On March 1st, 2013, the Department of Public Welfare (DPW) will change how Medical Assistance (MA) operates in North Central and Northeastern Pennsylvania. Medical Assistance in these areas will transition a majority of MA recipients from ACCESS Plus to a physical health managed care plan. This change will create a HealthChoices New East Zone and will impact individuals who live in Bradford, Carbon, Centre, Clinton, Columbia, Juniata, Lackawanna, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northumberland, Pike, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne, and Wyoming Counties.
To help providers, consumers and advocates prepare for this change, PHLP will offer two free in-person trainings (December 11, 2012 and December 18, 2012) and a webinar (December 14, 2012) on the HealthChoices New East Zone expansion. Please see our flyer for more details.
Open Enrollment begins on October 15th and ends December 7th. During this time all Medicare beneficiaries can change their drug coverage or their Medicare Advantage plan coverage.
Specifically, Medicare has approved 38 Prescription Drug Plans for 2013, 14 of which are zero-premium for dual eligibles and other individuals receiving the full low-income subsidy. Select here for a complete listing of the 2013 Medicare Part D Standard Zero-Premium Prescription Drug Plans.
Changes made during the Open Enrollment period will become effective on January 1, 2013.
PHLP is hosting a series of information sessions to educate consumers, providers, and advocates about upcoming changes to Medicare Part D in 2013. Click here to learn more.
Under a grant from the William Penn Foundation, PHLP is working with Community Legal Services, PA Chapter of the American Academy of Pediatrics, PA Partnerships for Children, and Public Citizens for Children and Youth to assure that children fare well in Pennsylvania’s implementation of the Affordable Care Act. This summer and fall, the group has organized a series of conference calls, webinars and face-to-face meetings. Materials and information from that series can be found here.
For more information, contact Ann Bacharach.
Beginning October 1st, 2012, Medical Assistance consumers in Erie, Crawford, Mercer, Venango, Warren, Forest, Clarion, Jefferson, Elk, McKean, Cameron, Clearfield, and Potter counties will receive their physical health care through HealthChoices. ACCESS Plus will end in these counties.
In August, PHLP is offering a series of trainings throughout these northwestern counties to help consumers and advocates prepare for the switch.
To learn more about the changes, read the June/July Combined edition of PHLP’s Health Law PA News and Senior Health News.
PHLP has also published a series of fact sheets about , advising consumers and advocates on how to choose a managed care plan, and on their appeal rights and options in HealthChoices.
The Department of Public Welfare will begin implementing co-payments for certain services for children in Medicaid’s PH-95 category (sometimes called “loophole”). The information shared with families has produced confusion and a number of questions. Join the Pennsylvania Health Law Project (PHLP) for a one hour webinar led by David Gates and Ann Bacharach on the latest changes to co-payments, what remains to be clarified, and families’ responsibilities and appeal rights. At the end of the webinar there will be an opportunity to ask questions.
The Department of Public Welfare (DPW) has issued a Notice that some families with children with disabilities will have to pay copays for many services covered by Medical Assistance. These copays will be for children under age 18, who qualify for Medical Assistance due to their disability and whose family income is more than twice the federal poverty level. The copays are scheduled to start on October 1, 2012 for newly eligible children and November 1, 2012 for children currently eligible for Medical Assistance. For more information click here.
Effective April 9th, PHLP’s Helpline is now open from 8am-8pm on Monday, Wednesday, and Friday.
Cash assistance through Pennsylvania’s General Assistance (GA) program will end in Pennsylvania as of August 1, 2012. Consumers who had been receiving GA cash assistance are still eligible for Medical Assistance, and cannot be refused services if they are unable to pay a co-pay. For more information, see PHLP’s new fact sheet.
Beginning July 1st, 2012, Medical Assistance consumers in Bedford, Blair, Cambria, Somerset, Franklin, Fulton, and Huntingdon counties receive their physical health care through HealthChoices. ACCESS Plus has ended in these counties.
To learn more about the changes, read the May edition of PHLP’s Health Law PA News.
PHLP has also published a series of fact sheets about the Expansion, advising consumers and advocates on how to choose a managed care plan, and on their appeal rights and options in HealthChoices.
In his proposal for Pennsylvania’s 2012-2013 budget, Governor Corbett announced deep cuts to General Assistance (GA) programs that serve the state’s neediest, most vulnerable residents. The Governor’s budget calls for eliminating GA cash assistance entirely and slashing funding of GA-related Medical Assistance by as much as two-thirds.
The elimination of GA cash assistance will affect 67,000 Pennsylvanians living in poverty, including survivors of domestic violence, disabled or sick individuals, those caring for a sick or disabled person, and adults in drug and alcohol treatment programs.GA-related Medical Assistance pays for a limited amount of basic medical care to these individuals and many other Pennsylvanians making less than $215 or $425 per month. The Department of Public Welfare has not yet shared how it plans to implement the $170 million in planned cuts to this program. Based on the magnitude of these cuts, we estimate that as many as 80,000 of Pennsylvania’s most vulnerable residents could lose access to critical medical care.
