Pennsylvania Health Law Project pays special attention to vulnerable populations in need of assistance, and has dedicated resources to the initiatives and projects listed below.
Following the passage of Act 56 of 2007, which directed the Department of Public Welfare to issue regulations governing the licensure of Assisted Living Residences (ALRs), PHLP led a coalition of advocates for the elderly and disabled to ensure the new regulations were informed by and meaningful to consumers (especially vulnerable populations). To learn more about the final regulations, including provisions advocates support and oppose, click here. Assisted Living Residences are long term care option between the personal care home and nursing home levels of care. They provide food, shelter, personal care assistance and some health coverage to elderly and disabled residents who are not so sick as to require ongoing skilled nursing care. Pennsylvania has announced that it intends to submit an application to the Centers for Medicare and Medicaid Services (CMS) seeking a Medicaid Waiver that will allow the state Medicaid program to pay for services in an assisted living residence for qualified individuals with limited income. To read more about the proposed Assisted Living Waiver, including consumer priorities for the Waiver, click here.
Autism and Children’s Health—
PHLP advises the Commonwealth on how to implement and enforce the Autism Insurance Act (Act 62 of 2007), which requires commercial insurers to cover diagnostic and treatment services for children with autism spectrum disorders. PHLP is also actively monitoring how children and adolescents with autism spectrum disorders transition from Medical Assistance coverage as the sole payer of these services to having their commercial insurance become primary coverage.
Children with Special Health Care Needs—
With funding from the Department of Health, PHLP has partnered with the PA Chapter of the American Academy of Pediatrics and the PEAL Center to improve services to children and youth with special health care needs through six regional forums across the state. The forums are designed to gather input from parents, families, youth and service providers and set priorities for action steps at the local or state level.
Consumer Empowerment to Improve and Transform Mental Health Service System—
PHLP works to increase consumer knowledge and involvement in the mental health system. In Greene County (Southwest PA) in particular, PHLP works intensively with consumers to educate them about their right to determine their recovery path, to increase their knowledge of the mental health system, and to support their individual and collective abilities to shape that system to be responsive to their needs.
Health Center Enrollment Specialists—
PHLP collaborates with the Pennsylvania Association of Community Health Centers to provide training and technical assistance to health center Navigators, Certified Application Counselors, and other enrollment assisters. Through a series of in-person trainings and webinars, PHLP helps health center enrollment specialists gain expertise in Pennsylvania’s CHIP and Medicaid programs. The collaboration also focuses on identifying the best avenues of enrollment for patients seeking insurance coverage through state programs or the new Health Insurance Marketplace. Recordings of the webinar trainings on Medicaid eligibility can be found here (session on children, parents, and pregnant women) and here (session on disability-related categories). The webinar training on using COMPASS to apply for Medicaid and CHIP can be found here.
Helping Low Income Persons on Medicare Access Care—
PHLP monitors, reviews, and comments on changes in Medicare policy affecting low-income beneficiaries and advocates for our clients with the Centers for Medicare and Medicaid Services (CMS) and the Department of Public Welfare when we identify systemic issues. PHLP leads the Medicare Rx Coalition, a group of advocates across PA, and works regularly with national advocates to identify problems and seek effective solutions. We create consumer education materials and conduct trainings for advocates, providers, and community organizations across the state on programs that help low-income Medicare beneficiaries (such as the Medicare Savings Programs and the Part D Low-Income Subsidy), how consumers with Medicare and Medicaid access care, and Medicare Part D prescription drug coverage. PHLP also contracts with the Commonwealth’s APPRISE program (the State Health Insurance Program) to train their staff and volunteers on these and other topics as well as provide them with technical assistance on individual cases.
Home and Community Based Services—
PHLP works to increase awareness and improve the effectiveness of Home and Community Based Services (HCBS programs), which provide important alternatives to institutional care for individuals who wish to remain living in their homes or communities. Even though HCBS programs have been available for over a decade, many are not aware of their existence, how to qualify, or how to access these programs. Moreover, in recent years there have been HCBS policy changes relating to eligibility, accessing and purchasing services. PHLP monitors issues affecting HCBS programs through our individual and systemic advocacy work and through our involvement in statewide advisory committees. PHLP educates vulnerable adults (disabled and elderly), their family members, and the professionals who serve them on Home and Community Based Services and how to navigate their complex and cumbersome program rules.
Hospital Accountability Project—
The Hospital Accountability Project is an initiative funded by Community Catalyst to examine and improve hospital charity care policies and practices statewide. With PHLP as the lead entity, a collaborative effort by four organizations –Community Legal Services, Philadelphia Unemployment Project, PA ACORN, and PHLP– persuaded state officials to issue a new policy guidance requiring Pennsylvania’s hospitals to strengthen their charity care policies. See our charity care brochure for more information on how the uninsured and underinsured can access hospital charity care.
PHLP advises and represents low-income veterans having problems accessing care through the Veterans Health Administration. For information on eligibility for VA health care, how the VA health care system works, and VA health care appeals, consult our Advocate’s Guide to the Veterans Health Administration.