PHLP eNews: February 2015

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PHLP eNews

February 2015

PHLP Recognized for Leadership in Advocacy

Last week, the Association for Community Affiliated Plans (ACAP) honored PHLP's commitment to making Pennsylvania's Medicaid program more accessible. PHLP's Executive Director traveled to Washington, D.C. to accept the award and to deliver remarks.

ACAP CEO Margaret Murray addressed the importance of PHLP's work: "Effective advocates... can make an outsized difference in facilitating access to coverage and care. Without [PHLP's] efforts to educate consumers, practitioners and health policymakers, many Pennsylvanians would have fewer or no choices in care- especially those with low incomes or disabilities."

ACAP represents 59 nonprofit safety net health plans in 24 states, which together serve nearly 12 million people enrolled in publicly-operated health programs. The association's mission is to improve the health of low-income and vulnerable populations.

Executive Director Laval Miller-Wilson is presented with the Leadership in Advocacy Award.
Photo courtesy of Association for Community Affiliated Plans.

Client Spotlight: Obtaining Better Coverage for Bedford County Resident Waiting for a Heart Transplant

When living with a serious health condition, it is critical to have comprehensive health coverage. But sometimes, when we are in the midst of coordinating care, important deadlines slip by accidentally and jeopardize well-being.

When Orville, a 67-year-old who lives in Bedford County, went on a heart transplant waiting list, his wife contacted PHLP. She was concerned that his Medicare Advantage Plan would not cover all the treatments and costs he would face in the coming year. The family missed enrollment during the Medicare annual open enrollment period because Orville had been in and out of the hospital during the fall, which distracted them from changing his plan. Realizing that the enrollment period was over, Orville's wife worried they might have to wait until next fall to change his plan.

PHLP reviewed Orville's eligibility for Medicaid and for Extra Help from Medicare but determined he did not qualify for either program. Eager to find a solution for Orville, we determined that should be eligible for PACE, Pennsylvania's prescription assistance programs for older adults, and advised that he apply. Once he is approved, Orville will have a one-time Special Enrollment Period that will allow him to switch to another Medicare Advantage Plan with drug coverage that will better meet his needs. We also referred Orville to the APPRISE program in his county for help comparing Medicare plans and enrolling.

Orville's wife is now relieved, knowing that her husband will be able to get the treatments he needs.

To help clients like Orville, consider a donation to PHLP today.

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PHLP in the News

ACA Nonprofit Healthcare Navigators in the Last Week of Open Enrollment, Nonprofit Quarterly, February 13, 2015.

Medicaid Expansion Could Leave Some With Marketplace Coverage in the Lurch, WHYY, February 9, 2015.

Grassroots Campaign Helps Consumers Find Health-Care Plans Before Feb. 15 Affordable Care Act Deadline, Pittsburgh City Paper, February 4, 2015.

What We're Reading

Pennsylvania’s “Super-Utilizers” of Inpatient Hospital Care, Pennsylvania Health Care Cost Containment Council (PHC4), February 2015

Medicare and Medicaid patients admitted to Pennsylvania hospitals five or more times in a year cost those programs $761 million, a new report has found, with a disproportionate share needing treatment for mental health disorders — a condition many hospitals are not equipped to handle. On average, super-utilizers stayed in the hospital 5.9 days each time, compared with 4.4 days for patients admitted no more than two times in a year. The data were based on Pennsylvania hospital admissions between July 1, 2013, and June 30, 2014.

Health Care Success for Midwest Co-op Proves Its Undoing, The New York Times, February 16, 2015.

The Affordable Care Act funded nonprofit cooperatives to create increased choice and competition in insurance markets. Consumers saw many benefits with the introduction of the co-ops: lower out-of-pocket maximum costs, generous benefits, great customer service. However, as many with extensive health care needs flocked to these attractive plans, they’ve become victims of their own success.

The Tax Preparer's Guide to the Affordable Care Act, Center on Budget and Policy Priorities, February 2015.

With the tax system now playing an important role in making coverage more accessible, this guide is a valuable resource, explaining how the Affordable Care Act affects tax preparation. It covers topics including exemptions to the coverage requirement, calculating the penalty for not having minimum essential coverage, and reconciling advance payments of the premium tax credit with the final premium credit amount.

A Primer on Using Medicaid for People Experiencing Chronic Homelessness and Tenants in Permanent Supportive Housing, U.S. Dept. of Health and Human Services, July 2014.

This Primer offers state Medicaid officials and other interested parties strategies for using Medicaid to meet the needs of this very vulnerable population--some strategies that have succeeded in the past and some that are emerging under provisions of the Affordable Care Act.

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