Another key change announced in the proposal is an increase in the premium rate for workers in the MAWD program (Medical Assistance for Workers with Disabilities), a Medical Assistance program which allows disabled individuals to work without losing their health care coverage.
The governor also plans to consolidate several human services programs into block grants to counties, resulting in a 20% cut to funding for child welfare programs and programs that serve individuals and families struggling with mental and behavioral health issues, intellectual disabilities, and homelessness.
The governor’s proposed budget now goes to the General Assembly for legislative action that will begin with Appropriations hearings and culminate in legislation by June 30, 2012. A lot can change in the months between a budget’s proposal and its passage, including restoration of funding or increases in cuts to individual programs. PHLP will continue to provide updates as we learn more.
As of July 1st, 2012, ACCESS Plus will no longer operate in Blair, Bedford, Cambria, and Somerset Counties. These counties will be moved into the HealthChoices Southwest Zone.
In order to educate consumers, families, and advocates in these counties about the upcoming changes, PHLP held two training sessions on May 31, 2012 in Blair and Cambria Counties.
For more information, click here.
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, now also available in Spanish [Alerta de Acción].
A notice sent out recently from the Department of Public Welfare regarding changes to copayments under Medical Assistance effective May 15th has caused some confusion among families who have children with disabilities on Medical Assistance. While this notice does not apply to children under 18, it does not mean that DPW has dropped plans to impose significant copays under Medical Assistance on families with children under 18 with disabilities.
DPW still plans to impose significant copays on families with incomes at or above two times the federal poverty level for services provided under Medical Assistance to children with disabilities under 18. Those copays may begin in September although operational issues may push the implementation date back. Nonetheless, we fully expect DPW to impose copays on many families of children with disabilities sometime this year or next. A separate notice will be sent by DPW before they implement those copays.
While DPW is still going forward with copays on services to children with disabilities, there are still important issues regarding how much families will have to pay. For more information, see PHLP’s Action Alert, now also available in Spanish [Alerta de Acción].
In March 2012, the Federal Department of Health and Human Services released final rules for health insurance exchanges and Medicaid that will take effect under the Affordable Care Act (ACA) on January 1, 2014. These rules establish requirements regarding eligibility and enrollment processes that will allow people to obtain health coverage that is most appropriate to their financial and health needs and maximizes reliance on electronic databases and other technology. PHLP and Community Legal Services co-authored a white paper on the revisions necessary to Pennsylvania’s administration of Medicaid and CHIP.
Fran Chervenak, PHLP’s Director of Client Services and Managing Attorney of the Pittsburgh office, was honored by the Pennsylvania Legal Aid Network (PLAN) at its annual awards banquet. To view Fran’s tribute video, click here.
Congratulations to Fran and to the other 2012 PLAN Excellence Award Winners!
In February 2012, the Pennsylvania Department of Insurance released conceptual draft legislation for a state-operated exchange. The proposed bill would establish multiple private exchanges, a model very different from other states. PHLP is concerned about the multiple exchange approach and with Community Legal Services co-authored comments critical of the proposed model. A summary of the Department’s proposal, our comments, and the Department’s conceptual draft can be found here.
At the end of March, the U.S. Supreme Court will examine the constitutionality of the Affordable Care Act (ACA), potentially producing a landmark decision. For most cases, the Supreme Court allocates one hour for oral argument — 30 minutes for each side. For the health care reform case, the Court has scheduled six hours for oral argument — the most time devoted to a case in more than 45 years. These arguments will take place March 26, 27, and 28, and the Court’s ruling will probably be announced in June. In this preview, PHLP has compiled materials explaining the issues raised by the cases, answering some of the key questions about the parties’ legal arguments, and considering potential effects of the Court’s decisions. To read more, click here.
Effective January 3, 2012, the state has reduced pharmacy coverage to 6 prescriptions a month for adults in fee-for-service Medical Assistance. To learn more about the new limit and about important exceptions and work-arounds, see our new fact sheet.
It has been widely reported that a significant number of Pennsylvanians, primarily children, are losing coverage at a time when they can least afford it. PHLP is working with others to immediately halt these unnecessary and harmful terminations, and has re-issued a briefing paper about simplifying enrollment and renewal practices.
In December 2011 the Pittsburgh Post Gazette profiled a PHLP client, Alexander, a 5-year-old boy with leukemia whose mother carefully updated his Medical Assistance reenrollment forms, twice, but still lost his health insurance because the county assistance office declared that the paperwork was missing. PHLP was able to help Alexander’s family restore his health coverage, but his case is one of thousands. Nearly 32,000 Pennsylvanians were cut from Medical Assistance between August and September 2011. 18,000 of them were children.
PHLP believes that simplifying enrollment and renewal in Medical Assistance makes sense for families, as well as overwhelmed county assistance offices struggling to meet increased demands for assistance.
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