Winter/Spring 2018
The Docket
Quarterly Newsletter

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What's Inside...
  • A Message from the Executive Director
  • Staff Spotlight: Eliza Presson, MHAP for Kids Attorney
  • Client Profile: Robin
  • Matt Selig on NBC10
  • Protecting the Health of Children with Disabilities
  • HLA Submits Amicus Brief
  • MHAP for Kids - Legislative Briefing
  • Fellowship Opportunity at HLA
  • HLA Staff News
  • Bill Cummings of the Cummings Foundation Releases Memoir
Staff Spotlight
MHAP for Kids Attorney 
Eliza Presson joined HLA's Mental Health Advocacy Program for Kids' (MHAP for Kids) team in June of 2016. She made the move from Washington D.C., where she was a staff attorney at the Children's Law Center (CLC). While at CLC for three years, she represented and advocated for the best interest of children in abuse and neglect proceedings, working with social workers, teachers, mental health specialists, and probation officers.

Although she relocated hundreds of miles from the nation's capital, the scope of Eliza's work at HLA is very similar to her work at CLC.  
As a MHAP for Kids attorney based in Lowell, Eliza represents young people with unmet mental health needs who are involved, or at-risk of being involved, with the juvenile court system.  She works with various stakeholders: state agencies, school systems, parents, and treatment providers and designs a plan that meets the child's needs. Eliza works out of the state's Family Resource Center (FRC) in Lowell which is operated by NFI, Inc. and provides a wide range of critical services for vulnerable families.
Eliza graduated from Harvard Law School in 2012 and has since been an advocate for children. "There are a finite amount of public resources," says Eliza. "And those who are surrounded by limited resources are the ones most in need of a lawyer to advocate for them. It's a community responsibility."
Eliza has a deep understanding of the systemic powers at play. Armed with extensive experience in child advocacy and expertise in the juvenile justice system, she approaches conflict with a holistic solution in mind.  
"The deck is so stacked. Schools are under-resourced. The state's FRCs are under-resourced. MHAP for Kids is providing a service where there is a profound shortage of resources for these kids."
Eliza recalls an instance where an 11-year-old boy with cognitive and behavioral issues assaulted an EMT in an ambulance during an episode that started in the child's school and led school personnel to seek transport to emergency care. Charges were filed in juvenile court against the child and HLA intervened. Knowing that any further involvement with the juvenile justice system would only make matters worse, Eliza successfully advocated for the charges to be dropped, and negotiated with the school to place the child in a learning environment best suited to his needs. "We changed the school's perspective, which may impact future cases that are similar to this one."
Not every case leads to an permeating victory, but as Eliza says, "Sometimes those small wins are enough at this moment. Our goal is to help that young person, that family. If we do that, we're successful. But all these small wins are on their way to leading to a big scale change in how kids from disadvantaged backgrounds access mental health services." 
At NFI in Lowell, Eliza has the benefit of being a part of the community she is working for. "I really value that we serve a geographic area that is underserved. I'm lucky to work with a passionate set of colleagues who come to this work with a lot of experience and perspective." 
Protecting the Health of Children with Disabilities

Persons with disabilities, disability advocates, and many policymakers have long fought successfully for access to health services that enable persons with disabilities to live independently. 

In 2016, HLA announced the creation of its Protecting the Health of Children with Disabilities Project to contribute to these longstanding efforts. The impetus for this HLA initiative was a dramatic influx of client matters involving children with significant disabilities who were denied previously provided coverage for in-home nursing and other home-based services. We had handled several matters like this before, but the wave of new cases was staggering.

HLA heard from numerous families across the state who had lost access to health services needed to keep their children safe in their home.   A generous grant from The Boston Foundation enabled HLA to focus on the needs of these families. HLA Staff Attorney Elizabeth Ganz is leading these critical efforts for our clients.
The state is significantly reforming the way in which in-home health services are covered for children and others and there is much work to be done to ensure families receive needed care. The families HLA works with and many others still face significant hardships securing the services children need to be safe. Attorneys from other legal aid organizations report that their clients experience the same issues. HLA will be working with our legal aid colleagues and others to address this difficult challenge.   
Public Interest Fellowship Opportunity!

