PHLP eNews: March 2015

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PHLP eNews

March 2015

Helping Pennsylvanians Realize the Promise of Medicaid Expansion

Last month, the daughter of an uninsured woman (“Lacy Moore”) with multiple health conditions sought PHLP’s help. She did not want to lose her mother to illness but feared the future.

Despite suffering from uncontrolled diabetes, bipolar disorder, and high blood pressure, Mrs. Moore had not had health insurance since her husband passed away seven years ago. The 58-year-old Allegheny County resident used part of her modest pension of $512 per month to pay doctors and buy medications out–of-pocket. Her daughter often helped her buy insulin, which costs nearly $200 each month.

Mrs. Moore should have Medicaid. She applied in mid-December 2014, but she received no response from state officials in the intervening two months: no one answered the phone at the local county assistance office, and the online system said her application was still being processed.

PHLP requested the administrator at the local office speed review Mrs. Moore’s application based on her health problems. When the official raised a problem verifying Ms. Moore’s income, and then an issue regarding bank transfers, PHLP helped the family verify Ms. Moore’s pension income and the transfers from her daughter (that she used to buy insulin).

Two weeks after her daughter contacted PHLP, Lacy Moore had health insurance for the first time in seven years, and can regularly see a doctor and take medications to control her blood sugar and her blood pressure. The Moores now have the peace of mind that comes with knowing that diabetes need not lead to premature death.

Support Pennsylvanians like Mrs. Moore

PHLP Releases 2015 Updates About Two Important Medicare Programs for Low-Income Pennsylvanians

Medicare provides good health care coverage, but it can be expensive. People on Medicare generally have to pay monthly premiums and meet deductibles before Medicare starts to provide coverage. Then, they have co-pays or coinsurance when they get health care services. Often, seniors and people with disabilities who have limited incomes and resources struggle to pay their Medicare costs and may not get all the coverage or health care services, including medications, they need.

Programs exist to help lower Medicare costs, but too many people are not aware of these programs or do not know how to get the help that is available. PHLP recently updated publications about two important programs. The Medicare Part D Extra Help program (also called the Low Income Subsidy Program) lowers the cost of Medicare prescription drug coverage and limits what people pay at the pharmacy when they get their medications filled. The Medicare Savings Programs help with the Medicare Part B premium (currently $104.90/month) and may help cover other Medicare Part A and Part B costs for individuals with the lowest incomes.

These programs make a significant difference in helping Medicare beneficiaries get the health care services they need and keeping them healthy.

PHLP in the News

May I Move My Son off My Insurance So He Can Buy on the Exchange?, NPR and Kaiser Health News, February 25, 2015.

Impact of the ACA on Family Law Cases (subscription required), The Legal Intelligencer, March 2, 2015.

What We're Reading

A Guide to Oversight, Transparency, and Accountability in Medicaid Managed Care, National Health Law Program, March 2015

This publication provides tools, tips, and techniques to obtain information about states' Medicaid managed care programs. It explains how advocates, beneficiaries, and others can ensure managed care companies and state Medicaid agencies fulfill their obligations to enrollees and to taxpayers.

Not All Children in Foster Care Who Were Enrolled in Medicaid Received Required Health Screenings, Health and Human Services' Office of Inspector General, March 2015

Children in foster care often experience chronic medical, developmental, and mental health issues. States' ability to ensure that foster children receive needed health services is critical to these children's well-being. The Social Security Act requires each state to develop a plan for ongoing oversight and coordination of health services for children in foster care, which includes establishing a schedule for initial and periodic health screenings. This report found nearly one-third of children in foster care enrolled in Medicaid did not receive at least one required health screening.

Medicaid Beneficiaries in California Reported Less Positive Experiences When Assigned to a Managed Care Plan, Health Affairs, March 2015 (subscription required)

In 2011 California began transitioning approximately 340,000 seniors and people with disabilities from Medicaid fee-for-service (FFS) to Medicaid managed care plans. When beneficiaries did not actively choose a managed care plan, the state assigned them to one using an algorithm based on their previous FFS primary and specialty care use. Researchers found that 48 percent chose their own plan, 11 percent were assigned to a plan by algorithm, and 41 percent were assigned to a plan by default. People in the latter two categories reported being similarly less positive about their experiences compared to beneficiaries who actively chose a plan.

In and Out in 2 Years: Why Can't States Keep Medicaid Directors?, Governing Magazine, March 2, 2015

At least 23 Medicaid directors have left their posts since last January, according to the National Association of Medicaid Directors (NAMD). That's a spike in turnover, for sure, but the low-income health care program is already known for having more frequent departures than other top jobs in state government. So what fuels turnover among Medicaid directors, and what can be done about it?

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