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Open enrollment starts Wednesday for Vermonters who want to sign up for a health insurance plan for next year through the state's online exchange or existing subscribers who want to change to a different plan.

The annual enrollment period runs from Wednesday to Dec. 15.

Officials tell Vermont Public Radio that Vermont Health Connect's technical problems have largely been fixed and operations have improved dramatically in the past year.

Open enrollment comes as President Donald Trump has done away with federal subsidies to health insurance companies used to reduce out-of-pocket expenses to low- to moderate-income Vermonters.

Mike Fisher, chief health care advocate for Vermont Legal Aid, says the benefits will still be available and it's up to the insurance companies to figure out how to fund them.

Phantom rule could leave special needs kids, parents in limbo

State officials thought they’d had a rule in place since 2013 requiring school officials to respond within 15 days when a parent requests that a child be evaluated for special education services.

Now it turns out the rule was never filed properly with the Vermont Secretary of State’s office. Some parent advocates saying that means families have no recourse when school officials drag their feet.

Because some of the rules passed by the Vermont Board of Education are not the same as those posted on the Secretary of State’s website a new rule-making process must take place in order for the 15-day standard to go in effect, officials said.

The state Board of Education and Agency of Education say they are swamped with implementing Vermont’s Act 46 school district consolidation law, and don’t have time to deal the special education rules.

Now they’re asking local school districts to meet the 15-day response time as a “best practice.” But parent advocates say that gives them less power to challenge inaction by schools.

“The difference between best practice and a rule is that a rule is a procedural safeguard for parents’ rights,” said Karen Price, the family support director with Vermont Family Network.

With a rules violation, parents could enter a formal complaint process, Price said. When looking to cure a deviation from best practice, “a parent is relying on the good faith on the part of the school,” she said.

When a parent suspects their child may need special education services, the first step is to ask for an evaluation to see if the child is eligible. Price said that before the state board added the 15-day rule there was no defined timeline for schools to respond to parents’ requests.

“It has been a long-standing problem that parents that suspect their child has a disability and they make a request then never hear back,” Price said. “It happened a lot.”

Price said she knows of one parent who has since learned she cannot file an administrative complaint based on the 15-day rule.

“Now that it’s no longer a rule, she has no right to complain,” she said.

One parent in the Franklin-Northwest district said she had planned to file a formal complaint after becoming frustrated about the school’s lackluster response to her request for a special education evaluation for her child.

“I was going to lodge a complaint about the 15-day rule, but now I’m stuck with not knowing if it makes sense because the rules are changing,” said the parent, who asked for anonymity because being publicly identified could harm her own employment situation. She said she had been notified of the change to the rule by staff at Vermont Legal Aid.

“I believed the information I was finding online was correct. I’m really disappointed that they could make this type of mistake,” she said, adding that guidance is not good enough.

“If a child needs special services, it can’t wait. It needs to be addressed as soon as possible. In the meantime, while we are waiting, a child is suffering,” she said.

The agency has strongly advised school districts to use the 15-day rule until officials have a chance to update it, according to an agency memo released in August.

Haley Jones, spokesperson for the agency, said school districts have been using the 15-day rule since 2013 and everyone is used to it. “We have not heard that anyone intends not to continue to use it,” she added.

In 2013, the state Board of Education made a number of changes to the special education rules, mostly to bring them into compliance with new federal laws. Most of the changes did show up in the official rules posted by the Secretary of State’s office, but a few did not.

“This is the kind of thing that happens when you are short-handed and the state board also has no staff,” said William Mathis, vice chair of the board.

Recent years have been marked by increasing responsibilities for the state board and Agency of Education, including the implementation of the Act 46 school district consolidation law, without long-promised increases in staff, officials said.

The federal government requires schools to respond to parents within 60 days and the state has remained in compliance.

Mathis said the state board added the 15-day rule because members wanted to be more responsive and responsible to parents.

“But through a huge foul-up and a lack of staff to check and double check the work, it didn’t happen,” he said, adding that it will be put back in when the state board goes through the rules process again.

But that is little comfort to Vermont families, said Price. “It is the Agency of Education’s job to have these regulations be correct and protect parents’ rights. As a parents rights organization this is not a response we are happy with – they are short of people? Short of time? They can’t get to this? It isn’t right for parents of children with disabilities for this to remain unfixed.”

Mathis said he isn’t sure when they can start it up since the board and the agency have to deal first with Act 46 and the private school rules series 2200. “It is a matter of the workload for the Agency and for the board. We don’t have any staff.”

Nurse Shortage Puts Vermont Parents on the Hook for Kids' Care

Natalie Briggs spent the first six months of her life in hospitals. Born at 30 weeks with an extra chromosome, she couldn't breathe or swallow on her own. She was deaf. Doctors predicted she'd be permanently confined to a hospital bed.

Now nearly 8 years old, Natalie has short brown hair and a big grin. She is walking, learning sign language and living at home with her parents in Shelburne, although she still breathes through a tube in her throat. Another tube delivers food and water directly to her stomach.

"She has to have eyes on her 24 hours a day to maintain her airway, monitor her for seizures," explained her mother, Amelia Briggs.

Amelia and her husband, Will, rely on nurses to help care for their daughter. The state determined that the family needed 112 hours of home nursing a week — and that Medicaid, the federal insurance program for those with low incomes and disabilities, should pay for it.

