The Jimmo Settlement: Its Importance and Implementation to Date: A Conversation With Margaret Murphy

In 2011 a 78 year old blind, amputated Vermont woman, Ms. Glenda Jimmo, was denied physical therapy services under Medicare because her condition was determined to not likely improve. Because Medicare therapy services via skilled nursing, home health and outpatient care never required the patient "improve" in order to receive services and because thousands of other Medicare beneficiaries along with Ms. Jimmo had been denied therapy the Center for Medicare Advocacy and Vermont Legal Aid filed a class action suit against the federal government, i.e., Jimmo vs. Katheleen Sebelius. 

After 11 months of negotiations, a settlement agreement was reached in late 2012 that affirmed there is no "improvement standard" required to be met for beneficiaries to receive therapy services.

During this 18 minute discussion Ms. Murphy explains the impetus for the case, speculates why DHHS did not act on its own in resolving the problem, how well or effectively CMS has implemented the terms of the settlement agreement (not very well) and why the decision has received so little attention over the past three years.

Finally: Vermont Health Connect is supposed to be fully functional today

The governor held a news conference Thursday to announce that the site should finally work today, Nov. 1, as the open enrollment period for 2016 health care plans begins. He remains “cautiously optimistic,” he said, a phrase he has likely uttered hundreds of times in the past year when asked about the exchange’s progress.

Trinka Kerr, chief health care advocate at the Office of the Health Care Advocate, a division of Vermont Legal Aid ... said the exchange’s struggles have had a major impact on many Vermonters.

“We heard about a lot of different problems that people have had over the last couple of years. Problems that lasted for months and sorted of snowballed into other problems,” she said. “It’s been hell for a lot of people. It really has. Really, really frustrating. That’s not a secret.”

There were many customers who had paid their premiums but did not have active coverage. Many of them delayed seeking health care treatment because they feared they would be on the hook for the costs, Kerr said.

“Vermont Health Connect worked pretty hard to handle those cases as fast as they could, but they happened,” she said. “A lot of them had tried to resolve the problems by themselves for months and were really frustrated and really angry. And if they had health care needs that compounded it.”

Kerr added, “There have been plenty of angry people and you can’t really blame them when they’ve been making calls for months and not getting anywhere.”

Vermont Health Connect Open Enrollment

The open enrollment period for buying a Vermont Health Connect plan for 2016 is November 1, 2015 - January 31, 2016.

If you are new to Vermont Health Connect and you want your plan to start on January 1, 2016, you need to choose a plan by December 15, 2015.
  If you choose your plan after December 15 but before January 16, your plan will start February 1, 2016.
  If you choose your plan between January 16 and January 31, your plan will begin March 1, 2016.

If you miss the January 31, 2016 deadline to apply for a 2016 health plan through Vermont Health Connect, you will have to wait until the next open enrollment period in fall 2016 unless you have a “qualifying event”. A qualifying event is a big change like having a baby or losing a job. You can apply for Medicaid or Dr. Dynasaur any time, even if you don’t have a qualifying event.

Visit our health care website for information about what to do if you need insurance or if you have a Vermont Health Connect plan now and want to keep it or change it.

If you have a problem with your Vermont Health Connect plan that you haven’t been able to resolve with them, you can contact the Office of the Health Care Advocate at 1.800.917.7787.

Schools chief: Suspension doesn't always lead to jail

Vermont Education Secretary Rebecca Holcombe raised questions Thursday about a report saying tough school discipline often puts kids on a path that leads to prison later.

Holcombe was responding to a report issued in January by Vermont Legal Aid and to testimony by Jay Diaz, a former Legal Aid lawyer who since writing the report has moved to the Vermont chapter of the American Civil Liberties Union.

Thousands Who Didn’t File Tax Returns May Lose Health Care Subsidies

Tens of thousands of people with modest incomes are at risk of losing health insurance subsidies in January because they did not file income tax returns, federal officials and consumer advocates say.

"A substantial number of people are at risk for losing their health insurance subsidies for 2016," said Christine Speidel, a tax lawyer at Vermont Legal Aid.

Ms. Speidel identified three groups of people at risk: those who did not file a tax return; those who filed a return without the correct form to reconcile advance payments of the premium tax credit; and those who filed and reconciled this fall, too late for the information to be made available to health insurance exchanges before the open enrollment period.

Burlington landlord still defies city

Vermont Legal Aid attorney Jessica Radbord is quoted extensively in this article detailing the struggles of two city departments to police a landlord who draws frequent complaints.

