In order to educate consumers, families, and advocates in these counties about the upcoming changes, PHLP is holding two training sessions on May 31, 2012 in Blair and Cambria Counties.

For more information, click here.

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].

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. The copays will not apply to families with countable income below two times the poverty level. We have urged DPW to deduct out-of-pocket costs and insurance premiums for the child from parental income in determining whether the family is above or below two times the poverty level. Furthermore, for those families who would still be at or above two times the poverty level, deducting out-of-pocket costs and insurance premiums would still help as the total amount a family pays in copays cannot exceed 5% of their “countable” income. We also support premiums on a sliding scale based on income. To that end, we continue to urge families to write to the Director of Policy for Medical Assistance in support of these recommendations at the address below:

Leesa Allen, Director
Bureau of Policy, Analysis and Planning
Office of Medical Assistance Programs
Department of Public Welfare
P.O. Box 2675
Harrisburg, PA 17105

Please explain how these recommendations would assist your family in coping with copays.  Send a copy to your State Senator and State Representative.

Congratulations to Fran and to the other 2012 PLAN Excellence Award Winners!

March 2012

In November 2011, Governor Corbett announced Pennsylvania’s decision to establish a state-run health insurance exchange as required by the Affordable Care Act, rather than defer to an exchange run by the federal government. The exchange will be a marketplace where consumers can comparison shop for health insurance coverage based on their needs and budgets. The exchange will also manage the available subsidies and tax credits for insurance for consumers. The Pennsylvania Insurance Department (Department) estimates that 2 to 2.5 million Pennsylvanians would participate in a health insurance exchange in 2014 (excluding individuals eligible for Medicaid or CHIP). These are conservative estimates but reportedly provide a reasonable foundation for the volume of consumers expected to participate in the exchange.

Legislation consistent with Governor’s Corbett’s vision is expected to be introduced very soon. In late January 2012, the Insurance Department announced its vision for a state-operated exchange and released a 32-page conceptual draft. The proposed bill would establish multiple, private exchanges; a model very different from other states which have proposed no more than two exchanges operated by either state government or a quasi-government authority. Any private entity meeting the exchange criteria would be certified, and be permitted to sell qualified health insurance plans and other types of insurance including auto and home-owners.

The statute provides for the establishment of an advisory council made up of twenty-one members to advise the Insurance Department on a number of issues regarding the Exchange. There would be only four consumer representatives on the Advisory Council: one representative who is not a medical provider or insurer, one consumer who purchases individual health insurance, and two small employers. In contrast, there would be three representatives of health insurers and two representatives of insurance brokers.

PHLP is concerned about the multiple exchange approach and with Community Legal Services co-authored comments critical of the proposed model. We appreciated the Department’s desire to create an Exchange unique for Pennsylvania, but discouraged the use of multiple Exchanges. To view our comments, click here. To view the Department’s conceptual draft, click here.