Transcript Degrading the Safety Net - University of Pittsburgh

Degrading the Safety Net
The following represents a summary
of the negative impacts to
the PA Safety Net as they affect
the Person in Recovery in the
Pennsylvania Public MH Services and Family
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10/1/11 New Limits:
•Imposed on MA Enrollees for Dental Services
originally limiting participants to ONE Dental
examination and one cleaning per 12 months
and elimination of all periodontal and
endodontic services.
•In addition an individual is eligible for ONE
set of dentures in a lifetime.
•Later, limit for Teeth Cleaning and
Examinations was changed back to two
per twelve months.
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8/11 Eligibility:
•All backlogged re-assessment of eligibility
for MA and GA Eligibles were sent letters
requiring submission of data for
reassessment—nearly 235,000 cases in the
Commonwealth.
• This resulted in termination of MA
eligibility for over 71,000 children and
65,000 adults.
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•Many terminations reported to have
occurred due to Office of Income
Maintenance Staff in County Board of
Assistance Offices being overwhelmed with
paperwork.
•No follow up with terminated children was
planned nor carried out.
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1/12/12 “Six Prescription Limit”:
•Imposed by PA DPW Office of Medical
Assistance programs for all MA Enrolled in
the Fee for Service MA.
• Most Managed Care insurers followed
suit.
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7/12 PA 2012/13 Budget Passed:
• With a 10% cut to MH Community
Services, Drug and Alcohol Programs,
Homeless Assistance, Human Service
Development Fund, Behavioral Health
Service Initiative, and Children and Youth
Service funding, totaling $84 Million for
the year.
• It has NEVER been restored.
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7/12 PA 2012/13 Budget Passed:
•Including an 20 County “Human Services
Block Grant Pilot Program” allowing local
authorities to reallocate MH Community
Service Funding to other funding lines
based on choice of the County and
approval, without guidelines for how this
approval will be granted, from the
Commonwealth.
• Since MH Community Funds account for
over 75% of this total, it is likely that this
reapportionment will negatively impact MH
Service Funds.
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7/12 General Assistance Benefits:
• To PA Residents who are unable to work
were cut originally to be effective on 8-1-12.
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•The Commonwealth’s refusal to participate
in the Expansion of Medical Assistance, as
approved in the Affordable Care Act of 2010,
thus declining the offer of 100% Federal
Funding for expanded coverage for services.
•This federal offer has been accepted and
implemented in most States surrounding
Pennsylvania!!
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Healthy PA Plan:
Submitted to the Federal Government in
February, 2014 with measures requiring a
work search and punitive measures in place
for those who do not/cannot comply.
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2010-2014 Overall Revenues:
The Commonwealth continues to be
negatively impacted by corporate and
individual tax reductions implemented since
2010.
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9 Considerations
1. Medicaid Expansion is in the best interest of the
individuals that we serve.
2. We strongly recommend that individuals with any
behavioral health challenge as self identified or as
determined by a physician or other health care
practitioner be provided the opportunity to be enrolled in
the behavioral health HealthChoices program.
3. Years ago in Philadelphia, it was the private insurer’s
poor performance as highlighted in the Philadelphia
Inquirer, that led to establishing the public sector
(HealthChoices) option through the county.
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4. Creating different benefit packages and shepherding
individuals to a commercial plan will create disruption for
individuals with behavioral health needs as they may
need to navigate between low and high risk plans,
different provider systems as well as different services
options.
5. Individuals enrolled in the low risk benefit plan, or private
option plans, will be ineligible for retroactive billing,
ineligible for cost-effective alternative Medicaid services.
6. Those individuals will seek supports from existing
(capped and limited) county mental health and substance
use base funding—the SAME funding which was reduced
by 10% in 2012 by the State!! Retroactive coverage
SHOULD be reinstituted.
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7. Maintaining benefits currently offered for children and
pregnant women by ensuring that such benefits are
incorporated in the two-benefit package structure is
essential.
8. Care for other complex health conditions, it is
important that the scope and/or duration of benefits do
not unduly impede access to medically necessary
care.
9. Failing to meet Premium and Work Search
requirements should NOT result in termination of
benefits to the recipient nor her/his family.
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STOP
THE
“Tears in the Safety Net”
NOW!!!
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Share your story of loss with the
“Tears in the Safety Net” Project
and be heard.
If you are willing to share your story, you may do so in one
of three ways:
•Email to [email protected].
or
•Mail it in a letter to: Tears in the Safety Net, P.O. Box 103,
Conestoga, PA 17516-0103
or
•Call (855) 278-0031 to share it directly or via Voice Mail.
•NOTE: This is NOT a HELP LINE.
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