Medicaid review board votes to lift some restrictions on life-saving cures for Vermonters with hepatitis C
At its meeting on December 6, Vermont Medicaid’s Drug Utilization Review Board (DURB) voted to lift some of the restrictions that currently prevent most Vermont Medicaid patients with hepatitis C from accessing life-saving cures. If the DURB’s recommendation is accepted by Department of Vermont Health Access Commissioner Steven Costantino, many more Vermonters on Medicaid who have the life-threatening disease will gain access to treatment. According to the CDC, hepatitis C kills more Americans than any other infectious disease and Baby Boomers are most at risk.

Vermont Legal Aid’s Office of the Health Care Advocate and a coalition of organizations sent a letter to the DURB in late October asking the Board to review and remove all restrictions on hepatitis C medications that deny patients access to medically necessary care and cause unnecessary harm to Vermonters. ...

Julia Shaw, a policy analyst with the Office of the Health Care Advocate, said, “We were hopeful that the DURB would lift all the restrictions as other states like Massachusetts and Connecticut have done, and as we believe is required by federal Medicaid law. However, this is an important step in the right direction. We are very happy that the DURB lifted the sobriety requirement, which is particularly arbitrary and punitive to people, many of whom are unable to access substance abuse treatment.

Ensuring that more patients can access curative treatments for hepatitis C will benefit those individuals greatly and will help prevent new infections.”

“We’re pleased that the DURB voted to revisit the issue within the next six months to consider expanding access further,” Shaw added. “Federal courts, national medical guidelines, and other state Medicaid agencies have recognized that treatment of every patient with hepatitis C is the standard of care. There is simply no medical reason for Vermont to withhold access to this cure.”

“Commissioner Costantino acknowledged in remarks last week that those who have hepatitis C should have the opportunity to be cured of hepatitis C – and that it’s morally the right thing to do. We’re hopeful that he will not only accept the DURB’s recommendations, but also move as quickly as possible to make treatment available to every Vermonter who needs it,” Shaw said.

This article was the lead story in the Vermont Biz eHealth newsletter, which is distributed every Tuesday. Vermont Business Magazine included additional information from the CDC and other sources about the scope of hepatitis C infection and risks, along with this quote:

“Why are so many Americans dying of this preventable, curable disease?” asked Jonathan Mermin, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “Once hepatitis C testing and treatment are as routine as they are for high cholesterol and colon cancer, we will see people living the long, healthy lives they deserve.”

Some Americans are Choosing to Take a Tax Penalty Instead of Buying Health Coverage

It’s possible that the Affordable Care Act (ACA) – also known as “Obamacare” – may be an endangered species. And those who have called for a repeal have one specific element that draws their ire: the individual mandate. But it turns out, the government’s requirement that Americans buy healthcare plans may not exactly be working as expected anyway. ...

I recently spoke with Christine Speidel, a tax lawyer at Vermont Legal Aid. She explained to me that the tax penalty was largely created to spur citizens who have been known to forego health coverage, most notably young and healthy ones, to enter the “risk pool,” which would help cover the more popular components of the law, like coverage for those with pre-existing conditions.

“In order to make this work as a private insurance market, you have to have a viable risk pool,” Speidel explained. “Which means you have healthy individuals in the risk pool as well as sick ones.” ...

So if the ACA needs everyone to buy in for it to work, why not just simply raise the penalty to a level that Americans would actually feel? Speidel says it’s not that simple.

“That might work for people who have higher incomes. But for people who are already feeling like they can’t afford insurance, increasing the penalty may just lead to resentment and huge tax bills,” she said. “If the penalties were equal to the premiums, there would be no incentive for those who can afford it not to purchase insurance. But for those who truly can’t afford it, that would be terribly unfair and punitive. Raising the subsidy levels would also help with compliance and improve the risk pool. ...

“I think it’s too soon to say what effect a Trump presidency will have on the ACA, but it’s interesting that both Mitt Romney, when he enacted a similar plan to the ACA when he was governor of Massachusetts, and President Obama, when he started to draw up the ACA, were against some sort of mandate. But when the economists and the actuaries ran the budgets, it became hard to have a bar against pre-existing condition exclusions without having some sort of mandate.”

CONTACT:   Eric Avildsen, Executive Director

Former State Representative Michael Fisher to Join Vermont Legal Aid as Chief Health Care Advocate 

Former state representative Michael Fisher will join Vermont Legal Aid as Vermont’s Chief Health Care Advocate on January 2. Fisher will lead the Office of the Health Care Advocate, which was established by the legislature in 1998 to assist Vermonters who have questions and problems with access to health care services and health insurance and to represent the health care interests of all Vermonters in the legislature and before state agencies.

