Highlights of Our Recent Activities and Accomplishments
Welcome to the latest edition of NHeLP Matters, our quarterly look at all-things NHeLP.
Summer may have wound down, but health care is heating up as the first open enrollment under the Affordable Care Act (ACA) approaches and the health care landscape evolves under increasing political and economic pressure. Learn more about some of the great work our attorneys and experts have accomplished this summer below!
Health Reform Implementation
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Equipping State Advocates to Tackle Premium Assistance
Implementation of the Affordable Care Act (ACA) is moving at full speed and states are still deciding whether and how to expand their Medicaid programs. The latest development involves states trying to use premium assistance--buying private insurance for certain Medicaid beneficiaries by paying their premiums--as a cost-effective way of providing coverage. When news out of Arkansas and other states broke, NHeLP responded quickly, laying out our concerns in an extensive legal memo joined by 10 leading national health organizations to the Department of Health and Human Services and arguing for strong protections in Medicaid premium assistance. NHeLP's expertise and analysis have been critical for state advocates working in this still-evolving policy area. Our piece, 30 questions state advocates should consider if facing premium assistance in their states, has been particularly well received.
Helping Advocates Make Health Reform a Reality
In 15 days, millions of people will be able to compare and shop for affordable health insurance in the new Marketplace, many gaining coverage for the first time in years. The Medicaid expansion alone promises coverage for up to 17 million low-income people, but presents a challenge for advocates working with new benefits plans and enrollment processes in the Marketplace. NHeLP's experts are providing up-to-date analysis leading up to Oct. 1 open enrollment and beyond to ensure health reform truly becomes a reality, from extensive comments on rules impacting charitable hospitals to national webinars on Medicaid Alternative Benefits Plans and Medicaid cost-sharing. NHeLP and national partners successfully advocated for the Department of Health and Human Services to include in-language taglines on www.healthcare.gov and support for translated application tools in 34 languages. These improvements are critical for those who do not speak English or do not speak English very well.
Ensuring that Pediatric Dental Care is an Essential Benefit in California
When advocates realized that Covered California, the new state-based Marketplace, intended to restrict health plans from including pediatric dental benefits in their covered services, NHeLP immediately stepped in. Leaving these critical dental services to be purchased separately in stand-alone dental plans, at a much higher cost, would be a major financial burden for families who would be left with fewer than the 10 Essential Health Benefits required by the ACA. NHeLP spearheaded efforts with other California advocates, providing extensive analysis and testimony before the Exchange Board. As a result, Covered California reversed its decision in July and adopted a resolution that will require that dental coverage be available as part of the benefits package offered by health plans no later than 2015.
Reproductive Health
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Helping to Ensure the 4 Million Births in the U.S. Each Year are Healthy and Safe
Prenatal care is critical to preventing maternal mortality and improving maternal health outcomes and newborn health, and yet accessing affordable care remains a challenge for many women. The impact on health is substantial. Women who receive no or late prenatal care have three to four times higher rates of pregnancy-related maternal mortality, and infant mortality rates are six times higher for those newborns. Thanks to the ACA, prenatal care will now be covered by most insurance plans, without cost-sharing, as part of the law's preventive services requirement. NHeLP is working with state advocates to make covered prenatal care a reality for women and our detailed analysis of this ACA provision provides a handy breakdown for health advocates.
Improving the Lives of Women Living with HIV (WLWH)
The ACA offers a real opportunity to improve the health of WLWH. The ACA's Medicaid expansion alone could potentially provide affordable coverage to approximately 34% of uninsured low-income WLWH; and approximately 21% of WLWH will be eligible for insurance subsidies to help them afford coverage in the new Marketplace.
NHeLP is a leader on the intersection of Medicaid, the implementation of the ACA and the health needs of low-income WLWH. We are a founding member of the 30 for 30 Campaign, a coalition of organizations dedicated to ensuring that the unique needs of women living with and affected by HIV, including transgender women, are addressed in the national HIV response. Check out our latest fact sheet for some of the ways the Medicaid expansion and the ACA's reforms will benefit WLWH.
Tracking, Analyzing and Litigating to Protect Health Reform
Over a year has gone by since the Supreme Court upheld the constitutionality of the ACA, but that has not stopped new legal challenges from cropping up. NHeLP litigators are busy tracking the dozens of new challenges working their way through the courts in a comprehensive ACA docket covering all of the cases that have arisen since the 2012 decision and analysis of those cases. In addition, we are on the front lines, defending the ACA's no-cost contraceptive coverage requirement in nine amicus briefs. The contraceptive coverage requirement continues to garner serious opposition in spite of the benefits for millions of women and will likely be heard by the Supreme Court.
Medicaid Defense
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Standing Up for 600,000 of California's Most Vulnerable Medicaid Beneficiaries
In July, NHeLP's California team and state partners saw real results when California's Medicaid agency announced that it would give counties the option of suspending redeterminations in the state's early Medicaid expansion program for the last quarter of 2013. The decision is an important victory and protects some of California's most vulnerable enrollees who are far below the federal poverty line and have significant health challenges including multiple chronic illnesses, homelessness, mental illness and substance abuse. California's decision will help ensure these people do not fall through the cracks when they transition into California's Medicaid expansion in 2014. NHeLP has repeatedly urged the state to pursue this option to minimize confusion and promote continuity of care for thousands of enrollees in the early expansion program who might otherwise lose their coverage. More than 600,000 Californians are enrolled in the early expansion and most will automatically transition to 100% federally funded Medicaid in January.
Relief for Youth with Disabilities in Washington
NHeLP and co-counsel reached a significant settlement in a class action lawsuit brought on behalf of 10 named plaintiffs and thousands of other children and youth in T.R. et al. v. Quigley et al. against the state of Washington, bringing critical mental health services to one of the state's most vulnerable populations who rely on Medicaid for their health care. The settlement will ensure that youth with mental and emotional disabilities are able to receive intensive mental health services in their homes and communities, rather than being forced to get these services in hospitals and institutions. The settlement brings needed overhaul to Washington's Medicaid program and puts the state at the forefront in striving to provide better and more coordinated mental health services for Medicaid beneficiaries. An estimated 3,000-6,000 youth will benefit each year from the improved services, putting them on a path to better and healthier futures.