The Disability Rights Education and Defense Fund (DREDF), founded in 1979, is a leading national civil rights law and policy center directed by individuals with disabilities and parents who have children with disabilities.
DREDF Comment on Kentucky HEALTH 1115 Waiver Proposal
AUGUST 18, 2018
DREDF submitted comments August 18, 2018 in response to the Federal Department of Health and Human Services (HHS) reopening Kentucky’s 1115 Medicaid Waiver for public comment after a federal district court judge recently struck HHS’s approval of the state’s proposal as being unsupported by the public record. The waiver would allow the state to impose work requirements, premium charges, Medicaid lock-out periods, and eliminate non-emergency medical transportation as a benefit for over 75% of Kentucky’s population of approximately 650,000 working age adults enrolled through Medicaid expansion. DREDF, along with many other disability, healthcare and aging advocacy organizations, believes these changes would impair Medicaid’s core purpose to furnish medical assistance on behalf of persons with insufficient income and resources to met the costs of medically necessary care, and to provide rehabilitation and other services to help families and individuals attain or retain capacity for independence or self-care. Our comment supports our conclusion with research and analysis.
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Health Disparities at the Intersection of Disability and Gender Identity
July 18, 2018
DREDF continues to work on examining health disparities and access barriers that affect people with disabilities who are also members of other historically marginalized groups. Our new paper on the intersection of disability and gender identity looks at data on disability among transgender people made available through the 2015 U.S. Transgender Survey, analyzes the limited data on health outcomes and social determinants of health in this intersectional population, and makes recommendations for further research. This paper was developed through a grant from the Gill Foundation, one of the nation’s leading supporters of advocacy to secure LGBT equality.
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New Advocates' Guide to Accessibility in Medicaid Managed Care Grievances and Appeals.
June 28, 2018
The 2016 federal Medicaid Managed Care Rule established a bifurcated framework for how Medicaid managed care grievances, appeals and fair hearings should work. This new Advocates’ Guide provides guidance on how that framework can be made fully accessible to Medicaid beneficiaries with disabilities. The Guide, sponsored by DREDF, Justice In Aging and the National Health Law Program (NHeLP) and written by Carly Myers, DREDF’s George Barrett Social Justice Fellow / Attorney, provides suggestions for state regulatory language, best practices, and practice tips for every aspect of the grievance, appeal and state fair hearing process.
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Letter of Opposition to Proposed California Legislation to Expand Conservatorship (AB 1971 and AB 2157)
April 2018
Unfortunately, two bills introduced in California’s Assembly seek to expand the definition of “gravely disabled” in order to make it easier to conduct involuntary commitment and treatment of certain mentally ill people, and to expand conservatorship. DREDF strongly disfavors the needless expansion of conservatorship, which broadly allows a conservator to manage the financial affairs and daily life of a conserved person. Those who are conserved are left with limited legal capacity, inevitably lose personal choice in many facets of their lives, and face institutionalization against their will for some period of time.
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Amicus Brief in Kentucky Medicaid Work Requirements Case
April 2018
DREDF joined AARP, Justice in Aging, National Association of Elder Law Attorneys (NAELA) and Arnold and Porter to file an amicus brief in the DC Circuit, in support of NHeLP’s Motion for Summary Judgement against the U.S. Department of Health and Human Services for approving Kentucky’s 1115 work requirements Medicaid waiver.
The brief focuses on how the waiver’s work requirements, elimination of non-emergency medical transportation, and roll-back of retroactive coverage will hurt low-income people with chronic conditions and functional limitations, which occur over twice as often among those aged 50-64 as those who are younger.
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DREDF Statement on Electronic Visit Verification
March 2018
DREDF Opposes Electronic Visit Verification (EVV) When It Threatens Disabled People’s Civil and Privacy Rights and Impedes Personal Choice, Autonomy, and Community Participation
Disabled people have the right to receive home and community-based services in a manner that maximizes our personal autonomy and independence and that does not compromise our privacy. EVV could potentially infringe on these principles.
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Improving Support for Health Maintenance in HCBS
February 2018
The Community Living Policy Center releases Improving Support for Health Maintenance in Home and Community-Based Services: How States Adapt Nursing Rules for the Community First Choice Program, authored by DREDF staff.
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DREDF Comments on HHS Proposed 2019 NBPP for Marketplace
November 29, 2017
HHS’s recently released Notice of Benefit and Payment Parameters proposes a number of significant “updates” to rules that regulate the ACA marketplaces, as well as changes in who is responsible for the actual monitoring and enforcement of those rules. DREDF’s response highlights our opposition to proposals to change how essential health benefit standards are established in each state, the way that provider network adequacy is enforced for plans participating in the exchanges, and the requirement that requires plans to limit their use of premiums for expenses other than medical benefits. DREDF also criticizes greatly reduced federal support for Navigators and increases on individual and family cost-sharing limits.
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DREDF responds to CMS Innovation Center's RFI
November 21, 2017
The Centers for Medicare and Medicaid Services Innovation Center (CMMI) put out an informal Request for Information on September 20, seeking stakeholder feedback on a “new direction to promote patient-centered care and test market-driven reforms.” The RFI emphasizes choice and competition as the keys to higher quality, reduced costs, and improved patient outcomes. DREDF response emphasizes the critical need for enhancing and integrating long-term services and supports across all of CMMI’s models, including within accountable care organizations, advance payment models, and PACE programs for younger people with disabilities.
