For Some Vermonters Suffering From Hepatitis C, Life-Saving Cure Is Out Of Reach

Health advocates are challenging a Vermont Medicaid policy that has restricted curative treatment for hepatitis C only to patients with advanced liver problems. And while state officials say they’re open to changing the policy, they say offering treatment to all low-income Vermonters could cost taxpayers as much as $25 million over two years. ...

Julia Shawis the health care policy analyst in the Office of the Health Care Advocate, which is administered by Vermont Legal Aid. Shaw says the policy is tragically misguided.

“Because hepatitis C is such a serious illness and because our Medicaid program is systematically denying a large portion of the population access to a curative treatment for something so serious,” Shaw says.

Here’s the issue for the potentially hundreds of Medicaid beneficiaries like the Patient in this story: Doctors assess liver damage using what’s known as a Metavir fibrosis score. It basically measures the amount of scarring on the liver. And under Vermont Medicaid’s prior-authorization policy, beneficiaries don’t get the cure until they have a score of F3 or higher, which, according to Shaw, “basically requires a patient with Hepatitis C to have significant liver damage before they’re able to be treated.” ...

With the abundance of medical evidence pointing to the benefits of early treatment, Shaw says the Vermont Medicaid policy is indefensible.

“Denying patients access to something with such clear benefits is immoral, it’s illegal, and it shouldn’t be happening,” Shaw says. ...

Vermont Legal Aid is also trying to get the state to change other elements of its hepatitis C treatment policy. Existing policy requires patients to see a specialist, a requirement Shaw says creates a too-high hurdle for patients in rural areas of the state.

The state also requires patients to remain drug- and alcohol-free for six months before they begin treatment.

Shaw says people using drugs or alcohol are statistically as likely to benefit from the treatment as people who abstain. And she says the requirement might allow the virus to remain in populations at highest risk of passing it on to others. ...

The state’s Drug Utilization Review Board is meeting next week to consider a rule change.

Council recommends fighting poverty with affordable housing

One of Gov. Peter Shumlin’s special commissions says the state can eradicate poverty faster if it dedicates more money to building affordable housing and funding rental assistance programs.

For the second year in a row, the Council on Pathways from Poverty has proposed a new $2 per night occupancy fee on people staying in hotels and motels so the state can use the money revenue to fight homelessness. The measure didn’t pass in the last biennium. ...

Chris Curtis, an attorney for Vermont Legal Aid who serves as co-chair of the council, said low-budget motels are already subsidizing homelessness programs because they accept state-funded vouchers that pay for people in housing crises to stay in the motels.

He said those motels are sharing the burden of addressing homelessness by accepting the vouchers, but larger and higher-end hotels are not. He said if all hotels and motels had to collect the fee, the whole industry would be involved in ending homelessness.

The $2 nightly occupancy fee the council is proposing would raise between $11 million and $12 million per year. Curtis said that out-of-state tourists would pay 94 percent of the total.

“We hear over and over again that Vermonters do not have any additional taxing capacity,” Curtis said. “This is a fee that would not fall on Vermonters. It would primarily fall on out-of-staters.”

Increasing Access: It must be Ethical

Over the next few days, I’m going to use this space to share the ideas that I shared at [the Vermont Law School Summer Lecture Series]. The ideas are limited to how the Rules of Professional Conduct can be used to increase access to legal services.  Many other ideas exist and are worth discussing.  However, they are beyond the scope of the ethics rules and, therefore, beyond the scope of this column. ...

Don’t get me wrong: many lawyers are providing top-notch work to clients who have little or no ability to pay. Among them, the staff attorneys at Vermont Legal Aid, LawLine of Vermont, and the Defender General’s office.  Further, there are several excellent programs that are up & running.  At the risk of excluding some, I’ll list a few off the top of my head:
◾VLS Clinics
◾Vermont Volunteer Lawyers’ Project
◾Chittenden Rent Escrow Clinic
◾Vermont Bar Foundation
◾VBA Modest Means Programs
◾VBA Pro Bono & Low Bono Programs

Shumlin touts health exchange as best argument for Obamacare

Gov. Peter Shumlin said Tuesday that Vermont Health Connect is working as well as it possibly can and the majority of users are not experiencing problems. ...

The governor used the status update on Vermont Health Connect to defend the federal Affordable Care Act that created it. He said it would be “a disaster” for Vermont if President-elect Donald Trump dismantled the law, as he promised during the campaign. ...

Chris Curtis, an attorney for Vermont Legal Aid, said the mantra in Washington, D.C., is to “repeal and replace” the Affordable Care Act, but when he asks what should replace the law, “you hear crickets.”

“The reason that nobody wants to talk about that is that what they would be replacing it with is higher costs associated with health care, a higher rate of uninsured, more people struggling to make ends meet because they can’t afford to pay their bills,” Curtis said.

He said repealing the Affordable Care Act would have an “incredibly destabilizing effect” on Vermont’s economy and people who depend on subsidized health insurance to get medical care.

“(Repeal) is going to be incredibly confusing,” he said. “It’s going to be anxiety producing because nobody’s going to know what to do or where to turn.”

Rooming house zoning requirement has to be redone

A sharp-eyed attorney from Vermont Legal Aid has discovered that the town failed to follow the state requirement for public posting of potential new zoning regulations, meaning the new rooming house regulations have to have another public hearing and be re-adopted. ...