HLA seeks recently admitted attorneys to serve at HLA through the AmeriCorps Legal Advocates of Mass. program. Fellows serving at HLA gain invaluable legal experience while serving some of the most vulnerable members of our society and receiving mentoring from experienced attorneys and the opportunity to build your professional network. Please contact HLA's Executive Director Matt Selig if you wish to serve a fellowship at HLA.   
HLA Staff News
Please join us in welcoming the following recent additions to our fantastic staff:
Eugenie Aikens is HLA's newest paralegal through Northeastern University's Co-op program. She is in her third year of her undergraduate degree studying International Affairs with a regional focus in African Studies. She currently plans to graduate next spring with the hope of pursuing a law degree.  
Elizabeth Ganz joined HLA as a Staff Attorney on the public programs team in December 2017. Prior to joining HLA, Liz worked with the SHINE Program, counseling clients regarding their health insurance options under public health benefit programs, and has worked in both the AG's Medicaid Fraud Control Unit and the Joint Committee on Health Care at the State House. Liz holds a law degree with a health care concentration from the Boston University School of Law. 
Ethan Kolodny joined in January 2018 as the new AmeriCorps Fellow. He is a graduate of Northeastern University School of Law, and worked in a variety of health-related legal fellowships; including Krokidas & Bluestein LLP, Parter's HealthCare in their Office of the General Counsel, among others.  
We also bid a bittersweet farewell to:
Kimberly Romero served as HLA's valued Paralegal/Intake Coordinator through Northeastern University's co-op program. Kimberly will be returning to classes and plans to graduate in May 2019 and plans to pursue a law degree.   
Caroline Donahue, who first started as HLA's Parmet Fellow in 2015 and worked on the private insurance team, returned in Spring 2017 as the AmeriCorps Fellow and served on the public programs team. Caroline recently ended her highly successful tenure and joined the General Counsel's office at UMass Memorial Health Care.  
View the full staff list here.  
A Message from the Executive Director
Dear Friends, 

We are very pleased to share this newsletter to provide you with a slice of the action here at HLA. We have a great team who, because of your ongoing support, are working hard on behalf of those who need our help to access health care. 
Each day, we take on new clients who come to us with a wide variety of barriers to health care. We're also dedicating significant resources to projects we have developed to address health care barriers that impact a large number of people. We have 8 such programs at this time and you can read more about each one of them here.
HLA is proud of our role as the state's only non-profit law firm dedicated exclusively to ensuring health care access for low-income consumers. We strive to serve consumers from every area of the Commonwealth. We also welcome your thoughts on what we should be doing in our current programming and what else we should be doing! To let us know, simply reply to this email.

We hope you enjoy the Spring (when it eventually arrives)! 

With appreciation, 
Matt Selig
Executive Director   
A Small Change in Her Health Plan Makes a Big Change in a Transgender Woman's Life  
Fighting for the health of the transgender community

It was the beginning of February of 2015. The paperwork and medical records were completed and signed and, along with a letter of reference from her counselor, Robin submitted them to her health insurer. Everything seemed to be in order. February 10th was the day Robin would undergo gender-affirming surgery.

Gov. Patrick signing the Transgender Equality Bill into Law.
In June of 2014, only seven months prior to Robin's scheduled surgery, the state's Division of Insurance (DOI) issued a rule requiring health plans to cover gender-affirming health care. The rule implemented the Act Relative to Gender Identity signed into law by then-Governor Deval Patrick in 2011. 

HLA, AIDS Action Committee, the Center for American Progress, Community Catalyst, GLAD, Health Care For All, the Mass. Transgender Political Coalition, and MassEquality joined forces in 2013 to advocate for the DOI to issue this important rule. This was a big win for the transgender community, who so often experienced discrimination when they sought surgery, hormonal treatments, and other gender-affirming care. It meant that low-income transgender individuals in particular could finally receive coverage for life-changing and necessary health care, something that was reserved for those who could afford to pay out-of-pocket or were lucky enough to be enrolled in a plan that voluntarily covered gender-affirming health care.

When Robin heard about this new insurance rule, she called her health plan. "They confirmed it," she said. "I couldn't believe it. I've been in the wrong body my entire life. And now... now I could really be who I was."