"A reporter read the letter to Jessica Radbord, an attorney with Vermont Legal Aid who often represents tenants. Radbord said she believes Kwon was within his rights to pen the letter but said the note could have a chilling effect on tenants."

"'As someone who represents tenants, do I like seeing that sort of thing? No," Radbord said. "It seems like the landlord is trying to dissuade them from taking legal action they are entitled to take.'""'A lot of tenants get trapped in junky apartments because a landlord won't give them a good reference,' Radbord said."

"Landlords often have many applicants to choose from, she said, and have little incentive to rent to tenants with a bad reference."

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Report: Vermont legal services should be more effective, affordable

A new report from Vermont attorneys and court officials proposes improvements to the state’s judiciary system to make legal services more accessible to Vermonters.  
Eric Avildsen, executive director of Vermont Legal Aid, who served on the legal services committee of the commission, said making the judiciary website more comprehensive and easier to navigate would help everyone.

“When you end up in the court’s system to find something, a lawyer can’t find their way to get where they need to go,” Avildsen said.

Avildsen said many of the other changes will not have a significant impact on the lowest income Vermonters.

One of the biggest issues the judiciary faces is a shortage of lawyers who can afford to work in rural communities or at firms like Vermont Legal Aid that serve low-income populations, according to Avildsen. Crushing student debt incurred by recent law school grads has made it harder than ever to attract new attorneys to poverty law, he said.

Insurers say billing issues persist with Vermont Health Connect

Vermont’s largest health insurance provider says its members still call with complaints over Vermont Health Connect and the company’s auditors are waiting for regular customer billing reconciliations.
Trinka Kerr, the chief health care advocate, said customers are often confused about when bills are due and how long the grace periods are if they pay a bill late. Right now, someone buying insurance through the exchange using a subsidy has a 3-month grace period to pay her bill; if the person isn’t receiving a subsidy, she has 30 days to pay.

“We’re hoping to improve the notices that (are sent to customers),” Kerr said. “If they don’t catch up, you’re not going to be able to get insurance until next year.”

Customers are also appealing the decisions Vermont Health Connect makes about their coverage, according to Kerr. They go to the state’s Human Services Board, which she considers understaffed, and the issues get backed up.

“Many of these cases that are going to hearing should not be going to hearing,” Kerr said. “I am concerned that the Human Services Board is very understaffed and the Vermont Health Connect appeals are adding to that problem.”

October is National Domestic Violence Awareness Month. Consider these 2012 Vermont statistics:

The member programs of the Vermont Network Against Domestic and Sexual Violence: Answered 12, 507 hotline calls Helped 1,527 victims/survivors of sexual violence Provided 32, 390 shelter night stays to 1, 065 individuals Had to turn 264 people away from shelter due to lack of capacity The Vermont Department for Children and Families accepted 2,536 reports of child abuse for investigation. 323 children were found to be victims of sexual abuse. Over half of all homicides in Vermont in the last decade have been related to domestic violence.

Vermont Legal Aid and Legal Services Law Line of Vermont partner to maintain the Vermont Law Help website, which provides information and resourcesto guide victims of domestic violence to get the help they need.

The Vermont Network Against Domestic and Sexual Violenceis a statewide group that works for abuse victims. There are also local domestic violence groups.

Dr. Mercedes Avila Headlines Training for Vermont Advocates

Vermont Legal Aid and Legal Services Law Line of Vermont will host the Guen Gifford Advocate Training October 30, 8:30 - 4:30, at the Franklin Conference Center located at 1 Scale Ave. in Rutland.

Registration closes on October 23 - so register now to join us for a full day of information-packed courses that offer tips, tools and updates to help advocates across the state serve clients more effectively.

Dr. Mercedes Avila, Multicultural Director of the Vermont Leadership Education in Neurodevelopmental Disabilities Program at the University of Vermont College of Medicine, is our plenary presenter.*

Dr. Avila will discuss issues related to racial, ethnic, and class biases; demographic changes in the US; links between racial, educational, social, and health disparities; and how culturally responsive practices can lead to systemic changes.

This training is for professional advocates. We are not able to address individuals’ legal issues related to these and other topics.

Use these links to see the agenda, course descriptions, and to register online.

For more information, email Becka Wells or call 802.863.7153.

* Dr. Avila's presentation is made possible by a generous donation from the Caroline Fund.