PHILADELPHIA – Beginning May 1, as many as 68,000 low-income people in Philadelphia may find themselves unable to get medical care at Temple University Hospital. Temple’s health system will stop accepting the Keystone Mercy health plan for recipients of Pennsylvania Medicaid, often called “Medical Assistance.” Medicaid recipients with Keystone Mercy insurance cards no longer will have access to Temple’s health system except in medical emergencies.
Community Legal Services wants the Temple health system, Keystone Mercy, and the Department of Public Welfare to enter into a new agreement so low-income patients in North Philadelphia and surrounding areas have reasonable access to health care. “This is not about taking sides in a contract negotiation. This is about assuring that 68,000 elderly, disabled and sick Philadelphians have access to health care. Residents of North Philadelphia already live in a medically underserved area. Withdrawing Temple and all its physicians from the list of available doctors leaves people in a very dangerous position.” according to Richard Weishaupt, a Senior Attorney at CLS.
The Pennsylvania Department of Public Welfare will require Keystone Mercy to send notices in late March, asking enrollees to switch to non-Temple primary care doctors, or to switch Medicaid health plans. If people do not respond to the notices very quickly, they will be assigned to new primary care physicians and be forced to find new specialists far from their community. The problem, according to Pam Walz, co-Director of the CLS Aging and Disabilities Justice Project, is “when you switch coverage or health care providers of this population by just sending them a notice, many of them don't read or understand the notice. Then they go to the old provider, where they get billed or denied care.” The result, says Walz, is “a big mess.”
DPW claims that Medicaid recipients in North Philadelphia will still have access to health care. Keystone Mercy has told DPW that it has enough non-Temple physicians to serve everyone affected by the switch. According to DPW, if all enrollees switched to other Medicaid managed care organizations, those providers have adequate capacity to absorb the new enrollees. Neither DPW nor Keystone Mercy has provided data to confirm these claims, according to Weishaupt.
CLS’ Kristen Dama is unconvinced that there are enough non-Temple physicians to serve affected Medicaid recipients. “Most primary care sources in Temple’s immediate area are City or Federally Qualified Health Centers that are overwhelmed with patients. Specialists – particularly in orthopedics, neurology and obstetrics – are already in short supply. Many of the specialists listed by the other providers are not accepting new patients, or they have extremely long wait times for new appointments.”
The impact on prenatal care and deliveries is particularly troubling. In 2006/2007, Temple handled more than 10% of all Philadelphia births. The vast majority of these births were covered by Medicaid. While existing patients may continue to receive prenatal care at Temple after the split if the treating physician agrees, newly-pregnant women will have to seek prenatal care elsewhere.
While Philadelphia has other hospitals, pregnant women covered by Medicaid living in North Philadelphia would have to travel prohibitive distances to receive care, despite the financial limitations that made them eligible for Medicaid in the first place. CLS’ Dama says, “For women facing a difficult pregnancy or simply a late-term pregnancy, an additional trip of up to an hour on SEPTA can be grueling and medically dangerous.”
“This should not be a matter of dollars and cents, this is a matter of life and death for people in North Philadelphia,” said Weishaupt.
-----------------------------------------------------------------------------
To discuss this situation further, please contact Richard Weishaupt or Kristen Dama. Richard can be reached via telephone at (215) 981-3773, or via e-mail at rweishaupt@clsphila.org. Kristen can be reached via telephone at (215) 981-3782, or via e-mail at kdama@clsphila.org.
Community Legal Services, Inc., was established by the Philadelphia Bar Association in 1966. Since then, CLS has served more than one million low-income Philadelphia residents through individual cases, class actions, and advocating for improved regulations and laws that affect low-income Philadelphians. For more information, contact 215-981-3743 or visit www.clsphila.org.