NHeLP Matters - December 2013

Executive Summary

Summary of the recent accomplishments of NHeLP, including the 24th Annual Health Advocates Conference, Health Reform Implementation and Medicaid Defense.
 
Welcome to the year’s last edition of NHeLP Matters, our quarterly look at all things NHeLP. 
 
From the Affordable Care Act’s (ACA) first open-enrollment period, to pushing for national Medicaid expansion and standing up for the health rights of our most vulnerable, NHeLP’s attorneys and staff have been busier than ever. Learn more about some of our tremendous accomplishments below! 
 
 
NHeLP’s 24th Annual Health Advocates Conference 
 
For 24 years, NHeLP’s premier event—the annual Health Advocates Conference—has offered a forum for new and seasoned health advocates to parse some of the most pressing health issues affecting low-income communities. This year, NHeLP convened more than 150 advocates from 26 states, covering topics from public polling on the ACA to Medicaid eligibility and enrollment. The conference also featured a workshop on the most pressing issues impacting access to the courts, informed by decisions in the most recent Supreme Court term and providing a brief introduction to the subject Jane Perkins and co-authors extensively covered in “The Supreme Court’s 2012-2013 Term: Restrictions on Court Access Just ‘Too Darn Bad.’” 
 
The highlight of the three-day conference was a lively discussion from Dr. Ezekiel Emanuel and moderated by Leo Cuello. Dr. Emanuel engaged top health experts from around the country answering questions and making big predictions about the future of health-care delivery in America. NHeLP thanks Marc Fleischaker, NHeLP board chair and chairman emeritus of Arent Fox, LLP, for graciously hosting the event. 
 
 
Health Reform Implementation 
 
Monitoring, Supporting and Defending Medicaid’s Expansion
 
As states expand Medicaid, NHeLP is working closely with advocates not only to ensure that those who stand to benefit the most do, but also that programs fully comply with federal law. States such as Arkansas are attempting to expand Medicaid using premium assistance, a decision that could have negative consequences for new and future Medicaid beneficiaries. In Iowa, NHeLP strongly opposed the problematic Medicaid expansion waiver application, which attempted to waive full benefits for children, require expensive cost-sharing and limit access to family-planning providers. And when Pennsylvania tried to impose work requirements on the newly eligible, NHeLP swiftly responded with a point-by-point analysis on how the proposal clearly violated federal law. 
 
Preventing Discrimination in Health Care 
 
The ACA brings federal nondiscrimination laws to the health-care arena as well. NHeLP has been an ardent supporter of these protections, bringing decades of experience to protect long-standing civil rights laws. NHeLP’s extensive analysis and comments provide clarity and insight into the effect that discrimination on the basis of race and color, national origin and language spoken, immigration status, sex, sexual orientation, gender identity and disability have on health care. 
 
All forms of discrimination create serious and unacceptable inequities in health and access to care, and NHeLP is committed to protecting the rights of all. 
 
Protecting Due Process for Californians 
 
The ACA’s coverage opportunities come with rights guaranteed under the 14th Amendment, including the right to due process before being deprived of property. These rights become critical when applicants or enrollees do not have adequate notice of their rights and ability to appeal decisions denying or terminating coverage to which they are entitled. NHeLP worked extensively with Covered California and the state’s Department of Health Care; helping them draft policies that ensure the state’s regulations comply with federal due process rights. NHeLP’s legal expertise and keen understanding of the real implications that weak protections can have for consumers were invaluable in strengthening regulations. Although we achieved substantial improvements, NHeLP’s work is far from finished as California attorneys actively work to remedy the state’s legally deficient notices. 
 
NHeLP has the Go-to Resource on MAGI 
 
Hailed as “Impressive!”– the Advocates Guide to MAGI is now the go-to resource on the ACA’s new counting rules. The MAGI guide helps advocates understand and apply the rules, known as Modified Adjusted Gross Income, for counting income and family size. The rules affect millions and are being used to determine who is eligible for the new insurance affordability programs, including subsidized coverage through the Marketplace, Medicaid and CHIP. Spanning nearly 100 pages, the Guide walks advocates through how the rules work, including who is and who is not subject to MAGI, the types of income counted and excluded, and how to figure out who is in an applicant’s “household” for determining eligibility. 

 
Reproductive Health 
 
Training Advocates Nationwide 
 
NHeLP’s reproductive health team crisscrossed the country, training more than 1,700 advocates, health professionals and government employees with cutting edge and timely information on how to maximize enrollment and eligibility and ensure that low-income women have real access to full coverage. Not to be outdone, NHeLP’s California team utilized their skills and expertise as both lawyers and health advocates to equip more than 100 legal services staffers with the information and tools they need to help their low-income clients access coverage. NHeLP’s litigators moved beyond the courtroom, tackling some of the most pressing issues affecting Medicaid at conferences across the country. 
 
Preserving Prenatal Care for Minors  
 
Science and decades of health policy are clear: prenatal care is essential for healthy moms and babies. The ACA makes prenatal care a reality for millions of women by including it as an essential preventive service. The law’s new income counting rules governing Medicaid –MAGI – however, could unintentionally restrict, rather than expand, eligibility for minors. NHeLP is leading efforts with state advocates and the Centers for Medicare & Medicaid Services to preserve vital prenatal services in three states, with more in the pipeline. 
 
 
Medicaid Defense

A New Home for Jake and Eric 

 
In 2009, three brave young men with cerebral palsy demanded that Maine’s Medicaid program provide them all the health services to which they are entitled. Thanks to the diligent efforts of a team of attorneys, including NHeLP, the Disability Rights Center of Maine, Maine Equal Justice Partners and Jeff Young, plaintiffs Jake Van Meter and Eric Reeves were finally able to move back into their communities last month without fear of losing their health care. The settlement allows them to receive necessary Medicaid care and support in their own home, rather than in nursing facilities. 
 
Ensuring Children with Autism Get Full Care  
 
In a victory for low-income children in Florida, the 11th Circuit Court of Appeals affirmed the permanent injunction in KG ex rel Garrido v. Dudek, forcing the state to cover therapy for children with autism and relying on Medicaid. NHeLP and co-counsel Florida Legal Services and Legal Services of Greater Miami vigorously advocated on behalf of these children who need behavioral therapies, including applied behavioral analysis techniques, but were denied treatment. The denials violated Medicaid’s Early Periodic Screening Diagnosis and Treatment (EPSDT) provisions, which are designed to ensure that vulnerable low-income children get the care they need. This therapy is one of the only evidence-based treatments for autism. Although many private plans mandate coverage of this treatment, children face many barriers when trying to obtain Medicaid coverage of it. This decision will have national repercussions. 
 
Leading Analysis on Private Enforcement 
 
Federal law allows people to enforce their rights under certain spending clause programs, including Medicaid, using 42 U.S.C. § 1983. The Supreme Court, however, has become increasingly restrictive of private citizens’ ability to assert their rights using these so-called “1983” claims, and imposes a demanding standard. Despite these limitations, the law remains the primary vehicle for enforcing some of the Medicaid Act’s most important consumer protections. As a national leader, NHeLP's latest brief on the issue provides an extensive overview of where the law stands in light of Supreme Court rulings and an assessment of Medicaid enforcement in circuit courts of appeal for lawyers considering a 1983 action. 
 
 

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