Health Law Advocates
Winter 2015
The Docket
Quarterly Newsletter

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What's Inside...
  • A Message from the Executive Director
  • Client Profile: Denial of Coverage Threatens 13 Years of Sobriety
  • HLA Board Profile: Eleanor Soeffing
  • 2015 in Review... And Looking Ahead to 2016
  • HLA Staff News
  • HLA Celebrates Our 20th Anniversary at the Annual Benefit Breakfast
Board Profile:
Eleanor Soeffing  
Ellie Soeffing joined HLA's Board of Directors in 2005 and has contributed invaluable leadership from her over 25 years of experience in the health care sector. Ellie's diverse experience includes positions with academic and community hospitals, physicians, and insurance and technology companies and she brings a unique and valued perspective to HLA's mission and approach.

Ellie began her career in health care advocacy while as a student at Cornell University. Her passion for women's health and reproductive freedom drew her to Planned Parenthood, where she was a counselor, medical assistant, and performed community outreach in rural areas. Her interest in affordable and accessible health care continued at the University of Michigan, where she received her Master's in Hospital Administration.

After moving to Newton and having their first child, Ellie and her husband met Wendy Parmet, a mother with a child the same age as Ellie's, and coincidentally, one of HLA's founding board members. Knowing of Ellie's experience in health care finance and delivery, Wendy nominated Ellie to join HLA's Board. Given Ellie's financial expertise, she succeeded long-time Board member, Tom Sellers, in his role of Treasurer, a position she held for more than 5 years.

Ellie has held positions in hospitals and insurance companies, including the Director of Product Management and Strategic Planning Manager for Harvard Pilgrim Health Care, VP of Managed Care for two Boston-area hospitals, and has taught at Harvard University's Graduate School of Public Health.

Mid-career Ellie's interests led her to Health Dialog, a population management company that aims to "empower people to improve their health while reducing unnecessary healthcare costs." After five years there, Ellie pursued work organizing providers to provide high quality cost effective care through Accountable Care Organizations (ACOs) first at Beth Israel Deaconess Care Organization, managing their Medicare Pioneer ACO, then at the national level with Anthem, Inc. ACOs are a transformational model in which groups of doctors, hospitals, and other health care providers come together to provide coordinated high quality care to their patients. Ellie says, "I've always been interested in access and cost-effective care. That's always been a theme in my work... Healthcare has been delivered the same way for a long time. But it needs to be transformed to be a more patient-centered and cost-conscious industry."

Ellie has been a tremendous resource in helping HLA think critically about our strategic plan. Access to affordable health care remains to be a major obstacle for many low-income Massachusetts residents. "HLA has done great work making sure their clients have access to good care. And often people think that because Massachusetts as universal health care means that there aren't barriers. But HLA really fights to get the health care that people truly need," says Ellie.

Ellie still lives in Newton with her husband, and has remained active in her community as she did as a Cornell undergrad. She has served on the Health Care Advisory Council for the City of Newton, the Newton Wellesley Hospital Board of Overseers, and currently is a member of the Philanthropy Connection, where she sits on a grant review committee and counsels the team on financial analysis of grant requests.

After 10 years of serving on HLA's Board, Ellie says, "I am honored to serve on HLA's Board. I believe that access to health care is an important right and HLA never fails to amaze me with the large impact they are able to make, especially with such a small staff and a modest budget."
HLA Staff News
Please join us in welcoming the following addition to our fantastic staff:
To view a full list of HLA's staff and their bios please  click here
Jocelyn McAuley will
join HLA in January as our Paralegal/Intake Coordinator.  In this role, Jocelyn will be the first voice all of our new clients hear. She will conduct initial intake interviews with our clients, prepare case summaries and distribute cases to our lawyers. A member of the Northeastern University class of '16, Joceyln  comes to HLA through the school's co-op program. She has previous work experience at the Boston law firm Gilman, McLaughlin & Hanrahan, a non-profit social service agency in Buenos Aires and at General Dynamics.
We also bid a bittersweet farewell in December to:
Madeleine Laffitte
who joined HLA as our Paralegal/Intake Coordinator in June. Madeleine will graduate from Northeastern in May.
Hayley MacKenzie who joined HLA as our  Program and Development Assistant in July, and came with high accolades from our sister organization, Health Care For All where she served through Northeastern's co-op program. Hayley was a tremendous help in planningour 20th Annual Benefit Breakfast! She will graduate from Northeastern in 2018. 
Thank you for the fabulous work you've done at HLA. We wish you all the best in your future endeavors!
A Message from the Executive Director
Dear Friends,
We are very grateful for your generous support and partnership throughout this, our 20th, year. For HLA, it has been an eventful and extremely productive 2015. We've represented more than 600 low-income consumers denied health care access across every Massachusetts county. Our lawyers also won critical health policy reforms and educated thousands of consumers about their legal rights to health care access. A complete summary of our 2015 advocacy is below along with our plans for 2016.

