HEALTH LAW ADVOCACY IN ACA IMPLEMENTATION YEAR TWO

Washington Coalition On Medicaid Outreach

Vancouver, February 27, 2015

Alliance for Equal Justiceallianceforequaljustice.org

Partners in health advocacy include:– Northwest Justice Project www.nwjustice.org

– Columbia Legal Services www.columbialegal.org

– NW Health Law Advocates (NOHLA) www.nohla.org

– TeamChild: Advocacy for Youth www.teamchild.org

– Disability Rights Washington www.disabilityrightswa.org

ELIGIBILITY AND ENROLLMENT- ISSUES?

Distinctive problems of most vulnerable populations:• Eligible immigrants, e.g., Legal Permanent Residents not given conditional eligibility

and not auto- renewed.• Victims of domestic violence, e.g., Social Security Numbers not recognized; Address

Confidentiality Program problems with physical/ mailing address; • Youth turning 19• Pregnant women are recognized as priority for expediting but still experience delays• Newborns (e.g., lawful presence and income information is requested!)

Verification and renewals generally:• Cash/HEN clients are not all being auto-renewed for Medicaid as they used to be. A

few hundred each month are required to do “manual” renewal separate from cash renewal

• ID proofing: Healthplanfinder requires actual scan of document, no workaround, doesn't accept IPA attestation; renewals (even when using the same navigator) required to redo ID proofing

• Documents previously uploaded are requested again• Verification process can take months• Name changes are not recognized when the SSN doesn't change or spelling is different,

“locked #” problems.• Navigators might not be able to see Hpf dashboards that indicate what info is needed. • Incorrect failure to renew notices were sent to many clients got notices who had sent

in renewal information or renewed on-line

ELIGIBILITY AND ENROLLMENT – Advocacy

• NoHLA’s ACA Enrollment Survey of In-Person Assisters, Navigators and Community Partners (Nov. 2014): http://www.nohla.org/publications/surv14/Survey.pdf

• Holding monthly conference calls with HCA lead staff;

• Attending regular community forums (e.g., Seattle First Friday Forum, Vancouver Community Health Access Resource Group)

• Representing individuals and families in hearings and appeals

ACCESS TO SERVICESIssues:• HCA oversight of managed care plans’ performance under contracts;

• Network adequacy and timely access to services;• Approval criteria that differ from WAC’s;

• Long-term care service reductions (e.g., private duty nursing to nurse delegation; CARE hours)

• Potential broadening or narrowing (e.g., for budgetary reasons) of Apple Health or Qualified Health Plan covered services

• “Integration” of physical/behavioral-mental (BH) services delivery either statewide or regionally

Advocacy:• Engaging HCA about prior authorization and managed care issues;• Engage HCA and Local RSNs/BHOs re integration of BH services and

development of “early-adopter” pilot integration projects.• Participating in local development of Accountable Communities of Health• Representing individuals and families in appeals and hearings.

NOTICES AND APPEALSISSUES:• Inadequate or confusing “notice” letters denying either eligibility and covered services, issued by a

growing number of entities.

• Refusal to appropriately provide “continued benefits” pending hearing when the agency or plan terminates or reduces previously-covered services, and to reimburse people who eventually prevail their out-of-pocket costs while awaiting decision.

• Undue delay in giving “discovery” of documents that were relied on to make decisions and in responding to clients’ submission of additional information.

• Defaulting and “dismissing “appellants for failing to call in for pre-hearing conferences that are not necessary to a resolution of their appeals, placing the burden on them to get the dismissal vacated.

• Unreasonable opposition to “continuances” (postponements).

• Interpreter and translation problems for limited-English proficient clients.

Advocacy:• Accepted HCA’s invitation to discuss possible amendments to hearings WACs;• Developed outline of issues that arise in prior authorization, notice letters, and hearings• Further engage agencies and health plans regarding notice and appeal problems• Represent individuals and families in appeals and hearings

TAX FILINGISSUES:• Penalty for failing to have minimum essential coverage ("individual

mandate," there are some exemptions)

• Reconciliation when a person received an incorrect QHP subsidy amount. • BUT – IRS announced relief from repayment of some QHP subsidy

overpayments; check with a tax professional if this may apply.

• HBE tax statements will not match a taxpayer's personal records, so people must phone HBE's call center

• Unfamiliarity of people who are otherwise non-filers with what has to be done (ex: must file, can't use the 1040 EZ, if married must file jointly, etc.).

Advocacy : • Develop ways to advise/refer clients about exemptions• Provide training and resources for tax clinic volunteers• Develop www.washingtonlawhelp.org publications• Coordinate with HBE regarding tax statement issues

For individual/family legal assistance – CLEARCLEAR phone lines are open from 9:10 a.m. to 12:25 p.m. Monday - Friday. For some public assistance and housing problems, you can apply on-line at http://www.nwjustice.org/apply-online

CLEAR (low-income): 1-888-201-1014

CLEAR *Senior (60 and over): 1-888-387-7111

Deaf, hard of hearing, or speech impaired, please call CLEAR using the relay service of your choice.

For self-help informationWashington Law Help: www.washingtonlawhelp.org

Special thanks to Kate Laner and Charity Belanger of NJP, and to Janet Varon and Daniel Gross of NoHLA for contributing to and helping prepare these materials.

Charles P. Mitchell, Staff AttorneyNorthwest Justice Project

500 W 8th St., Ste. #275Vancouver, WA 98660

PH: 360-693-6130 ext. 202Fax: 360-693-6352

Email: CharlieM@nwjustice.org