However, though MassHealth and private insurers were mandated by law to cover gender-affirming care, establishing that the services are medically necessary and finding a provider to deliver care remain among the steep hurdles consumers still must climb. A misinterpretation of one's medical records by their insurer or an error in filling out the insurer's forms can result in gender-affirming surgery being denied. After a lot of time and energy, transgender individuals can find themselves back at square one if everything doesn't go just right.

Robin in January 2018.
Robin made an appointment with her doctor in December of 2014 to discuss her options. After years of taking hormonal treatments and living as a woman, her candidacy for gender-affirming surgery was deemed "ideal" and the procedure was scheduled.

There was a deposit of $2,000 required, which Robin put on her credit card thinking it would be fully reimbursed by her insurer when she submitted the paperwork.

A week before her surgery, she heard from her insurer. Coverage for the surgery was denied. "I was so close. February 10 th - that was the date. I looked forward to it for weeks. So... I put it all on my credit card." The out-of-pocket costs amounted to $19,500, but Robin was hopeful that she would eventually be reimbursed by her insurer.

In March, a month after her surgery, she submitted everything to her health plan again-and was denied, again. That's when she called HLA. Supervising Attorney Andrew Cohen, who leads HLA's transgender health advocacy took the case.

HLA had been hearing from and about a growing number of transgender individuals who were routinely denied access to transgender medical services for several years despite the positive developments in the law. So, in 2013, HLA developed its   Transgender Health Access Project to serve the transgender community and tackle systemic bias in the health care system.

The Boston Foundation's Equality Fund, Community Catalyst's ACA Implementation Fund, and the Massachusetts Bar Foundation have supported HLA's transgender health advocacy with targeted funding. Grants from the Blue Cross Blue Shield of Massachusetts Foundation, The Klarman Family Foundation, and The Nord Family Foundation and contributions from hundreds of businesses and individuals are critical to supporting HLA, including this initiative.  

"This work is at the leading edge of the civil rights movement for trans people," says Attorney Cohen. "Health care is critical to helping trans and gender non-conforming people affirm their identities. We're working with our clients and partner organizations to change a system that has been unfair for so long."

Robin recalled, "After I called HLA, I got a call from Andrew. He asked for documentation, copies of everything I paid out, invoices. He advocated for me and asked the tough questions." Still, the appeal HLA filed on Robin's behalf was unsuccessful. Robin had to go to an out-of-state surgeon because there was no in-state surgeon for her procedure. Despite Andrew's vigorous efforts to broker a payment arrangement between Robin's surgeon and her insurer, the two sides refused to come together, leaving Robin with the nearly $20,000 bill.   

Fast forward to 2017, Andrew, having kept Robin's matter in mind, found an opening to advocate once again for her. Through his continued advocacy on transgender health matters, he learned that her health plan had started reaching payment arrangements with out-of-state transgender health care providers. "Andrew called and said, 'Hey, something has come up and there have been some changes. I want to reopen your case,'" Robin remembers. Andrew sent Robin new forms to fill out. "It was very specific. The price of every scalpel, band aid, how many gloves were used, notes from the surgeon. Original payments to the doctor. That much detail." Robin and Andrew collected lists, notes, paperwork, receipts, and appealed once again.

"I just waited." About a month later in December 2017, Robin received a handwritten envelope from her insurance company. "I was so nervous, I couldn't open it. I was hoping I would at least be reimbursed for half the amount. I called Andrew but he was on vacation at the time. I thought, 'there may be legal implications to opening it!' So I let it sit there and tried to ignore it."

Andrew returned to the office from the holiday break and called Robin back immediately. "Yeah! Open it!". Inside the envelope was a check for $19,500, the full amount. "I cried," recalls Robin. "I thought it said $1,900. I had to take my glasses off. I couldn't believe it." Robin remembers her dog staring with a worried look in her eye. "I had to sit her down next to me and say, 'it's okay, Georgie,'" laughed Robin.

The reimbursement went directly to the bank and paid down some debts. "It's hard to describe the burden I was under. Finances have always been a weight on my chest, but now I feel like I can live my life again. 
I'm who I am on the outside for the first time in my life. I have hope now. I didn't have much of that before."