We wish you the very best during this holiday season and look forwarding to seeing you in 2016. 

With appreciation, 
Matt Selig
Executive Director 

Client Profile
Denial of Coverage Threatens 13 Years of Sobriety
Suffolk Law's Health Law Clinic Comes Through in HLA's Legal Network 
Suffolk University Boston Law School

HLA's Pro Bono Legal Network is made up of lawyers who accept pro bono referrals from HLA. This program is vital to HLA in that it expands our capacity beyond our staff to assist those who contact us seeking help accessing health care. For many years, the Suffolk University Health Law Clinic, under the leadership of Associate Clinical Professor Sarah Boonin, has been an outstanding member of our Legal Network. In fact, Professor Boonin was named our Legal Network Lawyer of the Month in April.

Timothy R. Shannon, a third year law student at Suffolk University School of Law with a focus in health law, reports here on a recent success story involving an HLA referral case... 

The Suffolk University Health Law Clinic recently prevailed in the case of S.K., a 61-year-old man in long-term recovery from opioid dependency, who was denied coverage for much-needed methadone maintenance treatment. S.K. first came to HLA distraught and frustrated after his employer switched insurance carriers and after years of coverage for his methadone maintenance, the new insurer denied him coverage. This abrupt loss of coverage occurred after the client had been successfully receiving methadone treatment and maintaining his sobriety for over 13 years. Opioid dependency is a life-long battle with alarmingly high relapse rates, and in this client's case, methadone maintenance had been nothing short of life-saving. The sudden loss of coverage, and unsustainable medical expenses associated therewith threatened S.K.'s long-term sobriety. Moreover, the take-home dosing the client had been receiving permitted him to work full-time for a non-profit organization helping at-risk youth. The client knew that ongoing maintenance treatment was critical to his survival.

S.K.'s new insurer had denied coverage for the methadone maintenance on the basis that it was listed among the plan's general exclusions and was not a covered benefit. The client, desperate to maintain his treatment, struggled to pay for the methadone out-of-pocket for several months, incurring a total of $3,650 in costs. The Suffolk Law Clinic immediately sprang into action, discovering that the insurer had recently changed its policy regarding methadone and was scheduled to begin covering the treatment (along with many other Massachusetts insurers) beginning in July. Suffolk Law students obtained copies of the new policy and re-submitted the claim, which was accepted. This allowed S.K. to once again begin receiving coverage for his ongoing treatment. Once his ongoing coverage was secured, student attorneys then filed an appeal with S.K.'s insurer for retroactive coverage to reimburse the client for his costs incurred during the gap in coverage. The students gathered affidavits and letters from the client, his providers and others, and utilized creative advocacy to argue for coverage based on reasons of public policy, medical necessity, and violations of Massachusetts and Federal Mental Health Parity laws.

In early November, S.K. received news that the insurer would fully reimburse him for all out-of-pocket costs associated with the treatment, and continue to provide coverage going forward. The client, as well as the students and faculty who worked on the case, were extremely pleased with outcome. The next phase in the Clinic's work on behalf of the client will involve challenging the coverage limitations of the client's secondary insurer. A victory in that appeal will allow S.K. to drop his employer-sponsored insurance and save the costs of two premiums each month .

2015 In Review...
Thanks to our supporters, HLA's team was able to make strides in all of our initiatives, including breaking down health care barriers for immigrants, eliminating devastating medical debt, and advocating for coverage for substance use treatment.
  • Led a coalition of advocates' successful effort to move the state to improve its process for enrolling low-income immigrants in health insurance by correcting systemic flaws that were denying immigrants health coverage.
  • Represented more than 80 low-income immigrants denied health care and conducted more than a dozen trainings for immigrants on how to navigate the health care system.
  • Launched a two-year pilot mental health advocacy program in two juvenile courts as the basis for a statewide juvenile court mental health advocacy program. The pilot is being evaluated by independent experts to quantify the program's return on potential investment by the state. The program builds on HLA's ten years of advocacy for more than 400 youth in juvenile court with mental illness.
  • Advocated for more than 175 low-income clients with medical debt and relieved them of more than $400,000 in unjustly imposed medical bills.
  • Instituted a special project to protect the rights of 1.4 million Massachusetts residents required to reapply for subsidized coverage in 2015 due to prior problems with Affordable Care Act implementation.
  • Led a statewide advocacy movement to ensure aggressive state enforcement of a 2014 law mandating coverage for vital substance use treatment.
  • Worked with a 6,000 employee business to bring its health plan into compliance with the parity laws after identifying a non-compliant limit on autism services in an individual client matter.
  Looking ahead to 2016...

