PA Residents: Information from Pennsylvania Health Law Project

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03/25/04 19:27:23

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Alert: Information from Pennsylvania Health Law Project

 

Dear AutismLink Subscribers:

 

For those of you who are new to wraparound services and/or the

autism world, the information below refers to an event that occurred

approximately two years ago. At that time, the Governor and the Department

of Public Welfare in Pennsylvania attempted to take wraparound services

from our children by changing the medical necessity criteria so that

our children would be excluded from receiving wraparound services.

 

At that time, they also looked into the possibility of putting an income

cap of $100,000 on wraparound. That would mean that any family earning

over $100,000 annually would be excluded from receiving services.

 

Thanks to work of so many people across the state, and particularly PACAS

(The Pennsylvania Action Coalition for Autism Services), State

Representative

Dennis M. O'Brien (Philadelphia) and State Senator Jane Clare Orie

(Allegheny Co.),

and David Gates, Esq. of the Pennsylvania Health Law Project, this action

was averted.

 

Language was drafted that specifically stopped the DPW from changing the

wraparound

system. The reason for this was mostly because the DPW did not conduct an

impact

study. In other words, it did not have any idea how many families would be

affected by the cap/wrap issue. It was at this point that the DPW began to

conduct an impact study by requiring parents of children with disabilities

to

supply income information.

 

THe results of the impact study have been published and are listed below. A

PDF

file will be sent soon to show the full report. PACAS will certainly

monitor

the DPW in the event that they continue their quest to implement an income

cap or change in medical necessity criteria:

___________________

 

DPW Issues Loophole Report

Pennsylvania Health Law Project

 

About 2 years ago, DPW attempted to place an income cap on Medical

Assistance eligibility for children with disabilities. Thanks to the

efforts of hundreds of families across the Commonwealth and the firm support

of several State Legislators, the income cap was defeated. However,

language was added to the past 2 State Budgets requiring DPW to “SUBMIT TO

THE PUBLIC HEALTH AND WELFARE COMMITTEE OF THE SENATE AND THE HEALTH AND

HUMAN SERVICES COMMITTEE OF THE HOUSE OF REPRESENTATIVES AN ANNUAL REPORT

INCLUDING, BUT NOT LIMITED TO, THE FOLLOWING DATA: FAMILY SIZE,

HOUSEHOLDINCOME, COUNTY OF RESIDENCE, LENGTH OF RESIDENCE IN PENNSYLVANIA,

THIRD-PARTY INSURANCE, DIAGNOSIS THE TYPE AND COST OF SERVICES PAID FOR BY

THE MEDICAL ASSISTANCE ON BEHALF OF EACH ELIGIBLE AND ENROLLED CHILD…”

 

DPW has drafted that annual report. Some of the findings from this report

are:

 

There are 30,000 children with disabilities with family incomes above the

poverty level (“PH95” a.k.a. “loophole” category) who are enrolled in

Medical Assistance.

 

The county with the largest number enrolled was Allegheny followed by

Montgomery, Bucks, Delaware, York and Lancaster. Philadelphia came in 7th

in number of children enrolled under the loophole.

 

Average monthly income was $5000.

 

90% of the families had annual incomes below $100,000.

 

Over 80% of the children had other primary insurance.

 

88% of the families had lived in PA for over 5 years.

 

$140 million was spent during a 6 month period on Medical Assistance

services for loophole children, $63 million of which was state money, the

rest federal.

 

The highest amounts of Medical Assistance funds were spent on children in

families with annual incomes below $100,000.

 

The most common diagnoses were ADHD and autism spectrum.

 

The most commonly funded service was behavioral health rehabilitation

services (wraparound).

 

 

David Gates

PA Health Law Project

101 S. 2nd St., Suite 5

Harrisburg, PA 17101

 

 

 

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