Read this month's Health Law PA News and learn about a policy victory resulting from PHLP's advocacy!

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PHLP eNews

February 2016

In This Issue:
- February 2016 Health Law PA News
- Client Spotlight
- C ommunity HealthChoices Update s
- PHLP Urges Officials to Reduce Churn
- What We're Reading

Health Law PA News

Click here for the February 2016 Health Law PA News.

This month's Health Law PA News includes the following articles:

Governor’s Proposed Medicaid Budget for FY 2016-2017
Community HealthChoices Updates: Victory Related to 18-20 Year-Olds!
Comments Sought on 2016 OBRA Waiver Amendment & Renewal
New Health Insurance Tax Forms for 2015
Pennsylvania Starts “Fast Track” Medicaid Enrollment
A Reminder About the Medicare Parts A & B General Enrollment Period
New Federal Poverty Level Guidelines Published

Client Spotlight: Helping Pennsylvanians Overwhelmed by the Healthcare System

Losing a job is stressful, especially when a benefit includes health coverage. Tom had lost his full-time job and the insurance that came with it. Since then, he had only been able to find part-time work—and he struggled to meet that commitment because his health was declining and he was receiving no medical treatment. Tom, an insulin-dependent diabetic, suffered from depression and also needed hernia surgery. Tom’s wife, Tina, tried to get coverage through the Federal Marketplace but decided it would cost them more than they could afford. She had also applied for Medicaid, but they were denied because their household income exceeded the Medicaid limits.

By the time Tina contacted PHLP, she was desperate. Without medical care her husband’s health had declined so much she feared he soon would not be able to work at all. After talking with Tina, it was clear that her husband’s chronic health conditions were limiting his ability to work and that he would be a good candidate for Medical Assistance for Workers with Disabilities (MAWD). This program allows individuals to qualify for Medicaid even when their income is above the normal Medicaid limits. We explained MAWD to Tina and mailed her the application, as well as the medical forms a doctor needed to complete to verify the effects of Tom’s health problems.

Tina contacted us a month later to report that Tom’s MAWD application had been approved and how relieved she was to know that he would have affordable health insurance that would allow him to get the care he needed.

PHLP steps in when low-income and vulnerable Pennsylvanians like Tom—who need timely, appropriate, affordable and quality care—get overwhelmed by the health care system. We respond when patients and their caregivers delay or fail to get needed care or seek care in inappropriate but more easily accessible settings, such as emergency departments.

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Community HealthChoices Update:
Victory Related to 18- to 20-Year-Olds!

As reported in February’s Health Law PA News, the PA Department of Human Services announced that the OBRA Waiver will continue to exist when Community HealthChoices begins in each region and will serve 18- through 20-year-olds with physical and developmental disabilities. Readers may recall that once Community HealthChices began future 18-20 year olds would not be included. PHLP argued this exclusion placed these young adults at risk of institutionalization because they would not be able to access important long term services and supports such as respite, home modifications and residential habilitation.

DHS maintained that the Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) mandate of Medicaid would cover all of the services these young adults needed. PHLP and other advocates disagreed and urged the state to change its position and provide for the needs of these young adults so that they can live as independently as possible within their communities.

PHLP is glad to report that our ongoing advocacy efforts have led to a successful result! DHS recently decided to address the needs of current 18-20 year olds, as well as any new 18-20 year olds who need long-term services and supports, through the OBRA Waiver. The OBRA waiver is the only OLTL Waiver program that will continue to exist once Community HealthChoices is implemented in a region.

PHLP Urges Officials to Make It Easier for Low-Income, Vulnerable Pennsylvanians to Enroll and Keep Medicaid

Low-income adults often cycle in and out of the Medicaid program when their income or life circumstances change. As a result, they face disruptions in care that put them at risk for poor health outcomes. A recent publication PHLP co-authored with Community Legal Services urges Pennsylvania policy makers to reduce this disruption (also called “churning”).

Churning hurts public benefits agencies and the Pennsylvania economy. The Center on Law and Social Policy recently estimated that churn from the Philadelphia County Assistance Office alone costs Pennsylvania almost $9 million annually in needless administrative costs, and the Pennsylvania economy loses out on an estimated $69 million each year due to lapsed SNAP benefits caused by churn.

While churn may occur due to agency or recipient error, it is just as likely to occur because of administrative requirements that eligible Pennsylvanians do not understand or cannot navigate, or that state officials cannot handle efficiently.

Streamlining requirements for public benefits programs can reduce churn, preserving health care coverage and saving taxpayers’ money. And moving toward more streamlined administration is consistent with federal trends under the Affordable Care Act and recent child care reauthorization.

What We're Reading

Patients Are The Sun: The Imperative For Consumer Engagement In Transforming Health Care, Health Affairs Blog, February 11, 2016

Last month, Community Catalyst, a national consumer health advocacy organization, launched its Center for Consumer Engagement in Health Innovation. The Center was created through a five-year, $14.8 million legacy grant, awarded in 2015 by The Atlantic Philanthropies, to advance the role of consumers in health system transformation-- that is, changes in the health system that are shaping the delivery of health care for all Americans. The Center brings a strong focus on health equity and a particular emphasis on the care of three vulnerable populations: older adults and people with disabilities who have both Medicare and Medicaid coverage ("dual eligibles"); people with substance use disorders and mental illness; and children and youth with special health care needs.

In his keynote speech at the Center's launch, Donald Berwick, president emeritus and senior fellow at the Institute for Healthcare Improvement, underlined the critical need for the Center's mission. He stated, "We lack balance in listening to the voices of patients, families, and communities with respect to the design of the care that's supposed to help them. We have enormous evidence, overwhelming scientific evidence, that when people can control their own care, the care gets better, and generally—by the way—the costs fall dramatically."

The themes raised in Berwick's talk and encapsulated in the Center's priorities were reflected in a short video featuring consumers who speak about challenges they have faced in the current health care system and what better consumer-centered care means for them.

How a New Kind of Worker May Keep Patients Healthier: A Push For Community Health Care, Without Medical Jargon, Philadelphia Inquirer, February 29, 2016

Pennsylvania's Medicaid program is funding Medicaid managed care programs to use community health workers like the one profiled by the Philadelphia Inquirer. A community health worker is a lay worker that DHS believes can communicate more effectively than professionals steeped in medical jargon. The health care workers profiled in this article work in Southeast Pennsylvania, but every Pennsylvania Medicaid managed care organizations is using community health workers.

Hospital Admissions for Overdose of Pain Medication and Heroin, Pennsylvania Health Care Cost Containment Council (PHC4), January 2016

The Pennsylvania Health Care Cost Containment Council (PHC4) has released a new research brief on hospitalizations for overdose of pain medication and heroin. Examining hospital discharges between 2000 and 2014 for Pennsylvania residents aged 15 and older, the brief presents statewide findings that show a 225% increase in the number of hospitalizations for overdose of pain medication and a 162% increase in the number of hospitalizations for overdose of heroin. While there were higher numbers of hospital admissions for these types of overdoses among urban county residents, there were larger increases for rural county residents. For rural county residents, there was a 285% increase between 2000 and 2014 in the number of hospitalizations for pain medication and a 315% increase for heroin. For urban counties, the percent increases were 208% and 143%, respectively.

Special Issue on Autism-Related Health Issues (subscription required), Pediatrics, February 2016

The February issue of Pediatrics, the official journal for the American Academy of Pediatrics, focuses on "Health Care for Children and Youth With Autism and Other Neurodevelopmental Disorders." 14 articles are authored by teams of researchers representing multiple medical centers, universities, and other organizations.

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