Archives

Written by Stephanie Akpa

Oct 06

2014

The Gap Between Health Care Coverage and Access

In 2013, the Social Security Administration told Ms. Andrews,* a 31-year-old woman with intellectual and cognitive disabilities, that her disability benefits would be terminated because she needed to provide medical evidence that she remained disabled. Shortly thereafter, Legal Aid began representing Ms. Andrews to show that she still suffered from intellectual and cognitive disabilities and thus remained entitled to disability benefits. To do this, we needed to submit updated medical evidence and find a doctor who would administer an IQ test for Ms. Andrews. Since Ms. Andrews is a Medicaid recipient enrolled in a managed care organization (MCO), she needed a specialist within the Medicaid MCO’s network of providers who could perform the test. We worked with Ms. Andrew’s doctors for nearly a year to secure a referral to an appropriate professional. We were repeatedly told, however, that there was no specialist within her MCO who could provide the services we needed. Ultimately, we had to resort to a non-Medicaid agency to provide the required IQ testing. Read more →

Jun 04

2014

Mixed Results for D.C. on Health Scorecard

On April 30, 2014, the Commonwealth Fund released its “Scorecard” on health performance results in the 50 states and the District of Columbia. The report, titled “Aiming Higher: Results from a Scorecard on State Health System Performance, 2014,” evaluates and ranks the states and the District based on indicators of health performance. Overall, the District came in 21st place, improving from its 24st place ranking in 2009, the year the last scorecard was released. Read more →

Aug 12

2013

Improper Terminations of EPD Waiver Program Recipients Grab Headlines

Stephanie Akpa

Stephanie Akpa, Equal Justice Works Fellow

This morning’s Washington Post features an insightful piece on improper terminations of participants in the District’s Elderly and Physically Disabled Waiver Program, commonly called the EPD Waiver Program.

The EPD Waiver Program provides home health care services to some of the District’s most vulnerable residents—seniors and individuals with physical disabilities who, without the services provided in the EPD Waiver Program, would be required to live in a nursing home or rely on family members to provide them with services or pay out of pocket for assistance. The program’s mission is to give people the home health services that they need to remain in their communities. In the last few years, that mission has been undermined as hundreds of EPD Waiver Program recipients have been terminated from the program by no fault of their own, but because their home health agency failed to submit the required paperwork to ensure that individuals continue to receive services.

Legal Aid is one of a handful of legal services organizations in the District that has represented and continues to represent and advocate on behalf of individuals who have been unfairly terminated from the EPD Waiver Program. Today’s article sheds light on this important issue and, with the advocacy of groups like Legal Aid, University Legal Services, and the Legal Counsel for the Elderly, will aid in reversing this alarming practice and help people get the support that they need to stay in their communities.

Jun 05

2013

DC Council Approves Health Care Reform Bill Establishing Unified Exchange

Stephanie Akpa

Stephanie Akpa, Equal Justice Works Fellow

Two of the better known parts of the Affordable Care Act are (1) the requirement for the creation of a health care marketplace (operated by the federal or state government, or a partnership between the federal and state government) through which individuals and small businesses can evaluate their health insurance options and sign up for plans, and (2) the accompanying requirement that individuals have public or private health insurance.  The District government is well on the way to having an operational marketplace by the October 1, 2013 deadline set out in the ACA, and Legal Aid attorneys have been actively participating in (and supporting) this effort. Read more →

Mar 08

2013

Implementing Health Reform in the District of Columbia

Stephanie Akpa

Stephanie Akpa, Equal Justice Works Fellow

In September of last year, I joined Legal Aid as an Equal Justice Works Fellow.  My project focuses on ensuring that African Americans in the District, a group that experiences disproportionately negative health outcomes, have access to quality health care.  One aspect of my project involves advocating for policies that advance the health care interests of the low-income African-American community.  With health reform underway in the District, I have had a unique and exciting opportunity to participate in the implementation of key provisions of the Affordable Care Act.

Legal Aid focuses on two primary features of the Affordable Care Act, often called the ACA or Obamacare, which President Obama signed into law on March 23, 2010:  (1) Medicaid expansion and eligibility determination, and (2) the creation of the DC Health Benefit Exchange.  As part of the ACA, states must decide whether to expand Medicaid to low-income childless adults. Although the District had provided coverage to this population even prior to the passage of the ACA through a program called the DC Healthcare Alliance, childless adults were previously ineligible for medical assistance in most states.  In conjunction with Medicaid expansion, the ACA changes Medicaid rules for determining household income and size.

The ACA also requires that states create Health Insurance Exchanges, virtual marketplaces where individuals and small businesses can compare and enroll in health plans.  Think Travelocity for health insurance.  Exchanges will also determine whether households or members of households are eligible for Medicaid, tax credits (which reduce the cost of premiums through the Exchange), and other subsidies.  Essentially, Exchanges will act as one-stop shops for federally-funded public health insurance and private health insurance.  Open enrollment will begin for health plans through Exchanges on October 1, 2013 and coverage will begin on January 1, 2014.

The expansion of Medicaid and creation of the DC Exchange touch upon the very heart of my project, as the vast majority of Legal Aid’s clients are eligible for Medicaid or other forms of medical assistance.  Although implementing health reform provides many opportunities to improve upon the existing process for obtaining and accessing health care in the District, these opportunities also present challenges.  One challenge will be ensuring that individuals who currently receive Medicaid do not lose coverage as a result of the process for determining Medicaid eligibility.  Additionally, the District must work to ensure continuous access to insurance coverage for individuals with fluctuating incomes—for example, individuals who transition from Medicaid to private insurance or vice versa.  The District must also provide sufficient staffing for the agencies that currently run the its medical assistance programs, as well as agencies that will oversee the Exchange, so that it can continue to meet the needs of the current Medicaid and medical assistance population even as the District implements health reform.  These are just a few of the issues that must be addressed for the Exchange to be successful in the District.

My project has allowed me to take an active role in articulating the concerns listed above and participating in the implementation process.  As part of my advocacy work, I have attended the District’s Health Reform Implementation Subcommittee meetings on Medicaid Eligibility and Expansion.  In October 2012, I worked with my Legal Aid colleagues to submit comments on the new process to determine eligibility for Medicaid.  Our comments addressed the potential negative impact of this new process on single-parent households and victims of domestic violence.  Last month, I testified before the DC Council’s Committee on Health on the implementation of the District’s Exchange, applauding the Executive Board for its efforts to engage stakeholders and noting Legal Aid’s concerns with implementation.  I also participate or will participate in a few short-term working groups designed to produce recommendations for how the District’s Exchange will operate, and anticipate potential problems before they arise.  And I was recently appointed to serve on the Consumer Assistance and Outreach Advisory Committee, a long-term committee that will focus on the District’s programs to provide education, outreach, and enrollment assistance to those seeking health insurance coverage.  In addition to this advocacy work, I will design and facilitate training sessions to educate community-based organizations and District residents about important aspects of health reform in the District.

All in all, the goals of my project and health reform are the same—ensuring that every District resident, regardless of income or ethnicity, has access to quality affordable health care.