No Room at the Motel for Those on the 'Do Not House' List

In winter, Vermont goes to great effort — and expense — to keep its homeless population out of the cold. But on any given night in Chittenden County, as many as 100 individuals are on a "do not house" list. The state maintains a running tally of people barred from its emergency housing program.
Jessica Radbord, an attorney with Vermont Legal Aid, rattled off reasons "vulnerable" homeless people might not follow through on claiming a bed: a victim of domestic violence gets word that her abuser's friend is staying at the same shelter; someone with a mental illness can't handle a communal shelter setting.

Sometimes, just the logistical requirements — phoning ESD or finding transportation to the motel — are too much for the person to handle.

Those who find themselves on the list do have the option of appealing to an independent board within the Agency of Human Services. If the situation is time-sensitive, he or she can request an emergency hearing to avoid a several-day wait. But assembling a case in a matter of hours comes with its own challenges: "Often you're appealing a denial based on something that happened at a shelter two weeks ago, so it's really hard to get your witnesses together," explained Radbord.

Radbord has represented clients who've successfully gotten their sanctions overturned. But she said she's concerned that people aren't always informed of this option: "A lot of folks just give up and walk away."
"I would love to see there be no sanction list at all," said Radbord, who previously ran a domestic violence shelter in New York, where the right to shelter is enshrined in the state constitution.

Involuntary Medication Back In The Spotlight

VLA's Jack McCullough, who directs the Mental Health Law Project at Vermont Legal Aid, was interviewed on Vermont Edition on Tuesday, March 15 about why he opposes the Shumlin Administration's efforts to fast-track the process of involuntarily medicating mental health patients.

The Shumlin administration's proposed budget includes language that would speed up the legal process of getting permission to involuntarily medicate psychiatric patients - two years after a 2014 law that spurred debate over the issue.

Advocates say streamlining the process further would save money and improve outcomes for patients. Opponents say it's another step in chipping away at patients' rights. 

Listen to the recorded interview.

Panel: Remove involuntary medication policy from budget

A key legislative committee has come out against the administration’s attempt to use the budget as a vehicle for changing the state’s policy on medicating Vermonters in severe mental health crisis against their will.  ...

Jack McCullough, of Vermont Legal Aid, said it was “outrageous” to propose the change in the budget.

“I don’t think that the savings claims are believable,” McCullough said, “and I do not think that the state should be trying to balance the budget on the back of the most vulnerable people in the state.”

Vermont woman sues for health-care coverage

A Bristol woman whose case was expected to expand Medicare for thousands of people across the nation said the government broke its promise.

Now, she’s going back to court again, saying the federal government failed to abide by the settlement of a 2013 lawsuit that said she could not lose Medicare coverage just because her health was not expected to improve.  ...

Michael Benvenuto, an attorney with Vermont Legal Aid Inc.’s Medicare Advocacy Project said it was not coincidence that a Vermont plaintiff took the lead role in the federal case.“We brought this national case in Vermont because we thought our judges would be good in this case,” Benvenuto said, adding that the same judge as before is expected to preside.

People are still being refused coverage, he said. The lawsuit could affect thousands — even hundreds of thousands — of people, but Benvenuto did not have an official count.

“Our case is, Medicare should cover people who have chronic conditions and need nurses or therapy to maintain their condition,” Benvenuto said. “They were supposed to change their manual, they were supposed to do an education campaign. ... Now three years later, we’re going back to ask the Vermont judge to really order them to do that, that we think what they’ve done has been really inadequate.”

This article was also published in the Rutland Herald.

Medicaid by the numbers: Reforms, demographic changes drive up enrollment

Over the past decade, enrollment has nearly doubled in health care programs Vermont pays for with Medicaid money. As of 2015, about one-third of Vermont’s population used some kind of program funded through Medicaid dollars. A VTDigger analysis shows that the increase is likely related to a combination of factors, including demographics, income changes and new eligibility rules.  ...

There is no specific type of person who uses a Medicaid program, says Trinka Kerr, the chief health care advocate at Vermont Legal Aid. She described people who qualify for Medicaid as “all over the map” and said they include farmers and small business owners.

“As a result of the ACA, they changed the methodology for determining eligibility,” she said. “It used to be there were very specific things that were included when you talked about income, and under the Affordable Care Act, they look at modified adjusted gross income, which is based on your taxable income, which is a completely different system.”

Self-employment income is particularly difficult to gauge, Kerr said. State officials may have misjudged the types of income and expenses of self-employed Vermonters, or “may have miscalculated how many people in Vermont are self-employed, and therefore benefited from (modified adjusted gross income),” she said.