HLA will continue to provide free legal services to low-income Massachusetts residents denied access to or unable to afford health care as HLA has for the past 20 years, and...

  • Defend low-income immigrants through legal representation and policy advocacy against limits on their access to affordable health care. 
  • Provide educational programs to help low-income immigrants navigate our health care system.
  •   Seek to expand HLA's juvenile court mental health advocacy pilot program to help more children who have been denied access to needed care and are at risk of further justice system involvement.
  • Advocate for the rights of many children with significant mental health needs who become stuck in hospital emergency departments or medical units or are simply sent home while they suffer awaiting inpatient mental health care.
  • Work to ensure that Massachusetts remains committed to implementing the Affordable Care Act with policies that address the concerns of low-income consumers.
  •  Protect low-income consumers who are denied health care they are supposed to receive under the ACA.
  • Engage in legal and policy advocacy to protect vulnerable consumers from high out-of-pocket health care costs that still concern more than 60% of low-income Massachusetts residents despite our high rate of insurance coverage.
  •  Continue to lead a movement of advocates seeking full realization of the promise of the federal and state Mental Health and Substance Use Parity Laws which are meant to prohibit discrimination in health insurance coverage against those with mental illness and substance use disorders.
Celebrating 20 Years Fighting for Health Care Justice
HLA's 20th Annual Benefit Breakfast on November 6, 2015 
Senator Elizabeth Warren, this year's featured speaker. View more photos here.

On an unseasonably warm November morning, the Boston Sheraton Hotel began to buzz with the excitement of HLA's 20th Annual Benefit Breakfast. Bagels, lox, and yogurt parfaits were arranged on the 99 tables that sat more than 950 friends and supporters; some of whom have been with us since the very beginning. The coffee stations were in place, the volunteers at their posts, and the programs were waiting on the seats in the Grand Ballroom. 

Soon, the guests began to fill the lobby, and as one supporter said, "I look forward to this event every year. Long lost friends and colleagues are found at HLA's Benefit Breakfast!" It is a reunion for many, and for many more, it is an opportunity to learn more about Health Law Advocates and support the thousands of low-income Massachusetts residents who need access to health care services.

View the video from the Breakfast here
 To honor HLA's 20th Anniversary, the program began with a video that highlighted three clients from different points in our history. In the video's opening segment, Governor Michael Dukakis spoke of the urgent need to make health care accessible to everyone, regardless of class, race, gender, or sexual orientation.

We also highlighted our Children's Mental Health Access Project which was launched ten years ago. Through four trailblazing initiatives, HLA has provided free legal help to more than 800 children and fought for much-needed policy changes.  
Patti Days, client speaker 
Patti Days, the mother of 17-year-old Carina spoke of how HLA's Juvenile Court Mental Health Advocacy Project (JMHAP), a major part of our children's mental health advocacy, rescued her daughter. Ms. Days spoke of her daughter's experience in and out of the emergency room, her troubles getting appropriate treatment and in school, her involvement with the juvenile court, and ultimately, the support and counsel she received from Attorney Marisol Garcia, Carina's advocate through (JMHAP). "I can't thank Marisol or HLA enough for all they've done for Carina. Marisol was our voice when we needed one; she was the driving force for change, accountability, and action."

After a beautiful musical performance by Gerald Elias and Ronan Lefkowitz,  Event Co-Chair Ann Muschett, (reprising her role with her husband, Michael Blau, as Co-Chair of our 10th Benefit Breakfast!) introduced U.S. Senator Elizabeth Warren.

The audience was enthralled. Senator Warren delivered an inspirational speech,  "Every day, HLA offers people - regardless of income, education, or immigration status - the legal services necessary to make sure they have a place to turn to take on the health system when that system is not following the law. Those efforts go beyond helping a single individual," Senator Warren said.

She discussed the stark inequity when it comes to health care, the necessity of mental health parity, and a call to action to everyone in the room: we need to fight to ensure everyone has the right to improve their health.

"Our work is not done because we know it is wrong that in America, one of the richest nations in the world - and a nation that spends more money per person on health care than any other country on earth - that in this country hard working families are still too often shut out of the system."

We were honored to have our senator, a fierce advocate for the health of the most vulnerable, speak at the Benefit Breakfast. Senator Elizabeth Warren's message rang loud and clear: "Change is hard, but it's possible. We have lived real change."