NHeLP Matters – December 2014

NHeLP Matters – December 2014

Executive Summary

Welcome to the year’s final edition of NHeLP Matters. In the past 12 months, we have fought for the health care rights of low-income people and individuals with disabilities in Washington and beyond. Learn more about our work advancing reproductive health, protecting Medicaid and bringing together advocates and policy makers across the nation to strategize on ways to improve health care.

Welcome to the year’s final edition of NHeLP Matters. In the past 12 months, we have fought for the health care rights of low-income people and individuals with disabilities in Washington and beyond. Learn more below.

25th Annual Health Advocates Conference 
Now in its 25th year, our Health Advocates conference brings together the nation’s leading policymakers, experts and advocates to strategize on improvements to health care access. Dr. Mary K. Wakefield, Administrator of the Health Resources and Services Administration at the U.S. Department of Health and Human Services, provided the keynote. She shared insights into where the agency is focusing its efforts, and the connection between access to care and advancing public health. Dr. Wakefield was joined by other federal colleagues including Cindy Mann, Deputy Administrator and Director of the Center for Medicaid and CHIP Services, Centers for Medicare & Medicaid Services (CMS); Lisa Campbell, Director of the Consumer Support Group at the office of Consumer Information Insurance Oversight (CCIIO); and Eileen Hanrahan from the Office for Civil Rights. This year’s workshops ran the gamut and addressed pressing topics such as progress in health reform implementation, developments in Medicaid, and discrimination in reproductive care.


One Step toward Ending HIV/AIDS Discrimination
The Affordable Care Act (ACA) was supposed to bring new protections for people living with HIV/AIDS, but Floridians and others across the nation still face considerable discrimination. It appears as though some insurers are structuring their prescription drug benefits to illegally discourage people with HIV/AIDS from enrolling in their health plans, such as placing all generic HIV drugs in the highest cost tiers and requiring prior authorization. NHeLP and The AIDS Institute filed a civil rights complaint asking federal officials to immediately stop four Florida insurers from taking such actions. Since then, two of those insurers, Cigna and Coventry, signed consent orders with Florida’s insurance regulator, announcing that they will restructure their HIV prescription benefits and remove barriers to HIV prescription drugs. CMS has also taken note and, in its proposed rules for 2015, agreed that placing all medications used to treat a specific condition discriminates against people with that condition. These are important steps and send a strong message to insurers across the nation.

Making Medicaid Work: Enforcing the Law and Covering Children 
Since the 1970s, Medicaid beneficiaries have brought claims in federal court using the Supremacy Clause of the U.S. Constitution and the civil rights statute, 42 U.S.C. § 1983, to stop state violations of the Medicaid Act. These claims are pivotal in allowing people to enforce their rights in court. NHeLP’s Update on Private Enforcement of the Medicaid Act covers the history of these claims and Supremacy Clause enforcement, provides an assessment on where Medicaid Act enforceability stands, and offers recommendations for lawyers considering claims. In addition, Medicaid’s responsibility to insure low-income children means that the program has a critical role in preventing vision and hearing loss, conditions that disproportionately affect poor children. NHeLP’s latest issue briefs present the results of 50 state surveys of state policies and provide recommendations for improving vision and hearing services for young children.

Fighting for 99,000 Californians and Counting 
Rivera suffered from an array of conditions that, had he a regular doctor, would have raised red flags. But Rivera worked a low-wage job and could not afford health insurance. When he found out he was eligible for California’s Medicaid program, he thought his luck had turned. He applied for coverage in Jan. 2014. But, he died five months later from a pulmonary embolism, still uninsured and still waiting to hear back from the state. Federal law requires that states process Medicaid applications within 45 days, but Rivera waited far longer. That’s why NHeLP and a coalition of legal groups and advocates sued California and filed a Motion for Preliminary Injunction to force the state to follow the law. The court will hear our motion this month. Meanwhile, over 99,000 people wait for coverage.


Sex Education is a Part of Health Care Too
Sexuality education is a required component of Medicaid health screens for adolescents, yet few advocates and policymakers realize this. NHeLP is building on decades of advocacy to improve and advance this Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit to which over 37 million children and adolescents are entitled. Our issue brief, fact sheet and webinar dive into the public health benefits and requirements for including sexuality education in health care delivery. In addition, we address sexual health across a youth’s lifespan and the role of sexuality education in encouraging healthy relationships and preventing domestic violence.

Using Reproductive Rights and Justice to Meet the Needs of Underserved Women 
NHeLP serves as the bridge between advocacy, provider and research communities, examining consent requirements for voluntary sterilization under Medicaid. These requirements were originally developed to prevent eugenic sterilization of low-income women, women with disabilities and women of color. As part of our efforts to ensure any revision of the consent process supports informed decision-making, NHeLP developed a panel at the 2014 North American Forum on Family Planning to address the history of involuntary sterilization in the U.S., the status of medical research on the impact of the consent process, and the need for additional research. Without this dialogue, advocates, researchers and providers would not have the opportunity to jointly assess ways to ensure that underserved women determine and consent to their reproductive health choices.


Language Access Victory!
Protections for limited English speakers are often ignored and unfortunately, the ACA is the latest example. During the first enrollment period, hundreds of thousands of limited English speakers faced discrimination in the federal marketplace. Many of them were not able to verify their identity online, a required step to enroll.  As a result, they had to work with Experian, a federal subcontractor responsible for manually verifying the identity of applicants who could not do so online. Limited English speakers could not effectively communicate with Experian, because in direct violation of federal law, the company did not offer any form of language assistance and even prevented some from using interpreters. Thanks to NHeLP and language-access advocates, Experian will now provide assistance in 240 languages- a pivotal win. And, as long advocated by NHeLP, HHS recently proposed regulations that build on existing language access requirements and would require that all Marketplaces, Qualified Health Plan issuers, and web-based health insurance brokers provide telephonic interpreter services in at least 150 languages.

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