Our History

In the early 1980s, several attorneys from the Delaware County Legal Assistance Association (DCLAA) and the Bucks County Legal Aid Society (BCLAS)—Ann Torregrossa, Michael Campbell, Dana Breslin, David Gates, and Nancy Schuster—began collaborating on cases to assure that Medicaid services were both accessible and of high quality for Pennsylvania’s poor.      

One of PHLP’s first cases was Simpson v. Schweiker.  In 1981, if you were low-income, pregnant, and living in Pennsylvania the medical standard for prenatal care simply did not apply to you.  Specifically, Pennsylvania’s Medicaid program refused to pay for ultrasounds, substituting x-rays as a “compensable alternative” for monitoring the progress of a pregnancy.  PHLP sued the state on behalf of clients needing up-to-date, quality health care.  The settlement agreement made more than 800 modern medical procedures available to Medicaid recipients.  This was the launching point of PHLP; to tear down the barriers to healthcare that stand in the way of those who need it most. 

During PHLP’s early years, Pennsylvania became a national testing ground for prepaid managed care for the poor.  In 1986, the federal government allowed Pennsylvania to contract with the private sector to create HealthPASS, a managed care program available to Medicaid recipients in south and west Philadelphia.  The assigned contractor, Healthcare Management Alternatives (HMA), received a fixed, prepaid, monthly payment for approximately 76,000 Medicaid recipients.  PHLP was not supportive of the new arrangement but worked to ensure clients’ interests were represented in program design and throughout implementation.  

PHLP also became legal counsel to several client groups, most notably the Consumer Subcommittee of Pennsylvania’s Medical Assistance Advisory Committee (MAAC), headed by Louise Brookins.  As legal counsel to the Consumer Subcommittee, PHLP briefed consumers on health issues, providing technical assistance, and identifying and interpreting legal issues.  The Subcommittee (still in existence) is one of the most active Medicaid consumer advisory committees in the country.   

In 1991, alarmed by Pennsylvania’s failure to ensure that low-income children received federally mandated health care, PHLP joined a host of public interest law offices in Scott v. Snider, a federal lawsuit.  The lawsuit settled in the spring of 1995.  The settlement tripled the number of children enrolled in the Medicaid program from 300,000 to 900,000, and it required the state to increase to the proportion of children in the Medicaid program who actually receive care to 80%.  PHLP also represented children with special health care needs who were denied coverage for specialized services and equipment in numerous fair hearings before state hearing examiners.

PHLP also aided state lawmakers in the creation of Pennsylvania’s Children’s Health Insurance Program (CHIP).  In 1991, Governor Robert Casey (father of current U.S. Senator Casey) developed his proposal for a children’s health insurance program.  During that year, discussions between State Representative Allen Kukovich and State Senator Allyson Schwartz, both counseled by PHLP, and Gov. Casey’s team results in compromise legislation establishing CHIP.  The program was one of the first of its kind in the nation and become a national model.

In 1993, PHLP officially separated from Delaware County Legal Assistance Association to become a separate non-profit corporation.  PHLP’s separation allowed for “a more effective and efficient delivery of support to legal service programs in Pennsylvania and greater advocacy on issues of access to health care for the poor.” 

In 1997, believing it had learned from the trials and errors of the 1986 HealthPASS pilot, Pennsylvania launched a new mandatory Medicaid managed care program (called HealthChoices) in Southeast Pennsylvaniva. State officials expanded HealthChoices into the Southwest in 1999, followed by the Lehigh-Capital Zone in 2001.  HealthChoices would have been implemented sooner, but for PHLP lawsuits (Hernandez v. Snider; Coalition of High Volume Medical Assistance Hospitals v. Snider) which successfully delayed the start of HealthChoices until additional consumer safeguards were implemented. 

PHLP was heavily involved in the drafting and approval of state regulations for the managed care provisions of Pennsylvania’s Quality Health Care Accountability Protection Act (Act 68), which passed the General Assembly in 1998.  PHLP was the only consumer representative that served on numerous work groups with insurers, providers, and regulators.  What emerged were new and stronger mechanisms—grievances and complaints—consumers could use to challenge service denials by Medicaid and commercial managed care organizations.   

A new decade brought many changes for PHLP and its clients.  In 2002, now that Medicaid Managed Care had expanded to 25 counties, PHLP and the Consumer Subcommittee persuaded the state to entirely re-write managed care appeal notices.  Consequently, Medicaid enrollees seeking to contest a managed care plan’s denial of services could better understand how to do so and learned they could contact PHLP for legal support. 

