Monday, March 19, 2012

Changes in Health Benefits for Low-income Community

Pennsylvania Health Law Project Website

On February 7, PA Governor Corbett proposed a state-wide budget that would eliminate General Assistance cash benefits entirely, and significantly reduce GA-related Medical Assistance for residents of the Commonwealth.

While a lot can change as the proposed budget moves through the General Assembly on its way to final passage by June 30, it is important to focus on some of the other changes to health care benefits for the low-income community that are taking place across the region.

MATP Co-pays

On May 1, the Department of Public Welfare (DPW) is planning to start a $2 co-pay ($4 per round trip) for people using the Medical Assistance Transportation Program (MATP) for trips to the doctor’s office and other health-related appointments.

According to DPW, some people will be exempt from the co-pays. These include the following:

· Consumers under age 18
· Pregnant women (through their 60-day post-partum period)
· Consumers in hospice
· Consumers in personal care homes without transportation for residents
· Women on MA through the Breast & Cervical Cancer Prevention Program

All other MATP consumers who use paratransit or taxi services will be responsible for the co-pay, while people who escort the consumer to the medical appointment are not. It is unclear, at this point, how DPW will enforce the co-pay for people who do not have the funds.

Prescription Drug Limit

Starting January 3, adults on Medicaid who use the ACCESS card to get their prescriptions had their coverage limited to six prescriptions per month. Beginning March 1, Medicaid recipients in northwestern PA with United Healthcare Community Plan as their managed care administrator will also be limited to six prescriptions each month.

If you have Medicaid and Medicare, Medicare Part D covers most of your drugs. This change applies to prescriptions that are filled with a PA ACCESS card or by United Healthcare.

Women who are pregnant, and adults who live in a nursing home are excluded from the drug limit, along with people in Intermediate Care Facilities for the Mentally Retarded (ICF/MR).

Many drugs prescribed by your doctor for serious conditions or illnesses are covered by an “automatic exception,” meaning you can get the drugs even after the six prescriptions are filled each month. See the box below for more advice on how to deal with this limit.

PA Act 22 of 2011

Signed into law by Gov. Corbett on June 30, 2011, Act 22 gives DPW the authority to make significant changes to Medical Assistance benefits and provider reimbursement rates without the traditional oversight by the PA General Assembly or the Independent Regulatory Review Commission.

What this means for Medicaid consumers across the state is that changes in their benefits can occur much more quickly than in the past. The decision by DPW to start co-pays for MATP on May 1 is an example of how DPW intends to use Act 22 to make benefit changes.

If you get an official notice from DPW about a benefit you receive such as Medical Assistance or General Assistance, take the time to read the notice to see how it affects you and/or your family members.

Also, please visit the Pennsylvania Health Law Project website at for current information about changes to benefits, and your rights and responsibilities under the law.