge families a copay for services their children receive under Medical Assistanceand to refuse services if the family doesn’t pay the copay. The copays would not apply to children on SSI or families whose children receive cash assistance. The copays could apply to children whose family income is above 200% of the federal poverty level. Read about income limits and other copay policy questions here.
As reported in The Philadelphia Inquirer, a study by the University of Pennsylvania found that callers posing as mothers with children on Medicaid or CHIP were more likely to be refused an appointment with a pediatric specialist than callers pretending to have private insurance. The Inquirer‘s June 16 coverage includes insights from PHLP Special Projects Director Ann Bacharach and PHLP co-founder Michael Campbell.
The PEAL Center is sponsoring four free upcoming workshops on Medical Assistance, Waivers and the Affordable Care Act: Using Public Insurance to Get Services & Supports You Need. The workshops will be led by PHLP Managing Attorney David Gates. Learn more and register.
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