Learn more about HLA's advocacy for transgender health care access here. 
HLA's Matt Selig Stops by NBC10 to Discuss the Persistent Issue of Medical Debt

"Recent data from the Urban Institute says that about 16% of adults have a medical bill that is past due. The Affordable Care Act has helped reduce that amount quite a bit, but medical debt still is a major problem for a lot of people in Massachusetts."

See the full interview here .
HLA et al file an Amicus Brief with the SJC 
For a duty of pharmacies to inform prescribers of prior authorization requirements 

HLA, along with the Massachusetts Law Reform Institute, Northeastern University's Center for Health Policy and Law, and the Public Health Advocacy Institute, filed an amicus brief in January in the state's Supreme Judicial Court arguing in favor of the Court imposing a legal duty on pharmacies to inform prescribers when there is a prior authorization requirement for a medication.
The case, Correa v. Schoeck, is a wrongful death suit brought by the family of a teenage girl who tragically suffered a fatal seizure as a result of not having access to her epilepsy medication. The young woman had previously been prescribed the medication, which was successful in treating her life-threatening condition. However, the medication required her doctor to submit a prior authorization request to her insurance to be approved. Despite repeated assurances, the young woman's local pharmacy never notified her doctor of the prior authorization requirement, and as a result, the form was never submitted and the young woman did not receive her medication. Tragically, this led to her death.
In considering this case, the Court requested amicus briefs to address whether a pharmacy owes a duty of care to its customer to notify her prescriber that her insurer will not pay for her prescription medication without prior authorization. HLA's brief supports the family's argument that pharmacies have a legal duty to notify the doctor of a prior authorization requirement. HLA's brief concluded, in part, that "(w)hen the steps to prevent harmful impacts upon patient care are minimal-such as a pharmacy faxing or otherwise communicating to the prescriber that the medication was not covered due to a PA restriction imposition of a duty to take such steps supports the public policy goals of controlling growing health care costs, while also safeguarding consumer health."

MHAP for Kids Holds Legislative Briefing at the State House

Rep. Thomas Golden, Eliza Presson, Marisol Garcia, and Lisa Morrow.

On January 25th, HLA's Mental Health Advocacy Program for Kids (MHAP for Kids) held a  briefing for legislators, legislative staff at the Massachusetts State House. Project Director, Marisol Garcia, shared the findings of a 2-year study that analyzed the efficacy of the program. State Representative Thomas Golden of Lowell spoke of the necessity of MHAP for Kids, adding "It is our responsibility to invest in the mental health of our kids."

Two parents recounted each of their experiences with MHAP for Kids attorneys, Lisa Morrow and Eliza Presson, and described the necessity of their advocacy within the schools, with their health care providers, and ultimately, the difference it made in each of their child's lives.

MHAP for Kids has offices in Lynn, Lowell, and beginning in April, in Boston. The program's attorneys work out of Family Resource Centers, funded by the Department of Children and Families, representing children, advocating for their mental health care, and divert them from the juvenile justice system.

MHAP for Kids is generously supported by a lead grant from The Peter and Elizabeth C. Tower Foundation and generous grants from The Theodore Edson Parker Foundation, The Cabot Family Charitable Trust, The Mabel Louise Riley Foundation, The Gardiner Howland Shaw Foundation, The John W. Alden Trust, and The Bennett Family Foundation. Prior generous grants for the program have been provided by The Klarman Family Foundation, the Blue Cross Blue Shield of Massachusetts Foundation, The Ludcke Foundation, The C.F. Adams Trust, The Massachusetts Bar Foundation and The Eastern Bank Foundation. 
The Massachusetts Department of Children and Families also provides generous support for MHAP for Kids.
Generous support for this work has also been provided by contributions from Boston Children's Hospital and Hagens Berman Sobol Shapiro LLP and many more corporate and individual HLA supporters.

Learn more about HLA's work advocating for the mental health of young people here.

Bill Cummings of the Cummings Foundation Releases Memoir

Through his latest venture, Bill Cummings has added "author" to his portfolio of titles. And in true Cummings fashion, he is dedicating all the proceeds from the sale of his new memoir to the Cummings Foundation for charitable causes.

Read some of the buzz on The Boston Globe and Inside Philanthropy.

The Cummings Foundation has been a generous supporter of HLA's work in the past and we're happy to promote the release of Mr. Cummings book!

Learn more here.