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Degrading the Safety Net

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. 10/1/11 New Limits:

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Degrading the Safety Net

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  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 7/12PA 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.

  7. 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. • 7

  8. 7/12General Assistance Benefits: • To PA Residents who are unable to work were cut originally to be effective on 8-1-12.

  9. 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!!

  10. 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.

  11. 2010-2014Overall Revenues: • The Commonwealth continues to be negatively impacted by corporate and individual tax reductions implemented since 2010.

  12. 9 Considerations • Medicaid Expansion is in the best interest of the individuals that we serve. • 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. • 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.

  13. 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. 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. 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.

  14. Maintaining benefits currently offered for children and pregnant women by ensuring that such benefits are incorporated in the two-benefit package structure is essential. • 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. • Failing to meet Premium and Work Search requirements should NOT result in termination of benefits to the recipient nor her/his family.

  15. STOP THE “Tears in the Safety Net” NOW!!!

  16. Shareyour storyofloss 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 PASafetyNet@PMHCC.ORG. or • Mail it in a letter to: Tears in the Safety Net, P.O. Box 103, Conestoga, PA  17516-0103 or • Call (855) 278-0031to share it directly or via Voice Mail. • NOTE: This is NOT a HELP LINE.

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