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DREDF Supports CMS Proposed Revisions to Payment Policies
September 11, 2017
DREDF supports the two proposed new CMS HCPCS G codes, GYYY1 and GYYY2, that address prolonged preventive service(s) many people with disabilities require beyond the typical service time of the primary procedure. We anticipate that the proposed HCPCS G codes will lead to a clear and measurable benefit for Medicare patients with disabilities, as well as Medicare practitioners who must be prepared to serve an aging Medicare population, and who are also accustomed to having fee schedules that guide their expected allocations of resources and time. (September 2017)
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DREDF Objects to the Massachusetts Request to Eliminate NEMT
DREDF objects to the proposal to eliminate the non-emergency medical transportation (NEMT) benefit for MassHealth CarePlus enrollees, otherwise known as the Medicaid expansion population, except for transportation for substance use disorder (SUD)-related services. We think it is highly likely that MassHealth CarePlus enrollees might not have access to reliable, affordable and physically accessible transportation, and therefore NEMT is a critical component to access health care services. (August 2017)
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DREDF Responds to HHS/CMS Request for Information (RFI)
In this RFI, HHS reiterated key principles of affordability, accessibility, quality, innovation, and empowerment for the agency’s work. Specifically, HHS requested public comments in four specific goal areas for individual and small group health insurance markets. DREDF addressed three of the four goal areas: 1. Empowering patients and promoting consumer choice, 2. Enhancing affordability, and 3. Affirming the regulatory authority of states. (July 2017)
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Promoting Physical and Programmatic Accessibility
The Community Living Policy Center at the University of California San Francisco releases a paper authored by DREDF entitled Promoting Physical and Programmatic Accessibility in Managed Long-Term Services and Supports Programs. The paper explores how managed long-term services and supports contracts promote physical and programmatic accessibility for enrollees with disabilities. (July 2017)
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Endrew F. vs. Douglas County School District
DREDF’s directing attorney Arlene Mayerson and co-counsel Samuel Bagenstos, the National Disability Rights Network, and Morrison Foerster filed an Amicus brief in the Endrew F. vs. Douglas County School District case before the U.S. Supreme Court. The Court will hear the argument on January 11, 2017. The Court will decide what level of educational benefit schools are required to provide to children with disabilities under the Individuals with Disabilities Education Act (IDEA). Read the brief (PDF).
Johnny T. and Lihn N. v. Vy Chi Nguyen, MD, et al.
Despite advances in education, awareness, and legal protections, people living with HIV continue to face stigma and discrimination in critical areas such as health care. The Americans with Disabilities Act (ADA) prohibits medical providers from discriminating against potential or actual patients based on their disabilities. Johnny T. and Linh N. experienced discrimination when they were informed by their long-time CalOptima Medi-Cal physician that he would no longer treat them, citing a CalOptima policy as apparent justification. According to the provider, CalOptima informed him that he could not treat patients with HIV unless he had a separate waiting area for them. The Complaint was filed in November 2016.
Read the Press Release and the Complaint.
Ninth Circuit Takes California Department Of Education (CDE) To Task
December 15, 2016
“This is a major and unprecedented victory for children with disabilities. The corrective action plan requires reforms to the design of CDE’s state-level monitoring system that will benefit all concerned about CDE’s responsibilities to monitor and enforce special education laws,” said Larisa Cummings, DREDF staff attorney representing plaintiffs. The decision protects the education rights of students with disabilities and is the culmination of nearly 20 years of attempting to reform failed local and state-level special education policies.
Continue reading Ninth Circuit Takes California Department Of Education (CDE) To Task
National and State Data on Impact of Affordable Care Act
People with disabilities at various income levels have benefited from changes brought about by the Affordable Care Act (ACA). Some of these changes include giving states an incentive to expand the Medicaid program to individuals with higher income limits and without asset limits, creating private insurance marketplaces where people with disabilities can shop for coverage options and potentially receive tax deductions or subsidies depending on their income level, and requiring insurers to provide coverage free of discrimination and regardless of an individual’s pre-existing condition. The incoming Trump administration has argued strongly that the ACA has been a costly mistake that provides few benefits. Today the federal Department of Health and Human Services, and the federal Council of Economic Advisors released lengthy and detailed data that illustrates the impact of the ACA on health coverage, our state and national economy, and the quality and costs of healthcare.
It is vitally important for the disability community to share our real- life healthcare stories with one another and with law and policy-makers. It is also important for us to see and understand the data behind the ACA. This allows us to refute bald and unverified statements with genuine facts that broadly support our own experiences of gaining access to the healthcare we need.
Today’s National Press Release on the available information.
A Compilation of up-to-date state-level data (xlsx) that includes numbers on the uninsured, private market reforms, employer coverage, Medicaid, the individual market (including the Health Insurance Marketplace), and Medicare.
Sources and notes (PDF) for the data compilation.
A new comprehensive economic report on the impact of the ACA.
Focusing on widespread barriers to care, these three, short video excerpts from our acclaimed HEALTHCARE STORIES series feature stories about inaccessible examination tables and weight scales and healthcare provider misperceptions and stereotypes. Advocates and practitioners alike recount their personal experiences and recommend actions for improving care. These downloadable videos present an all-important human perspective and affirm the barriers to care identified in a decade of research.