PHLP eNews: June 2015

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PHLP eNews

June 2015

Preserving Access to Life-Saving Treatment for Drug & Alcohol Addiction

Untreated addiction to controlled substances often leads to deadly consequences. That’s why PHLP quickly acted to secure care for “Rosemary,” a woman seeking inpatient treatment for her drug and alcohol addiction.

Despite being insured through Medicaid, Rosemary faced significant (and unnecessary) challenges securing treatment after she moved from one Pennsylvania County to another. Despite repeated attempts, Rosemary could not get her old County Assistance Office (CAO) to close her Medicaid file so a new one could be opened in her new county and she could be assigned a new behavioral health insurer and continue drug and alcohol treatment.

To make sure Rosemary’s treatment did not stop, PHLP contacted an addiction treatment provider in Rosemary’s new county to assess and admit Rosemary while we continued to work on the insurance problem. Thankfully, a willing provider immediately stepped up. Rosemary was assessed for inpatient treatment, determined eligible, and quickly admitted. Meanwhile, PHLP’s persistent intervention with CAO officials got Rosemary’s Medicaid closed in the county she left and opened in the county where she now resides.

A week later, PHLP received a touching and emotional message from Rosemary thanking PHLP for all our help and letting us know she was still in treatment.

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

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Analyzing PA's New Proposal for Long-Term Care Services and Supports

Pennsylvania has proposed placing the responsibility for providing long-term services and supports (LTSS) to seniors and people with disabilities under managed care organizations (MCOs). This proposal offers both significant risk and considerable opportunity. That's why more than 200 people at host sites throughout the state attended Senior PHLP Attorney David Gates' webinar about the ABC's of Managed Care. In the months ahead we'll work to ensure that any new managed care arrangement Pennsylvania advances is person-centered, promotes as much choice and independence as possible, and allows beneficiaries to receive care in their homes and communities.

Challenging Lack of Habilitative Benefits Available in Pennsylvania's Marketplace Plans

Earlier this month, PHLP urged the Pennsylvania Insurance Department to be more active in demanding that Marketplace health insurance plans meet the habilitative needs of Pennsylvanians with disabilities or significant health issues.

We are especially concerned about habilitative benefits because they enable persons with disabilities to attain and maintain maximum independence, full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life. Without these services and supports, persons with disabilities may not be able to work, go to school, worship or participate in cultural, sports or leisure activities.

PHLP's comments highlighted numerical limits in existing plans (e.g., 10 physical therapy sessions). Such arbitrary habilitation limits run counter to the goal that coverage should help individuals with disabilities achieve maximum functional capacity relative to their age. To read our comments and recommendation, click here.

Welcome, Summer Interns!

This summer PHLP has two law students assisting our Philadelphia staff and receiving valuable training.

Hyesu (Grace) Kim currently attends the University of Pennsylvania Law School where she serves on the board of the Asian Pacific American Law Student Association (APALSA) and as an executive editor for the East Asia Law Review. Her interests include health disparities of vulnerable and minority populations, bioethics, and federal-state interaction in the implementation of health laws. She worked with the Department of Health Outcomes and Policy as a research assistant, where she focused on minority health disparities and drug and alcohol use within young adult populations.

Grace is most excited about “working with the knowledgeable and dedicated staff at PHLP.” She says that “already their mentorship has taught [her] the meaning of client-centeredness.”

Ashwin Iyengar is entering his second year at Fordham Law School in New York. He is concurrently pursuing a Masters degree in Public Administration and a Clinical Masters degree in Social Work at the University of Pennsylvania. He hopes to work as an attorney focusing on health and disability rights. Ashwin is eager to follow all the “interesting things happening right now with healthcare in Pennsylvania, particularly now that we have a Governor fully committed to Medicaid expansion.”

After just two weeks at PHLP Ashwin succinctly captured PHLP’s mission: “Every day, we are giving clients the tools they need to access the resources they are legally entitled to, and I think that is empowering.”

For more information on PHLP internships, visit our website.

PHLP in the News

Study: Local Hospitals Overcharging Uninsured Patients, Lehigh Valley News, June 9, 2015

What We're Reading

Managed Long-Term Services and Supports Discussion Document, Commonwealth of Pennsylvania, June 2015

The Pennsylvania Department of Human Services (DHS) released a discussion document which sets out the framework for pursuing MLTSS in Pennsylvania. The document describes the target populations, goals and objectives, various program components, and a timeframe for implementation. With the release of these materials, the state is officially beginning the stakeholder input process to inform its development of a detailed proposal for how MLTSS will work in Pennsylvania. Statewide public hearings and input sessions began June 10th in Erie and end June 26th in Philadelphia.

California's Plan to Curb America's Overmedication of Foster Kids, Governing Magazine, June 16, 2015

Earlier this month, the California State Senate unanimously passed four bills that would strengthen the state's monitoring system for foster kids' prescriptions, require stronger evidence documenting the need for medications, add more medical expertise in the area of oversight, and force group homes that overprescribe to develop plans to change their practices. This could be a national model for states like Pennsylvania to curb the prescription of antipsychotics to children in foster care.

This month Pennsylvania's Department of Human Services (DHS), in partnership with PolicyLab at the Children's Hospital of Philadelphia (CHOP), released new data on psychotropic medication use among Pennsylvania children in foster care enrolled in Medicaid. It found the use of psychotropic medications was nearly 3 times higher among youth in foster care than youth in Medicaid overall (prescribed at 43% vs 16%). "The research confirms our concerns and shows an unacceptable use of these medications for children in foster care," said DHS Secretary Ted Dallas.

King v. Burwell Won't Destroy Obamacare, by Ezra Klein in Vox, June 19, 2015

Commentator Ezra Klein provides a "big picture" look at the true impact of the plaintiffs winning King v. Burwell which goes beyond the specific numbers of people impacted or the dollar amounts involved. While the results would be pretty horrible, they wouldn't result in the law being repealed any more than the Medicaid expansion ruling did.

Financial Analysis 2014 Volume One: General Acute Care Hospitals, Pennsylvania Health Care Cost Containment Council (PHC4), May 2015

Data released in May by PHC4's annual financial analysis paint a troubling picture of acute care hospitals' financial health, as 35 percent of the state's 169 facilities landed in negative territory. In a statement, Joe Martin, Executive Director of PHC4, pointed to reduced reimbursement payments for government programs such as Medicare and Medicaid as one reason for the decline, while the total number of days patients spent in the hospital decreased for the sixth consecutive year.

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