But the young couple says they receive only 70 hours of care a week. They take turns monitoring their daughter at night, each picking up a four-hour shift. On July 26, Amelia was on duty from 3 a.m. to 10 p.m., while Will, a software engineer, worked.

The Briggs' plight isn't unique.

For the last 20 years, the United States has suffered a nursing shortage, a problem that's expected to worsen as baby boomers age. The crisis is especially acute for home health agencies that provide nurses for families such as the Briggs, because they compete for employees with higher-paying hospitals and doctors' offices. [...]

"The problem is that we're not compensating home health nurses at a rate that allows there to be enough of them to meet the needs of these kids with high needs, and so there's a shortage of nursing, particularly in the home and particularly nights and weekends," said Barbara Prine, an attorney with Vermont Legal Aid's Disability Law Project. "What that creates for these families who are dealing with really medically complicated kids is a tremendous amount of stress." [...]

In the meantime, families continue to pick up the slack.

"The consequence of not having someone alert, ready to take care of the kids, is really dire," said Prine of Vermont Legal Aid. "Part of the problem is we have this expectation that parents can go above and beyond. These parents are going above and beyond night after night, week after week, month after month, year after year, and that is a huge toll on them and their families."

The issue is not just about providing relief for overextended parents. "They are saving Vermont money by keeping these kids home," Prine noted. [...]

Regulators deny Blue Cross request to strike public comments

Health care regulators say public comments and statistics on wage growth must be part of the case in which Blue Cross Blue Shield of Vermont is seeking to raise premiums on Vermont Health Connect by more than 12 percent.

The Green Mountain Care Board made the ruling Thursday, in response to the company’s effort to strike information that Vermont Legal Aid’s Office of the Health Care Advocate put in a legal argument Wednesday.

The state of Vermont pays the advocacy office to represent the public during legal proceedings, such as Vermont Health Connect premium cases, in front of the Green Mountain Care Board.

Blue Cross [originally requested] to increase premiums on Vermont Health Connect an average of 12.7 percent. After some legal and mathematical processes, the company [now says] the increase should be 12.6 percent.

The Office of the Health Care Advocate argued in a hearing July 20 that the premium increase should be just 8.7 percent. The advocate then argued in a document submitted after a July 20 hearing that health insurance premiums are already unaffordable.

“If the proposed 12.7 percent increase is approved, between 2014 and 2018,” Blue Cross will have raised premiums by a cumulative 37.9 percent, the document said, more than twice as much as Vermont’s economy grew in that period, and nearly three times what Vermonters’ wages grew in that period.

The health care advocate said rates are unaffordable based on a standard in the Affordable Care Act saying premiums should not cost more than 9.69 percent of someone’s income, and a standard from the Department of Financial Regulation saying that a person’s deductible should not be more than 5 percent of their income.

The advocate then included comments from people who had submitted public comments to the Green Mountain Care Board. In the comments, people generally told personal stories about how they struggle to afford health insurance.

“As a self-employed clinical social worker I am paying almost $600/month for coverage for myself,” one person who was quoted wrote. “This is already outrageous. If the rates rise I will be forced to go without insurance, taking another healthy Vermonter (who supports the unhealthy population) out of the system.”

Another who was quoted wrote: “Last week, I cancelled an MRI that my neurologist ordered because I just can’t afford it, even with insurance. It is outrageous that an insurance plan that already costs 10% of my income doesn’t provide the coverage I need to make important procedures affordable.”

A third person said: “Though I do not make much and work two jobs, I don’t qualify for much of a subsidy and currently pay a lot for health insurance—one-quarter of my monthly mortgage. A rate hike would make it impossible for me to continue to have health insurance.”

A spokesperson for Blue Cross declined to comment on the issue.

Blue Cross argued in legal documents on Wednesday that the board should disregard “new evidence” in six pages of the health care advocate’s 15-page legal argument, and that to do otherwise “would be plain, reversible error.”

Blue Cross said the arguments about affordability are “without proper evidentiary foundation, not substantiated and … not subject to cross-examination.”

The public comments, meanwhile, were “not under oath,” “not subject to direct or cross-examination,” and “cannot be offered as evidence of the truth of what was said,” according to Blue Cross.

The board ruled against Blue Cross.

A hearing officer wrote on behalf of the board that the Office of the Health Care Advocate’s comments are “appropriately sourced” and “reasonably reliable,” and that the evidence “as a whole speaks to the statutory criteria of affordability, equity, and fairness to policyholders.”

The hearing officer also said the information, “stands for the incontestably true proposition that (Blue Cross’) proposed average 12.7 percent rate increase dramatically outpaces Vermont wage growth or any other reasonably selected index of inflation.”

The hearing officer also said the board has to review public comments as part of the case, anyway: “The Board is required by statute to take public comments before, during, and after rate hearings, and repeatedly makes clear at every opportunity that these are accepted by any available medium.”

“It would be excessive legalism to strike the (Health Care Advocate’s) memo in whole or in part over the presence of public comments that Board members are, in any event, required by law to read prior to rendering a decision,” the hearing officer wrote.

The board has not yet issued a decision on how much Blue Cross will be able to charge customers. Such decisions usually come out sometime in August.