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News for Immediate Release Oct. 5, 2012

Department of Public Welfare Releases Statement on Co-payment Initiative Harrisburg – Department of Public Welfare Secretary Gary D. Alexander today released a statement about the department’s co-payment initiative for families of eligible children with mental and physical disabilities. In his statement, Alexander said:

“The department has always preferred the option of applying a premium to this program and will be working with stakeholders who have come to us in support of a premium as opposed to the co-payment. Therefore, we have decided to delay the co-payment initiative, and families will not owe a co-payment for any services until further notice.

“Stakeholders have clearly indicated to the department an understanding of the need for families to contribute to this program. With the delay, there is an opportunity to work with stakeholders to continue to pursue the premium from the federal Centers for Medicare and Medicaid Services. We look forward to working with them in achieving this shared goal. “Once a decision is reached, we will immediately inform any affected families.”

Pennsylvanians who suspect welfare fraud should call 1-800-932-0582. Media contact: Carey Miller or Anne Bale, 717-425-7606

PA Bulletin 5303 – Amendment to the Commonwealth’s Medicaid State Plan for Children with Disabilities

It is the Commonwealth’s plan to apply copayments to services provided to certain MA eligible children with disabilities.  Click here to see PA Bulletin 5303.

Pennsylvania  Department of Public Welfare – “Loophole” Copayment FAQs

MA Co-payment Notice to Families

DPW has started to mail out notices to families of children with disabilities who may be subject to the copays.  Because both the obligation to pay copays and the cap on the amount of copays a family will have to pay depends on the amount of parental income as listed in DPW’s records, it is essential families check the notice they get to be sure that the income listed is correct.  We know of several families whose letters listed incomes well above their actual incomes.

If the income listed in your letter is incorrect, you should:

  • First – file an appeal.  Attached to the notice is information about filing an appeal.  Read it carefully and follow the instructions.  Make a copy of the notice and your appeal and, if possible, mail it certified mail so you have a receipt to prove when it was mailed.
  • Second – call your child’s caseworker at the County Assistance Office (not your child’s case manager or supports coordinator).  If you can get through, tell them you have filed an appeal and will be sending them copies of paystubs or other documents verifying your current income.
  • Third – make copies of paystubs or other documents verifying your current income and mail them (certified mail if possible) to your County Assistance Office.  Make sure to put your child*s name and case number on each document (in case these documents get separated).  Include a copy of the notice you received.

Thanks,  David Gates, Esq. PA Health Law Project

Families Subject to Copayments

The Pennsylvania Health Law Project (HLP) has informed PCPA and families that the Department of Public Welfare (DPW) will send letters September 17 to families whose children will be subject to the proposed PH 95 (‘MA Loophole’) co-pays. These letters will be individualized, setting out the family’s annual gross income according to DPW records, and information about the co-pays. Because the imposition of co-pays and the cap on aggregate monthly co-pays are based on family income, it is important that families review the income information on the letter carefully to determine if it is accurate.

If the information on the letter regarding family income is not accurate, families should call the child’s caseworker at the County Assistance Office and mail a copy of paystubs or other verification of income. If families cannot reach the caseworker or cannot get income information corrected through the caseworker, an appeal can be filed.

  • Families whose children are on the state Health Insurance Premium Payment program known (HIPP) and those who use a yellow Access card to obtain services (fee-for-service) will be subject to co-pays beginning November 1 for physical health and behavioral health care unless delayed by DPW.
  • Families whose children are enrolled in the Medical Assistance HealthChoices physical and behavioral health managed care programs will not be subject to the co-pays unless and until their physical and behavioral health managed care organizations make the decision to impose the co-pays and provide them and providers with prior notice about the change.

Many details impacting providers, families, and managed care organizations related to the co-pays have yet to be determined. PCPA is continuing its efforts with DPW, legislators, and other stakeholders to promote a reasonable, efficient, and minimally disruptive implementation of the state’s fair share Medicaid co-payment initiative.

IT IS URGENT FOR EVERYONE TO ACT!  Services and benefits are being cut!  In the past, the ASD Community came together to avoid loss of services and were successful.  We have been quiet for way to long!  NOW we need EVERYONE to speak up! Let your voice be heard!

The DPW Notice invites comments before a “Final Notice” is issued.  If you have concerns about the amount of the copayments, the method of calculating and collecting the copayments, or anything else, NOW is the  time to speak up.

What you can do ~ You can submit commentsto DPW.  Letters with comments must be received by September 10, 2012 via hardcopy.

Comments should be mailed to:
Department of Public Welfare
Office of Medical Assistance Programs
C/O Deputy Secretary’s Office
Attn:  Regulations Coordinator
Room 515, Health & Welfare Bldg
Harrisburg, PA  17120
Please send a copy of your letter to your State Senator and State Representative! To find your legislator, please use the above links.

Click here to: TAKE ACTION NOW!  (text document format)

Other Issues:

Pennsylvania Autism Community Action Alert State Budget Analysis by Policy Information Exchange – July 5, 2012 Supreme Court Upholds Affordable Care Act – June 28, 2012 Autism Diagnosis Change: What Does It Mean? Joint Statement of Autism Society of America & Autistic Self Advoacay Network on DSM-V 5 year federal funding for students with intellectual disabilities not guaranteed Pennsylvania Autism Community Action Alert