“Maybe they didn’t understand the nature of the state’s economy,” Kerr said. “There’s farmers. There’s people starting their own little boutique businesses. And I think that group is kind of large in Vermont.”

The good news about Medicaid expansion, Kerr said, is that her office gets fewer calls from people concerned about the cost of health care.

Relapse: The Fight Over Force-Medicating Psych Patients Is Back

Jack McCullough has long represented psychiatric patients in court proceedings which determine whether they should be committed against their will and forced to take medication. McCullough directs the Mental Health Law Project for Vermont Legal Aid.

On February 18, the white-haired and full-bearded attorney urged the House Human Services Committee to reject a Shumlin administration proposal to expedite the legal process that begins when mentally ill people land in the hospital.

"We just shouldn't be here," McCullough began. He reminded the lawmakers that only two years ago, they spent hundreds of hours taking testimony about the merits of moving patients through the system more quickly.

House committee wrangles details of license suspension bill

Helana Martin was 13 years old when an agent with the Bureau of Alcohol, Tobacco and Firearms in plainclothes caught her smoking a cigarette and issued her a citation with a fine she says she couldn’t pay. Sixty days later, she got a notice that her driver’s license was suspended — two years before she would even be old enough to get one.

Chris Curtis, of Vermont Legal Aid, said his organization strongly supports the version of the bill the task force proposed, which includes the waiver option for people who qualify based on a limited income.

He said it’s important that lawmakers produce a bill with some form of income sensitivity, so low-income Vermonters are not locked out of getting back on the roads legally. He also wants to see the law changed so offenses not related to driving do not result in license suspension — as with the underage tobacco offense that led to Helana Martin’s license being suspended.

DLS suspension is a “massive problem,” Curtis said. The new policy needs to “allow people to pay it and move on with their lives.”

This article was also published in Valley News.

Community Forum: Unfair and Unequal School Discipline in Vermont Schools

This community forum, organized by Vermont Legal Aid attorney Jean Murray and other interested people and organizations, was held on February 4 in Brattleboro.

Speakers included Jay Diaz, ACLU staff attorney; Hon. Katherine Hayes, Superior Court Judge, Windham Unit; Mary Ross, assistant principal - Academy School; Mike Szostak, Restorative Justice - Brattleboro Union High School; and Shenise Taliaferro, student and athlete - Brattleboro Union High School.

Watch a recording of the forum

Moving Toward All-Payer Health Care

Vermont Edition’s Bob Kinzel interviewed Al Gobeille, chair of the Green Mountain Care Board, about Vermont's proposal to move to an all-payer health care system. He also gathered input from stakeholders and from Trinka Kerr, chief health care advocate for Vermont Legal Aid. The Office of the Health Care Advocate represents consumer interests.

Kinzel asked Trinka for her thoughts about the potential move to an all-payer system. Her response:

“We do think there need to be changes. Health care costs are drastically increasing. Our concern is that consumers and patients have sufficient protections as these radical changes go into effect. There are a lot of protections already built in that Medicare requires and that exist today for Accountable Care Organizations. But we think today, with this level of change being proposed, that … those protections need to be across all payers – not just those on Medicare. Across all payers and the existing protections should be expanded. They should be in state law so that consumers can have some confidence that these protections will actually stick and be enforced.”

Kinzel then asked Trinka if she felt that the system might discourage providers from giving patients the care that they need.

“It is one of our concerns that access could be reduced because with providers taking on risk, which is what the model calls for, there’s incentive for them to cut costs by cutting care. How to prevent that under-service is something pretty difficult to figure out how to do that. I know that the plan is to monitor utilization and try to observe changes that way. But that is kind of after the fact – you can only do that as claims are submitted. We think there also has to be a robust appeal system so that if people feel that they’re being denied care because of some Accountable Care Organization policy, that there’s a mechanism for them to grieve that and have the decision reconsidered by some neutral decision-makers. So that is one are we have some concerns about, yes.”

A New Prescription for Treating Health Care — the 'All-Payer' System

Since Gov. Shumlin abandoned the single-payer health care model that he had worked to put into place, he is now working to transform Vermont's health care system by employing an "all-payer" model . The governor's health reform team and the chairman of the Green Mountain Care Board have spent the past year in talks with federal health care regulators about an agreement that would allow the state to make it happen.

However, Vermont Legal Aid warns that all-payer should be backed up with regulations that protect consumers.

In the current system, insurers wear the black hats and doctors go to bat for patients when they disagree with insurers' decisions about whether a costly treatment is a medical necessity, noted Julia Shaw, health care analyst with Legal Aid. But doctors and hospitals might hve financial incentives to deny care under the all-payer model, she wrote in a November paper outlining consumer-protection principles that should guide the deal. Patients must have "avenues for filing appeals and grievances," she said.