ENFORCEMENT AND LITIGATION
Ending Tennessee’s Life-Threatening Waiting Game
“It’s a sad situation that you have to have a lawyer to go to the doctor.”
Yet, that is exactly what April Reynolds had to do. Hailed as one of the worst-if not the worst-states for processing Medicaid applications, Tennessee’s hoops and hurdles have put the lives of thousands of adults and newborns in jeopardy. People with pending Medicaid applications have been in limbo for months, going without care while they wait for a decision. Thanks to NHeLP’s efforts, along with the Tennessee Justice Center and the Southern Poverty Law Center, applicants are getting help. A federal judge has granted immediate relief for our clients and certified our case as a class action, meaning residents across the state will be helped. The judge ordered Tennessee to make sure that decisions on Medicaid applications are made within a set timeframe and to provide a fair hearing to anyone waiting beyond that time.
A Novel Approach to Protecting Access to Charity Care
In a first-of-its-kind move, NHeLP joined Florida Legal Services to bring legal action against the Jackson Health System (JHS), Miami-Dade County’s publicly funded health care system, over access to charity care. Unlike other non-profit hospitals, JHS refuses to publicize its financial assistance and subjects applicants to onerous hurdles before they can get charity care. Eligible low-income residents often do not find out about assistance until after they have incurred hefty medical bills and experienced aggressive collection efforts. Floridians like Jacqueline Samuel, who needs routine care to manage her kidney disease, have been put in an untenable position of going without health care or racking up bills they have no way to pay, despite being eligible for the hospital’s charity care.
Mandating Medicaid Coverage for Autism Treatment
One in 68 children lives with Autism Spectrum Disorder (ASD), but comprehensive therapy is often out of reach. For too long, children with ASD have had difficulty obtaining Medicaid coverage for clinically proven behavioral health services and other therapies. On July 7, the Centers for Medicare & Medicaid Services issued important guidance that, for the first time, makes it clear Medicaid must cover services to treat ASD. This guidance, for which NHeLP has vigorously advocated, will eliminate barriers to access and help ensure that children with ASD receive the Medicaid-covered services they need to live life to their fullest potential.
Treating Abortion as the Health Care it is
Abortion is a basic health care service and yet, too often, it is treated differently and singled out. In a tremendous victory for women in California, NHeLP — working closely with ACLU California and Planned Parenthood Affiliates of California — has ensured that all health plans in the Golden State will cover abortion the same way as other health services. We stepped in and successfully worked with state officials to halt two universities that tried to eliminate or severely restrict abortion coverage in their employee benefit plans, actions that would have harmed more than 2,000 Californians. As a result of our efforts, California affirmed that health plans cannot “discriminate against women by limiting or excluding coverage for termination of pregnancies,”–what we have been advocating for over 40 years!
Making Contraceptive Equity a Reality
Any day now, California Governor Brown is expected to again demonstrate California’s leadership and sign the Contraceptive Coverage Equity Act (SB 1053), a groundbreaking piece of legislation that builds on the ACA to truly make access to contraception a reality. NHeLP, along with the California Family Health Council, spearheaded the bill with state Senator Holly J. Mitchell. Once signed, SB 1053 will serve as a model for states around the nation by not only requiring that insurance plans cover contraception, but ensuring California women are able to choose the birth control method that is best for them, without interference from their insurance companies and administrative hurdles. NHeLP looks forward to working with advocates in other states to fulfill the ACA’s promise that women across the country have the means to make their own reproductive decisions.
HEALTH REFORM IMPLEMENTATION
Breaking Down the Legal Complexities for Advocates
As the nation’s leading policy experts on Medicaid and the ACA, NHeLP provides training and technical expertise to advocates around the country. In August, we capped off an intensive training for over 70 advocates from Ohio, Michigan, West Virginia and Indiana. These advocates represent states at the cutting edge of Medicaid expansion and are most able to make a change in their clients’ lives and state policy. We provided these top legal aid advocates with support on a wide range of issues including what’s trending in Medicaid expansions, working though the ACA’s new income counting rules, and making sure they know how to get their clients enrolled and accessing care.
The Next Thing in Medicaid Expansions
With all of the changes ushered in by the ACA, Alternative Benefits Plans (ABPs) are a major one. States are adopting these plans as the benefits packages offered to enrollees in Medicaid expansions. NHeLP’s in-depth look at these plans analyzes state ABP decisions and what they mean for enrollees, compares three key plans and provides an implementation case study. The brief is a must-read for advocates trying to understand these new benefits packages.
Helping Advocates and Policy Makers Better Serve Older Adults
The health needs of older adults are increasingly on the forefront as the nation’s population ages. NHeLP serves as the bridge between this population and the health and legal issues impacting them. As part of our extensive agenda, via webinar, we provided over 150 individuals, including policymakers, legal service providers, state governments, non-profits and foundations with the essential issues impacting the aging Medicaid population, including eligibility, coverage for long term care and changes under the ACA. Without this type of guidance, aging advocates lack the technical understanding of how Medicaid coverage for older adults works, and more importantly, how advocacy can protect and improve that coverage.