Fisher was elected seven times to represent Addison-4 in the state legislature. He served in a variety of leadership roles including chairing the House Health Care Committee for three years and serving for six years as vice chair of the House Human Services Committee. Fisher played a key role in the passage of legislation that reduced Vermont’s uninsured rate from seven percent to three percent by establishing Vermont’s health insurance marketplace and expanding Medicaid. He also helped write and ultimately pass legislation that created the Green Mountain Care Board whose purpose is to reduce the rate of health care cost growth in Vermont while ensuring that the State maintains a high quality, accessible health care system.

Having worked as a community social work clinician for over 25 years, Fisher has direct knowledge of the multiple and complex health care and human service needs that many Vermont families face and the critical role the Office of the Health Care Advocate plays in assisting them.

“Mike brings a deep understanding of Vermont’s health care laws, the legislative process, and the numerous challenges that many struggling Vermonters face on a daily basis,” said Eric Avildsen, Executive Director of Vermont Legal Aid. “We are especially pleased to have someone with Mike’s experience during this time of great uncertainty for many Vermonters who are worried about losing the insurance they finally were able to obtain.”

“I look forward to being a strong, independent voice for Vermonters,” Fisher said. “This is a particularly interesting time to be involved in health care advocacy. I’m proud that Vermont has been a leader in expanding access to health care, yet we know that the cost of getting care is still too expensive for many.  As the state is poised again to lead the nation by implementing the All-Payer Model, we will evaluate critically the potential role of the private sector in payment and delivery reform, the intricacies of the model, and how to ensure that there is a transparent process where Vermonters are protected.”

The Office of the Health Care Advocate (HCA) helps Vermont consumers with a broad range of problems and questions related to health care services and health insurance. The HCA acts as a voice and advocate for consumers in health care policy matters before the Vermont legislature and government agencies that oversee insurance and health care programs. The Office of the Health Care Advocate is a project of Vermont Legal Aid.

Vermont Legal Aid (VLA) is a non-profit law firm that provides legal advice and services to individuals and families throughout Vermont who are facing a civil legal problem that threatens their rights, shelter, job, health, or well-being. VLA began serving clients in 1968.

For Some Vermonters Suffering From Hepatitis C, Life-Saving Cure Is Out Of Reach

Health advocates are challenging a Vermont Medicaid policy that has restricted curative treatment for hepatitis C only to patients with advanced liver problems. And while state officials say they’re open to changing the policy, they say offering treatment to all low-income Vermonters could cost taxpayers as much as $25 million over two years. ...

Julia Shawis the health care policy analyst in the Office of the Health Care Advocate, which is administered by Vermont Legal Aid. Shaw says the policy is tragically misguided.

“Because hepatitis C is such a serious illness and because our Medicaid program is systematically denying a large portion of the population access to a curative treatment for something so serious,” Shaw says.

Here’s the issue for the potentially hundreds of Medicaid beneficiaries like the Patient in this story: Doctors assess liver damage using what’s known as a Metavir fibrosis score. It basically measures the amount of scarring on the liver. And under Vermont Medicaid’s prior-authorization policy, beneficiaries don’t get the cure until they have a score of F3 or higher, which, according to Shaw, “basically requires a patient with Hepatitis C to have significant liver damage before they’re able to be treated.” ...

With the abundance of medical evidence pointing to the benefits of early treatment, Shaw says the Vermont Medicaid policy is indefensible.

“Denying patients access to something with such clear benefits is immoral, it’s illegal, and it shouldn’t be happening,” Shaw says. ...

Vermont Legal Aid is also trying to get the state to change other elements of its hepatitis C treatment policy. Existing policy requires patients to see a specialist, a requirement Shaw says creates a too-high hurdle for patients in rural areas of the state.

The state also requires patients to remain drug- and alcohol-free for six months before they begin treatment.

Shaw says people using drugs or alcohol are statistically as likely to benefit from the treatment as people who abstain. And she says the requirement might allow the virus to remain in populations at highest risk of passing it on to others. ...

The state’s Drug Utilization Review Board is meeting next week to consider a rule change.

Council recommends fighting poverty with affordable housing

One of Gov. Peter Shumlin’s special commissions says the state can eradicate poverty faster if it dedicates more money to building affordable housing and funding rental assistance programs.

For the second year in a row, the Council on Pathways from Poverty has proposed a new $2 per night occupancy fee on people staying in hotels and motels so the state can use the money revenue to fight homelessness. The measure didn’t pass in the last biennium. ...

Chris Curtis, an attorney for Vermont Legal Aid who serves as co-chair of the council, said low-budget motels are already subsidizing homelessness programs because they accept state-funded vouchers that pay for people in housing crises to stay in the motels.

