Pennsylvania Health Law Project: Free Medicaid Help for Families

What PHLP Does

The Pennsylvania Health Law Project is a nonprofit legal services organization that provides free help to Pennsylvanians who have trouble accessing healthcare coverage — including Medicaid, CHIP, Medicare, and the state's managed care programs. For families dealing with a parent's long-term care Medicaid application, PHLP is one of the most underused resources in the state.

They handle the exact problems that leave families stuck: Medicaid application denials, coverage terminations, Community HealthChoices disputes, and fair hearing appeals. Their staff attorneys specialize in health coverage law and may represent eligible clients at no cost.

When to Contact PHLP

PHLP is relevant at several points in the long-term care process:

Medicaid denial. If the County Assistance Office denies your parent's long-term care application — for excess resources, excess income, verification failure, or transfer penalties — PHLP can review the denial, determine whether it was legally correct, and represent you at a fair hearing appeal.

Managed care disputes. Once your parent is enrolled in Community HealthChoices through one of the three managed care organizations (UPMC, PA Health & Wellness, or AmeriHealth Caritas), disputes over authorized care hours, service denials, or care plan changes fall within PHLP's scope. If the MCO reduces home care hours or denies a medically necessary service, PHLP can help file internal grievances and, if needed, escalate to a DHS fair hearing.

Enrollment problems. If your parent is having trouble enrolling in a CHC plan, getting transferred between plans, or accessing the IEB enrollment process, PHLP can intervene.

Coverage terminations. If Medicaid coverage is being terminated due to a change in circumstances — income increase, asset reassessment, or a missed recertification — PHLP can advise on whether the termination is correct and how to preserve coverage through appeal.

How to Reach Them

Statewide helpline: 1-800-274-3258 (toll-free)

Regional offices:

• Philadelphia: 215-625-3990
• Pittsburgh: 412-434-4728
• Harrisburg: 717-236-6310

Website: phlp.org — includes fact sheets, self-help guides, and webinar recordings on Medicaid eligibility, managed care rights, and appeal procedures.

Call the helpline first. A staff member will screen your situation and determine whether PHLP can assist. Eligibility and capacity to assist vary by situation, so ask about your parent's case before assuming you must hire private counsel.

What PHLP Does Not Cover

PHLP focuses specifically on health coverage access. They do not handle:

• Asset protection planning (trusts, deeds, spend-down strategies) — this is elder law attorney territory
• Filial support lawsuits from nursing homes — these are civil litigation matters
• Guardianship petitions — handled through Orphans' Court
• Estate recovery disputes after a parent's death — though they can advise on rights during the parent's lifetime

For families who need both coverage advocacy and asset planning, PHLP handles the Medicaid application and appeal side while an elder law attorney handles the financial structuring. The two complement each other.

Why Most Families Don't Know About PHLP

PHLP doesn't advertise and doesn't appear in the directories that families typically search when they're in crisis. Hospital discharge planners and nursing home business offices rarely mention them because PHLP's advocacy sometimes creates friction with the facilities' preferred billing timelines.

The result is that families pay thousands of dollars for private attorneys to handle straightforward Medicaid appeals that PHLP would have taken for free, or they give up after a denial without knowing they had the right to challenge it.

If your parent has been denied Medicaid for long-term care in Pennsylvania, or if a managed care organization is reducing or denying services, calling PHLP at 1-800-274-3258 should be the first step — before spending on private legal representation and before assuming the denial is final.

For families still preparing their Medicaid application, the Pennsylvania Paying for Care Guide covers the complete eligibility framework and documentation requirements, helping you get the application right the first time so you may never need to appeal at all.

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