PHLP eNews: May 2015

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PHLP eNews

May 2015

Preserving Financial Security for a College Student Facing Significant Medical Bills

Moving away from home and starting college is an overwhelming journey for anyone. When a medical emergency and resulting debt are added to the mix, it becomes an extremely stressful situation.

Nineteen-year-old Deion had just moved to Pennsylvania from out-of-state to start his first year of college when he had an attack of emergency appendicitis. He went to the nearest hospital emergency department, where he was treated and kept overnight. While he had health insurance at the time, he still had a coinsurance payment of $12,000! Neither Deion nor his mother could afford a payment that large.

Overwhelmed by this hospital bill, Deion and his mother reached out to PHLP for help. PHLP determined that based on his income, Deion was eligible for Medicaid (known as Medical Assistance in Pennsylvania), and advised Deion to apply and ask for retroactivity to cover the large hospital bill. Pennsylvania approved Deion for Medical Assistance, but did not authorize retroactive benefits. PHLP intervened on Deion’s behalf to ensure retroactive coverage was approved. Medical Assistance will now cover Deion’s unexpected $12,000 bill, allowing him to start his college career free of that debt.

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

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PHLP Accepts State Invitation to Comment on Essential Health Benefits

Pennsylvania is deciding what benefits individual and small group health plans should offer consumers starting January 1, 2017. The Affordable Care Act's "essential health benefits" rule obligates insurers in the individual and small group markets to cover 10 categories of "essential" medical services. Pennsylvania is reassessing those essential benefits and inviting public comment.

PHLP is paying particular attention to the "rehabilitative and habilitative services and devices" category because insurance plans rarely, if ever, covered habilitation services and devices and provided limited rehabilitation services and devices. Moreover, Pennsylvania is one of only 11 states that permits insurers to define habilitative services.

PHLP is preparing comments to submit to the Pennsylvania Insurance Department by June 9th, urging the Commonwealth to adopt a more comprehensive definition of rehabilitative services. If you are interested in joining our comments, contact PHLP’s Janice Meinert (JMeinert@phlp.org).

ABC's of Managed Care and What it Might Mean for Home- & Community-Based Services

Pennsylvania's Department of Human Services (DHS) announced it would soon launch a process for stakeholder feedback about delivering long term services and supports through capitated Medicaid managed care programs. An increasing number of states are using Managed Long Term Supports and Services (MLTSS) to expand home- and community-based services, promoting community inclusion, ensuring quality, and increasing efficiency.

PHLP Senior Attorney David Gates will present on key differences between MLTSS and Pennsylvania's current fee-for-service system. Attendees will learn about core MLTSS concepts including "capitation," "provider networks," "network adequacy," "credentialing," "rate setting," and "utilization management."

The Disability Rights Network is hosting the training on Tuesday, June 9th from 1 pm to 3 pm at the Institute on Disability at Temple University in Harrisburg (Room 254, Strawberry Square, 11 N. 3rd Street). There will be host sites throughout the state that will connect to the training. All sites are accessible; requests for accommodations must be made at least 4 days in advance. The training will also be broadcast via webinar and can be accessed through a personal computer.

To register for the forum, click here.

PHLP in the News

Pennsylvania's Medicaid Expansion Smooths the Road to Addiction Treatment, But Barriers Remain, Institute for Research, Education & Training in Addictions, May 14, 2015

What We're Reading

Bridging the Gap Between Behavioral and Primary Health Care for Low-Income Patients, Health Affairs Blog, May 16, 2015

In states that expanded Medicaid, hundreds of thousands of residents now have access to mental health and substance use benefits—many for the first time. But some states—e.g., California—lack the capacity to respond to the needs of this growing patient population, and separate reimbursement streams for behavioral and primary care continue to stymie care coordination and information sharing across providers. This commentary highlights solutions underway.

ALL Pennsylvania Children Should Qualify for Public Health Insurance. Who is Left Out?, Public Citizens for Children and Youth, May 2015

All Pennsylvania children should qualify for health insurance. However, state law leaves out 47,000 children statewide from enrolling in CHIP or Medicaid. PCCY's fact sheet describes how many undocumented children are prevented from enrolling in health care coverage in each county in southeastern Pennsylvania and provides recommendations on what Pennsylvania needs to do to make coverage available to every child in the Commonwealth.

Pennsylvania Autism Census Update, Bureau of Autism Services, Pennsylvania Department of Human Services, November 2014

This relatively new report found that the number of individuals with autism receiving services in all age groups has increased tremendously since the original census study was released. It also found that adults with autism receiving services were the fastest growing group in Pennsylvania. The information collected can help individuals with autism, families, and others in our communities understand the landscape of autism in the Commonwealth.

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