New Haven Independent

Health Care

Can Health Care Win?

by Melissa Bailey | Apr 28, 2006 9:41 am | Comments (0)

“The number one issue that he understands is health care,” said Communications Workers of America Local 1298 President William Henderson (pictured) Thursday as he threw his union’s endorsement to John DeStefano for governor. Will DeStefano’s universal health care plan be, as his campaign desires, the issue to mobilize voters to the polls? Union leaders, citing carpal tunnel syndrome, burdensome premiums and denied sick leave, said “yes.”

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Health Care Cri…PHTTHPTHPTPH!!!!

by Staff | Apr 27, 2006 9:12 am | Comments (0)

This scary-looking guy is roaming the airwaves shutting up anyone who tries to send you to this website in order to talk about how to solve Connecticut’s health-care crisis. If you haven’t seen him on TV yet, click here to watch him in action. And click here to read what this is all about.

Legislators Told: Close The Drug Gap

by Staff | Apr 26, 2006 8:30 am | Comments (0)

Since the advent of Medicare Part D last January, a trip to the pharmacy hasn’t been simple for people like 47-year-old Dolores Jeter of New Haven. So she and hundreds of other people in Connecticut took a different trip on Tuesday—to the state Capitol—to tell their stories and push lawmakers to keep a promise to fund a gap in prescription drug coverage. Click here to read Christine Stuart’s report.

“How Come None of Us Knew About This?”

by Melissa Bailey | Apr 25, 2006 8:37 am | Comments (0)

Money is sitting in a state account is just sitting in the bank instead of going where it belongs—to underinsured families like Sarah Hasty’s (pictured), whose children have special needs. Some of those families found out about it Monday night at a public meeting in Dixwell.

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Panel: Universal Health Care Is Cure For Ailing System

by Staff | Apr 24, 2006 10:03 am | Comments (0)

The common illusion that America has the best health care system in the world was shattered at a forum Saturday by facts and figures from health care experts, who presented a remedy for the state and country’s ailing system –- universal, affordable access to quality health care. Click here to read Gale Courey Toensing’s report.

James Calls For Universal Care

by Melissa Bailey | Apr 18, 2006 9:26 am | Comments (0)

How do you fix a city where people just blocks away from reknowned health centers don’t have access to affordable care? “Universal health care,” says New Haven’s aldermanic Black and Hispanic Caucus. The topic was first on the list Monday, when Alderwoman Jackie James gave that caucus’ State of the City address.

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The D Bus—For “Dubious”

by Tess Wheelwright | Apr 17, 2006 1:04 am | Comments (0)

With less than a month to go to enroll in the “Medicare Part D” prescription drug-coverage plan for seniors, state and federal workers are scrambling to quiet critics and get more of the missing 8 million elders signed up. A Medicare bus and accompanying Social Security administrators brought the eleventh-hour outreach effort to the Hill Health Center to address the doubts of New Haven seniors like Margie Porter (pictured getting a lift onto the bus) who still “don’t know what it’s even about.”

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Secret no more

by Melissa Bailey | Apr 13, 2006 11:11 am | Comments (0)

NEW HAVEN LEGAL ASSISTANCE ASSOCIATION, INC.
426 STATE STREET
NEW HAVEN, CONNECTICUT 06510-2018
TELEPHONE:  (203) 946-4811
FAX (203) 498-9271

April 12, 2006

M E D I A R E L E A S E

FREEDOM OF INFORMATION COMMISSION RULES MEDICAID HMOS MUST DISCLOSE DRUG DENIAL INFORMATION TO PUBLIC

Today, the CT Freedom of Information Commission (“FOIC”) issued its final decision in the Hunt v. DSS case, ruling that the state’s publicly funded Medicaid HMO contractors must disclose data revealing how often they use preferred drug lists to deny access to prescribed medication at the pharmacy counter to low-income Medicaid recipients. 

The FOIC ruled that the HMOs, including Anthem Blue Cross and Blue Shield and Health Net of CT, improperly withheld documents containing the drug denial data in violation of the Freedom of Information Act (“FOIA”).  It also reaffirmed that the Medicaid HMOs, by administering the Medicaid program in Connecticut for about 310,000 low-income children and their parents, are performing a “governmental function” and are directly accountable to the public under the FOIA, as the FOIC had previously ruled in a related case in December.
For over a year, legal services attorneys have been seeking, on behalf of two low income Medicaid recipients, information about how often the HMOs deny Medicaid recipients access to prescribed drugs at the pharmacy.  Specifically, the recipients want to know:
− How many individuals are denied drugs each month for lack of prior authorization
− How few of these individuals get temporary supplies to tide them over within 24 hours of the rejection at the pharmacy
− How many of these individuals still have no appropriate drug even a month later. 

