Tens of millions of Americans go without needed dental care because they cannot find a dental provider, can’t afford care, lack dental insurance or are unaware of the importance of dental care. By the time they reach kindergarten, more than 40 percent of American children experience tooth decay. Painful dental problems affect children’s overall health and ability to focus in the classroom. Increasing numbers of adults are seeking care at emergency rooms for dental problems because they have nowhere else to go, creating a large unnecessary expense to the healthcare system. In a recent study of PHAN’s newly insured individuals, nearly half cited cost and 36% cited transportation as barriers to dental care. PHAN is advocating to advance practices that increase access to oral health services, education, and prevention – especially for our most vulnerable Pennsylvanians. PHAN believes we need to strengthen adult dental health benefits in our current Medicaid package.
Affordability & Rates
Health care costs are continuing to rise. Without adequate protections in place for consumers costs can become barriers to care. In addition to rising premiums, consumers also face out-of-pocket costs including deductibles, co-pays and co-insurance.
PHAN advocates to protect consumers and strengthen polices at the state and federal level that relate to affordability and how rates are set in Pennsylvania. We believe that costs should not create barriers to care, that consumers should easily be able to understand which costs they are responsible for paying, and that there is transparency and consumer input in our rate setting process.
Medicaid Managed Long Term Services and Supports (MLTSS)
Community Health Choices
Community Health Choices is a new program for Pennsylvanians that will coordinate physical health care and long-term services and supports through Medicaid. Older individuals, persons with a physical disability, and persons who are eligible for both Medicaid and Medicare (dual eligible) are eligible for Community Health Choices.
Under Community Health Choices, managed care organizations will be responsible for coordinating the physical and support services of each consumer, ideally in the home or community setting. This program seeks to fix our current system, where information about services is often confusing, navigating from primary care to long-term services can be difficult, and insurance options for long-term care are limited and expensive.
When managed long-term services and supports (MLTSS) programs were enacted in other states, the outcomes were positive:
- Reduced nursing facility use
- Reduced hospital use
- Increased use of physician services
- Increased quality
Pennsylvania will roll out the Community Health Choices program in three phases:
- Phase I = Southwestern PA (beginning January 2018)
- Phase II = Southeastern PA (beginning July 2018)
- Phase III = Northeastern PA, Northwestern PA, Lehigh-Capital region (beginning January 2019)
PHAN will be closely monitoring the implementation of Community Health Choices and reporting difficulties as they arise. Please contact us if you or someone you care about would like to share a story about Community Health Choices.
If your organization would like to learn more about Community Health Choices, please contact Erin Ninehouser at email@example.com or 412-863-1047.
We are committed to making sure Community Health Choices works for you!
Surprise Medical Bills
If you go to an “in-network” hospital clinic or have a medical emergency, you have every reason to assume your care will be covered. But, often this is not the case. Every year, Pennsylvanians receive out of network services without their knowledge — and are stuck with the bill. They are left to fend for themselves in negotiations with their insurance plans when their doctor and their plan can’t agree on a fair price for the services.
“Surprise” medical bills can place a significant financial strain on families. Almost two-thirds of personal bankruptcies are related to medical debt. These bills hurt families, which is just not fair.
Pennsylvania can change this, but we need your help!!!
- If this has happened to you, we need you to share your story! Please email firstname.lastname@example.org or call Melissa Knorr, PHAN’s Consumer Engagement Manager, at (412) 254-3685.
- File a complaint! If you’re gotten a “surprise” bill for out-of-network costs, contact the Insurance Department’s Bureau of Consumer Services. File a complaint online or by calling 1-877-881-6388.
- Join PHAN’s Consumer Protections Committee. We’re working to collect data in order to get a better understanding of how widespread this problem is. We’re raising awareness about the need to report these incidents, and also looking at consumer protection examples from other states. PHAN is committed to ensuring that consumers who have done their homework, and through no fault of their own are hit with “surprise” bills, aren’t stuck with the bill.