He said those motels are sharing the burden of addressing homelessness by accepting the vouchers, but larger and higher-end hotels are not. He said if all hotels and motels had to collect the fee, the whole industry would be involved in ending homelessness.

The $2 nightly occupancy fee the council is proposing would raise between $11 million and $12 million per year. Curtis said that out-of-state tourists would pay 94 percent of the total.

“We hear over and over again that Vermonters do not have any additional taxing capacity,” Curtis said. “This is a fee that would not fall on Vermonters. It would primarily fall on out-of-staters.”

Increasing Access: It must be Ethical

Over the next few days, I’m going to use this space to share the ideas that I shared at [the Vermont Law School Summer Lecture Series]. The ideas are limited to how the Rules of Professional Conduct can be used to increase access to legal services.  Many other ideas exist and are worth discussing.  However, they are beyond the scope of the ethics rules and, therefore, beyond the scope of this column. ...

Don’t get me wrong: many lawyers are providing top-notch work to clients who have little or no ability to pay. Among them, the staff attorneys at Vermont Legal Aid, LawLine of Vermont, and the Defender General’s office.  Further, there are several excellent programs that are up & running.  At the risk of excluding some, I’ll list a few off the top of my head:
◾VLS Clinics
◾Vermont Volunteer Lawyers’ Project
◾Chittenden Rent Escrow Clinic
◾Vermont Bar Foundation
◾VBA Modest Means Programs
◾VBA Pro Bono & Low Bono Programs

Shumlin touts health exchange as best argument for Obamacare

Gov. Peter Shumlin said Tuesday that Vermont Health Connect is working as well as it possibly can and the majority of users are not experiencing problems. ...

The governor used the status update on Vermont Health Connect to defend the federal Affordable Care Act that created it. He said it would be “a disaster” for Vermont if President-elect Donald Trump dismantled the law, as he promised during the campaign. ...

Chris Curtis, an attorney for Vermont Legal Aid, said the mantra in Washington, D.C., is to “repeal and replace” the Affordable Care Act, but when he asks what should replace the law, “you hear crickets.”

“The reason that nobody wants to talk about that is that what they would be replacing it with is higher costs associated with health care, a higher rate of uninsured, more people struggling to make ends meet because they can’t afford to pay their bills,” Curtis said.

He said repealing the Affordable Care Act would have an “incredibly destabilizing effect” on Vermont’s economy and people who depend on subsidized health insurance to get medical care.

“(Repeal) is going to be incredibly confusing,” he said. “It’s going to be anxiety producing because nobody’s going to know what to do or where to turn.”

Rooming house zoning requirement has to be redone

A sharp-eyed attorney from Vermont Legal Aid has discovered that the town failed to follow the state requirement for public posting of potential new zoning regulations, meaning the new rooming house regulations have to have another public hearing and be re-adopted. ...

As a result, adoption of the rooming house zoning change will be postponed by at least a month, since the town must re-warn the public hearing, resetting the clock on when the new zoning requirement goes into effect. ...

Jacob Speidel, a staff attorney with Vermont Legal Aid in Springfield, said he and fellow Legal Aid attorney Mairead O’Reillyhad written a letter to the town about the perceived public notice problems.

“We’re pleased they have acknowledged an error. We hope this will allow the Select Board to take a fresh look at the issue and our concerns,” said Speidel on Wednesday.

Providers prep for refugees amid post-election uncertainties

A network of service providers is moving ahead with preparations for the arrival of Syrian and Iraqi refugees in Rutland amidst uncertainty about what a Trump presidency will mean for resettlement efforts.

The Rutland Refugee and Immigrant Service Providers Network will hold its first meeting Nov. 30 at the Rutland Free Library. The network is based on a model used in Chittenden County, which has had its own provider network for at least 15 years, according to state refugee coordinator Denise Lamoureux.

Lamoureux said the Chittenden County group meets about every six weeks. Members go over the nuts and bolts of resettlement, such as who’s arriving and when, and address specific questions members have. For example, Vermont Legal Aid will be attending the next Chittenden County meeting to discuss questions regarding refugees and taxes.

Board grants anonymity to surgical center investors

The Green Mountain Care Board has granted a request by independent doctors to keep their identities secret in their permit application to open a surgical center. ...

The doctors have been called simply “Physicians A-P” in regulatory documents, where their lawyers argue that using their real names would subject them to retaliation by hospitals. ...

On Wednesday, Vermont Legal Aid’s Office of the Health Care Advocate asked the board to allow it to see the names of the doctors involved in the case, saying, “We cannot fully fulfill our role without access to all available information.”

The board declined to comment on whether it would consider the request, because it is part of an ongoing case.