[tab id=”one”]Introduction[/tab][tab id=”two”]Article 1[/tab][tab id=”three”]Article 2[/tab][tab id=”four”]Source[/tab]
by Patricia Livermore, May 23, 2014
Today’s two articles target the Medical Assistance for Workers with Disabilities (MAWD) through the Pennsylvania Department of Public Welfare’s ability to potentially provide full medical coverage, including psychiatric care, for young adults; and a new PA Supreme Court ruling that covers autism treatment at both mental health/behavioral clinics and in-school treatment in accordance with PA Autism Insurance Act 62.
Helping Young Adults Access Mental Health Treatment, PHLP’s Health Law News
Late last year, PHLP received a call from “Mary”, a 25-year-old woman living in Allegheny County. Mary was on her father’s health insurance as a dependent, but as her 26th birthday approached, she knew she would lose that coverage, and her part-time job would not provide health insurance.
Mary has bipolar disorder and relies on her insurance to cover psychologist and psychiatrist visits, as well as several medications to manage her condition. She was concerned that a lapse in coverage would impact her treatment. PHLP spoke with Mary about her options, and advised her about Medical Assistance for Workers with Disabilities (MAWD), which lets Pennsylvanians with disabilities work and keep their full medical coverage.
A few months later, Mary called back – she had been denied MAWD. PHLP stepped in to appeal the denial. PHLP worked with Mary to gather the necessary documentation of her diagnoses, her treatment plan, and the medications she needed. With that additional information, state officials approved Mary’s application and activated her coverage. She has access to the health care she needs to continue working and manage her bipolar disorder.
PHLP Defends the Rights of Children with Autism in Pennsylvania’s Supreme Court, PHLP’s Health Law News
What rights do parents of children with autism have to challenge insurance companies? Earlier this month, PHLP argued in the Pennsylvania Supreme Court (Burke v. Independence Blue Cross) that families should have a court decide their appeals. The outcome could affect 10,000 families seeking in-school autism treatment.
John and Suzanne Burke knew how important it was for their seven-year-old son to receive applied behavioral analysis therapy, which medical professionals say is vital to their son’s social acclimation and development. So when Independence Blue Cross (IBC) refused to pay for Tony’s therapy, the Burkes called PHLP.
The Burkes were represented by Senior PHLP Attorney David Gates. At issue was a Pennsylvania law called Act 62, the Autism Insurance Law, which requires private health insurers to pay for diagnoses and treatment of autism for children and adolescents. IBC argued that since the therapist worked at school, the law didn’t apply to them. A state trial court decided Independence Blue Cross, like all private insurers, was legally required to pay for needed services and treatment for autism, including those provided in school. To read the trial court decision, click here.
Note: PHLP assists families and individuals free of charge and did not receive attorney’s fees for this case. To learn more about how to support PHLP’s work, click here.