As a result, adoption of the rooming house zoning change will be postponed by at least a month, since the town must re-warn the public hearing, resetting the clock on when the new zoning requirement goes into effect. ...

Jacob Speidel, a staff attorney with Vermont Legal Aid in Springfield, said he and fellow Legal Aid attorney Mairead O’Reillyhad written a letter to the town about the perceived public notice problems.

“We’re pleased they have acknowledged an error. We hope this will allow the Select Board to take a fresh look at the issue and our concerns,” said Speidel on Wednesday.

Providers prep for refugees amid post-election uncertainties

A network of service providers is moving ahead with preparations for the arrival of Syrian and Iraqi refugees in Rutland amidst uncertainty about what a Trump presidency will mean for resettlement efforts.

The Rutland Refugee and Immigrant Service Providers Network will hold its first meeting Nov. 30 at the Rutland Free Library. The network is based on a model used in Chittenden County, which has had its own provider network for at least 15 years, according to state refugee coordinator Denise Lamoureux.

Lamoureux said the Chittenden County group meets about every six weeks. Members go over the nuts and bolts of resettlement, such as who’s arriving and when, and address specific questions members have. For example, Vermont Legal Aid will be attending the next Chittenden County meeting to discuss questions regarding refugees and taxes.

Board grants anonymity to surgical center investors

The Green Mountain Care Board has granted a request by independent doctors to keep their identities secret in their permit application to open a surgical center. ...

The doctors have been called simply “Physicians A-P” in regulatory documents, where their lawyers argue that using their real names would subject them to retaliation by hospitals. ...

On Wednesday, Vermont Legal Aid’s Office of the Health Care Advocate asked the board to allow it to see the names of the doctors involved in the case, saying, “We cannot fully fulfill our role without access to all available information.”

The board declined to comment on whether it would consider the request, because it is part of an ongoing case.

Episode 16 - You Have Power

This "No Makeup Podcast" features Brenda Brown, a low-income advocate who sued the City of Barre in 2012 for shutting off the water in her rental unit for two months when her landlord failed to pay the water bill. With the help of Vermont Legal Aid, Brenda successfully helped pass a law ensuring that no one else in Vermont would have to endure the hardship of living without water because their landlords failed to pay the bill. Renters have a right to the public water supply and must be given an opportunity to pay for water service and deduct it from their rent if the water is noticed for shut-off and is included in the tenant's rent.

Later, in 2015 Brenda helped pass a law regulating Vermont's "rent-to-own" industry as a member of Governor Shumlin's Pathways From Poverty Council. In this episode, Brenda discusses the importance of fighting for what is right.

Health Law Tax Penalty? I’ll Take It, Millions Say

The architects of the Affordable Care Act thought they had a blunt instrument to force people — even young and healthy ones — to buy insurance through the law’s online marketplaces: a tax penalty for those who remain uninsured.

It has not worked all that well, and that is at least partly to blame for soaring premiums next year on some of the health law’s insurance exchanges.

“In my experience, the penalty has not been large enough to motivate people to sign up for insurance,” said Christine Speidel, a tax lawyer at Vermont Legal Aid.

Some people do sign up, especially those with low incomes who receive the most generous subsidies, Ms. Speidel said. But others, she said, find that they cannot afford insurance, even with subsidies, so “they grudgingly take the penalty.”

Too Soon: Could the Suicide of a Burlington Artist Have Been Prevented?

In this powerful article about the life and suicide of Burlington artist Darshana Bolt, Jack McCullough, director of Vermont Legal Aid's Mental Health Law Project, says that evaluating and caring for suicidal patients requires balancing their safety and their liberty.

Jack maintains that we need more alternatives to hospitalization for patients in crisis and that the only people who should be in hospitals are those who can't be safely treated elsewhere.

Read Excerpts:

Burlington artist Darshana Bolt spent most of the hot, humid day of July 13 at the Howard Center's crisis center on Pine Street. The 31-year-old woman had threatened to kill herself, which landed her in the six-bed ASSIST Program in the city's south end. Despite being under supervision, shortly before 7 p.m. she informed staff that she was going outside to smoke a cigarette.

She never returned. ...

While the Bolt family finds fault with ASSIST, mental health advocates defend it. The Howard Center's program opened at 851 Pine Street to provide short-term residential care to patients in psychiatric crisis whose needs are not as acute as patients who are treated in hospital psychiatric wards. ...

Vermont needs more such facilities, not fewer, said Jack McCullough, director of Vermont Legal Aid's Mental Health Law Project. Even after learning of the state's investigation of ASSIST, and expressing sympathy for the Bolt family, he said the answer isn't to push more people into psych wards.

"The only people who should be in hospitals are people who can't be safely treated somewhere else," he said. "So it's a good thing that we have these alternatives to hospitalization."

Facilities such as ASSIST can't legally force people to stay, but they can "follow them out of the facility and keep track of them and try and talk them into staying," McCullough said. Staffers can always call the police if they believe a more secure environment is required. ...

Evaluating and caring for suicidal patients requires balancing their safety and their liberty, McCullough explained: "It's a big, big deal to have ... the power of the state ... confine them against their will and then, even beyond that, potentially inject them with powerful drugs ... that change the workings of their brain. I think we need to be extremely cautious in taking that step for anybody."

That longer-term involuntary commitment is even more complicated — it requires a court process — is a good thing, McCullough added.