Lawsuit: Pennsylvania Unlawfully Delaying Health Coverage for Low-Income Women

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Lawsuit: Pennsylvania Unlawfully Delaying Health Coverage for Low-Income Women

Nina Liss-Schultz

Two women’s health groups along with a state resident on Tuesday filed a class action lawsuit against the Pennsylvania Department of Human Services, alleging that the department systematically delayed enrolling 85,000 low-income women for comprehensive health coverage.

Two women’s health groups along with a state resident on Tuesday filed a class action lawsuit against the Pennsylvania Department of Human Services (DHS), alleging that the department systematically delayed enrolling low-income women for comprehensive health coverage.

The case, Planned Parenthood Southeastern Pennsylvania v. Mackereth, alleges that 85,000 women are affected by the department’s delay.

Those thousands of women currently receive limited health coverage through SelectPlan, a public program that covers only family planning care for low-income women, most of whom did not previously qualify for Medicaid. Pennsylvania administers 14 other limited Medicaid programs for low-income people who, like the women in SelectPlan, didn’t qualify for full coverage. Those programs include one called General Assistance, which covers very low-income individuals who have short-term disabilities, are survivors of domestic violence, or are in treatment programs for drug and alcohol abuse.

Last year the state expanded the eligibility criteria for Medicaid, allowing anyone with an income up to 138 percent of the federal poverty level to qualify starting January 1, 2015. Thousands of the Pennsylvanians receiving limited Medicaid coverage before the new year now qualify for comprehensive coverage through the expansion.

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Due to the expanded eligibility criteria, the DHS automatically transferred people receiving limited coverage, except the women in SelectPlan, into full coverage Medicaid. But instead of the automatic and timely transfer into comprehensive coverage that the other groups received, the DHS decided to have caseworkers manually review each woman’s case file over a period of several months.

The beneficiaries of SelectPlan were the only group not automatically given full coverage by the DHS. SelectPlan was originally set to expire completely at the end of 2014, but local advocates were able to get the expiration of the program pushed back until the end of June 2015.

Still, the delay could leave thousands of women in a health-care gap, according to the suit. The women in SelectPlan who qualify for Medicaid will be without comprehensive coverage for the several months during which their applications are being reviewed. And the women whose incomes are still too high to qualify them for Medicaid might be out of coverage altogether after February 15, the last day of open enrollment for private insurance.

“DHS never told these women they would qualify for full health coverage starting January 1, and they never mentioned the February 15 open enrollment deadline,” Women’s Law Project staff attorney Susan Frietsche, who is helping represent the plaintiffs in the suit, said in a statement. “Instead, DHS told them it was evaluating what coverage to offer them and if they want timelier help, they should call the Helpline or fill out another application.”

About 70,000 women currently on SelectPlan are now eligible for coverage under Medicaid, according to the suit. The remaining 15,000 would be eligible for private health insurance.

The suit, filed by Planned Parenthood of Southeastern Pennsylvania and New Voices Pittsburgh, a reproductive justice organization, alleges that women on SelectPlan are being unlawfully delayed from full coverage by the DHS. Under federal law, states are required to provide Medicaid “with reasonable promptness to all eligible individuals” and to “timely screen those individuals not eligible for full Medicaid and timely refer them to the Marketplace for subsidized health insurance through the Affordable Care Act without requiring a separate application,” according to the suit.

“This is discrimination against low-income women and it has very real consequences for the Black women and women of color in Pennsylvania,” said La’Tasha D. Mayes, founder and executive director of New Voices Pittsburgh, in a statement. “As states surrounding Pennsylvania expanded their Medicaid program over the last year, these women were denied full Medicaid simply because of their zip code. Now that a new plan is finally in place, they are still being denied coverage, this time because they are women. This is unacceptable.”