In 2002, PHLP released a major study detailing significant shortcomings in personal care homes, which led to great improvement in conditions, including passage of the Assisted Living License Act several years later (Act 56 of 2007).  PHLP’s report, “A Report on Pennsylvania’s Personal Care Homes and Assisted Living Residences: A Call for Reform That has Gone Unheard for Over 20 Years” detailed the terrible history of failure to enforce regulations for personal care homes.  PHLP worked with then-Auditor General Robert Casey Jr. The Secretary of Aging asked PHLP to Chair an Assisted Living Advisory Committee that lead to a report calling for their licensure so people could age in place and not have to move from facility to facility as their needs changed.  

Beginning in 2003, and continuing throughout the decade, PHLP deepened its commitment to increase access to health coverage for low-income elderly and disabled persons; particularly in response to massive state and federal changes impacting both access and coverage.  The most significant of these changes was the January 1, 2006 start of the Medicare Prescription Drug benefit.  Many consumers found themselves no longer eligible for home and community based services waiver programs (due to MA eligibility changes) and facing potential institutionalization.  Other consumers were unexpectedly and involuntarily enrolled into Medicare HMOs when they had chosen to remain in original Medicare.  Low-income elderly consumers, who never paid co-payments, faced a $1 to $5 co-payment per prescription. 

Thanks to generous support from the Pew Charitable Trusts, FISA and the McCune Foundations, PHLP focused on education and outreach in order to make sure consumers with disabilities, their family members and the professionals that work with them understood Part D and how they would be impacted.  In addition to outreach and education activities, PHLP provided individual assistance to thousands of consumers to help them overcome specific barriers to coverage and prescription drugs.

In 2007, PHLP advised then-Pennsylvania House Majority Leader Denny O’Brien on legislation to require that group insurance plans provide coverage of up to $36,000 annually for the treatment of children diagnosed with autism spectrum disorder.  In the past, commercial insurers typically did not provide any coverage for diagnosing and treating autism spectrum disorders.  The Pennsylvania Autism Insurance Act, or Act 62, was passed in July 2008 and went into effect in July 2009. 

The most significant event for PHLP and our clients this decade was the federal government’s passage of the Patient Protection and Affordable Care Act (ACA) in April 2010.   Pennsylvania was slow to implement the law.  State policy makers, for example, delayed modernizing Medicaid eligibility and enrollment systems despite the availability of substantial federal funds, and hoped either for a U.S. Supreme Court decision that would invalidate the ACA or a Presidential election that would suspend its implementation. 

In the meantime, PHLP and its clients saw the adverse effects of an economic downturn with severely depressed state revenues and higher demand for human services.  Federal health reform prevented Pennsylvania from expanding Medicaid until 2015, but in 2011 the state dramatically reduced optional Medicaid benefits like prescriptions and dental care for adults.  That same year the state also eliminated a state-funded safety-net program called adultBasic, which was a bare-bones coverage plan for 40,000 Pennsylvanians who cannot afford health insurance but who have too much income to qualify for Medicaid. 

In 2012, Pennsylvania began extending mandatory managed care (HealthChoices) to the remaining 42 rural counties in the state.  This represented a major change in healthcare delivery for the over 500,000 Medicaid enrollees who reside in those counties as well as for the current providers of their medical care.  PHLP developed materials and sponsored trainings to help consumers and their advocates understand how to choose a managed care plan, the significance of network providers, consumers’ rights to file complaints and grievances, and the rules regarding continuity of care.

In September 2014 then-Governor Tom Corbett and the federal government agreed to expand and reform Medicaid. The Governor conditioned his embrace of Medicaid expansion to: (1) the federal government agreeing to substantial changes to PA’s existing Medicaid program; and (2) being allowed to place “newly eligible” individuals who are included in the expansion into very unconventional arrangements—i.e., private (non-Medicaid) managed care plans. BUT this new expansion of Medicaid did NOT happen easily and was significantly complicated by a change in state leadership: the November 2015 election of Governor Tom Wolf. PHLP used a combination of approaches (policy, training, individual representation) to advocate for our clients during this uncertain time.

In 2015, the state launched a new managed care program called Community HealthChoices for 420,000 low-income seniors and adults with physical disabilities, making private insurance companies responsible for coordinating and delivering services and supports that help people with activities of daily living (e.g., eating, bathing, dressing). PHLP was deeply concerned about the state's plan.  Its approach posed significant risks for Pennsylvanians with extensive medical, social, and long-term care needs because managed care organizations (MCOs) have limited experience providing long-term care.  PHLP persuaded the state to delay the implementation until more protections and readiness measures were in place.