In September, 2005, Governor Rell responded to an appeal from legal services attorneys by ordering DSS to obtain the HMO documents.  DSS requested the documents from the HMO contractors, to which the taxpayers pay about $700 million per year.  Some responsive HMO documents were produced.  But the two largest HMOs, Anthem and Health Net, have continued to refuse to turn over critical information about their drug denials.

At an FOIC hearing on October 19, 2005, the complainants’ attorneys established that Health Net and Anthem withheld documents from DSS containing this data and provided incomplete and misleading information to DSS about the requested data

For example, a letter on behalf of an Anthem officer to DSS dated September 9, 2005 claimed that the frequency of these rejections at the pharmacy was “zero,” while, under oath, the same Anthem officer admitted that the frequency was definitely not “zero”—yet, Anthem continued to refuse to provide the data.  A December 15, 2005 letter to DSS from Health Net defended the failure to provide this critical data, although it provided the data three years ago, on the basis that
“Hours and hours of Health Net manpower were required to gather and assemble this information because it is not tracked in the normal course of Health Net’s business.” 

Jeanne Milstein, Connecticut’s Child Advocate, stated:

“We know that needed medications which are not on an HMO’s preferred drug list and thus require prior authorization are routinely denied to children at the pharmacy for lack of prior authorization.  We also know that, often, this results in the child ending up in an emergency room or the taxpayers paying twice—when DCF pays directly for these rejected medications.  What we don’t know is the frequency with which these rejections occur.  This ruling should get us this data.”

Kevin Lembo, the State Health Care Advocate stated:

“This is an important ruling for accountability in health care, and I commend the Commission for again recognizing that the Medicaid HMOs perform a governmental function and should be subject to the sunshine laws.  The specific documents they are now ordered to produce are critical to improving access to health care.  Members of the General Assembly are currently considering legislation requiring the HMOs to provide temporary supplies of medication that require prior authorization. The data that will now be available will help our Representatives and Senators to quantify the problem and craft a workable solution.  This information should be readily available within the HMOs’ massive computer systems, and their claims that it is burdensome to provide the data are hard to believe.” 

A mental health provider for children, Jody Rowell, M.S.W., also saw it as a victory:

“The staff at Clifford W. Beers Child Guidance Clinic spends an inordinate amount of time arguing with the Medicaid HMOs to get payment for essential psychiatric medications needed by our young clients.  But no matter how diligent we are, inevitably we prescribe drugs for which prior authorization was required and the drug is then rejected at the pharmacy.  A lot of these clients don’t have the wherewithal to even let us know this has happened, let alone fight with the HMO.  This Freedom of Information ruling should allow us, finally, to get a handle on how often this happens.” 

The FOIC’s ruling orders DSS to obtain the data from the HMOs “forthwith.”

In addition, the complainants’ attorneys sent a letter to counsel for DSS on April 5, 2006 asking that DSS finally produce the withheld drug rejection data by April 13th, regardless of the results of today’s hearing, based on the Governor’s independent instructions to DSS that how the HMOs are spending the taxpayers’ money should be fully transparent.  A followup letter (attached) was sent to DSS’ attorney this afternoon requesting production of the documents tomorrow. 

For further information, please contact:

       
Sheldon V. Toubman             Randi Faith Mezzy
New Haven Legal Assistance Association, Inc.      Connecticut Legal Services, Inc.
(203) 946-4811 x148           (203) 756-8074

Greg Bass        
Greater Hartford Legal Aid, Inc.
(860) 541-5018

# # #

DeStefano: Look Out, Massachusetts

by Paul Bass | Apr 12, 2006 4:05 pm | Comments (1)

On the morning that Massachusetts’ governor signed an historic near-universal health care law, New Haven’s John DeStefano unveiled an even more ambitious plan Wednesday for the state he hopes to lead. DeStefano (pictured earlier Wednesday during a tour of new million-dollar “Soho-style” lofts in downtown New Haven)  is looking to put universal health at the center of his Connecticut campaign for governor. Everyone gets insurance, and even middle-class families of four pay no more than $180 to $300 a month. (Click here to read Christine Stuart’s account of the event. Read on for more on the plan’s details.)

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What Happened When The Kids’ Dentist Showed Up

by Tess Wheelwright | Apr 10, 2006 4:11 pm | Comments (0)

There aren’t enough children’s dentists like Bill O’Meara willing to take Medicaid rates instead of much higher private pay. Monday morning, it meant that 5 year-old Alex Bonaparte (pictured) had been waiting three months to have his cavities filled—and O’Meara was swamped.

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