Fall 2022 Newsletter

​Save the Date! Give Miami Day is November 17!

Dear friend,

What we're doing at FHJP is more important now than ever. Here are some highlights from recent months. Thank you for helping to make this work possible. 

Litigation

Florida Health Justice Project is working overtime to ensure that the state complies with federal Medicaid law as well as the protections of the Affordable Care Act, and that residents covered by Medicaid have access to medically necessary services.

This summer, the state issued a hateful new rule denying Medicaid coverage of gender-affirming care for transgender beneficiaries. FHJP brought together a team of partners – Southern Legal Counsel, Lambda Legal, and the National Health Law Program – who leapt into action, first to oppose the rule via public comments, and when the final rule was published, to file a lawsuit with pro bono support from Pillsbury Winthrop Shaw Pittman LLP.

FHJP took the lead in assuring that the Florida Medicaid Agency provided essential protections to medically fragile youth who need round-the-clock healthcare. As a result of FHJP and Disability Rights Florida filing an administrative petition challenging the agency’s erroneous interpretation of the state law, the agency undertook extensive and robust corrective actions. 

FHJP has also taken the lead in assuring that aged and disabled adults who are medically incontinent are no longer denied Medicaid coverage of needed incontinence supplies. Along with Disability Rights Florida (serving as both co-counsel and an organizational plaintiff) and attorney Lewis Golinker, we filed a class action complaint in July of this year asking that the federal court order the state to provide much needed medical supplies for plaintiffs like Blanca M., a 22 year old Floridian who suffers from multiple disabilities, including spastic quadriplegic cerebral palsy, and who relies on a gastrostomy tube for nutrition. Read more about the case here.

And, in June, along with co-counsel National Health Law Project, FHJP filed B.T. v. Marstiller, a case that seeks to address longstanding issues with a pediatric therapy administrator whose policies and practices result in both lack of coverage for medically necessary speech therapy and failure to comply with due process notice requirements. Read the complaint here. 

Connecting Kids to Coverage

FHJP is the new South Florida lead for USF's Connecting Kids to Coverage grant, run by Florida Covering Kids and Families. FHJP has hired two new part-time staff, Alejandra Sepulveda and Nicole Licairac, to assist families in enrolling their children in Medicaid and CHIP (public health insurance for children). We are excited to be working to address uninsurance among Florida's children, and to learn from this experience about the systems barriers that leave eligible children uncovered.

Home and Community Based Services

Home and community based services (HCBS) allow low income elderly and disabled individuals with intensive care needs to receive services at home, rather than relocating to a nursing facility. Unfortunately Florida’s HCBS programs are woefully underfunded; the state ranks an appalling 51st out of 50 states & D.C. on the AARP's Long Term Services and Support Scorecard. Increasing access to these services and improving accountability within the Medicaid HCBS system is one of our top priorities. We are immensely grateful to the Retirement Research Foundation for four years of support.

HCBS Storyteller Visibility: Key to FHJP’s work is telling stories. We amplify the stories of Floridians who experience the injustice of our broken healthcare system. Alene is one of those individuals. Last year, she shared with us her story about the challenges of relying on Medicaid’s home-based care system. 

“People in my situation should not have to spend another day alone in their wheelchair without a caregiver," Alene says. “We need funding and incentives to increase the pool of workers willing to provide care for Medicaid patients.” 

With her story launched into the world, Alene has become a powerful advocate. She was featured in the New York Times, and subsequently invited to testify before the U.S. Senate’s Special Committee on Aging at their hearing on “An Economy That Cares: The Importance of Home-Based Services”. We are gratified that our work has brought Alene’s voice, and the urgent issues impacting her health, into the spotlight. You can watch her testimony here.

Advocating for Increased HCBS Funding: FHJP submitted a comment letter to the state Medicaid agency urging an increase in pay for vital home health workers, and together with United Way of Miami organized a roundtable discussion on this issue with speakers from the White House, the US Health & Human Services Administration, Miami Dade County Mayor Daniella Levine Cava, and Justice in Aging. We applaud the state’s pay increase for HCBS workers to $15 per hour, a critical first step in ensuring that individuals like Alene and Shirley, a bed-ridden elderly Jacksonville woman who has suffered a series of strokes, will have consistent care.

FHJP also worked closely with national, state and local partners for inclusion of funds for home and community-based services in a federal reconciliation package that would have helped both patients and the workers who care for them, many of whom are immigrant women and women of color. Though HCBS did not make it into the Inflation Reduction Act, the educational work we undertook with members of Florida’s congressional delegation and with the public laid important groundwork for on-going advocacy.

Maternal Health & Birth Justice

One fifth of Florida women of childbearing age are uninsured. Without insurance, too many women head into pregnancy with uncontrolled health conditions and unaddressed risk factors that imperil outcomes. And while almost half of all pregnant women in Florida are covered by Medicaid, many experience difficulty accessing important services, including midwifery care. These access issues are characterized by historic and persistent systemic and institutional racism that lead to significantly worse outcomes for Black moms and babies. 

FHJP is proud to partner with Southern Birth Justice Network and Catalyst Miami on the Miami Birth Justice Initiative, which aims to address institutional bias and racism in maternity care, to reduce the high C-section rate, and to improve access to midwives and doulas. Through this collaboration, we met Keshia, who shared her pregnancy and birth story, highlighting the dearth of services, including mental health services, available to support new mothers.

FHJP also worked closely with the University of Miami School of Law’s Human Rights Clinic to draft a maternal health policy agenda for on-going advocacy as well as a joint submission presented this summer in Geneva to the United Nations Council on the Elimination of Racial Discrimination. Our recommendations to address the disparities in maternal health outcomes and access, which are deeply tied to systemic racism, were reflected in the Committee’s findings.

And there’s good news to report: this Spring the U.S. Centers for Medicare & Medicaid Services approved the state’s application to extend postpartum coverage to a full year, up from just 60 days. FHJP had led the statewide coalition that pushed for this change, and we were honored that our Executive Director, Alison Yager, was invited to participate in CMS’s press conference announcing this approval. 

We are now focused on working with our partners, including the March of Dimes, to create a Medicaid Postpartum Coverage Extension Implementation Toolkit targeting providers, pregnant people, and Medicaid managed care organizations, to ensure that the coverage extension is well known, well understood, and well utilized.

Immigrant Access to Healthcare

For the past three years, FHJP has been one of the leaders of Florida’s Protecting Immigrant Families coalition, a partnership dedicated to addressing the chilling effects of an immigration rule known as the public charge rule, that was made harsher under the Trump administration. Though the Biden administration has reversed the changes to the rule, we have seen an on-going impact: high rates of immigrant and mixed-status families enrolled in public benefits are disenrolling, and those who are eligible are declining to enroll, for fear of harm to an immigration application. 

Education: In coalition with our partners, FHJP is working to ensure that individuals and families in impacted communities know their rights, and take advantage of available health and food benefit programs. This Spring, our coalition hosted a public convening, with nearly 90 attendees, for administrative agency staff and social service providers on Public Charge, the on-going chilling effect and reimagining the social safety net for immigrants. We also recently gave a training on the topic to some of the state’s leading healthcare navigators, and wrote a related article for Southern Poverty Law Center's Learning for Justice newsletter that reached thousands of teachers. If you know an organization that would benefit from training on the issue of Public Charge, please reach out.

Advocacy: For 25 years, an arcane federal policy known as the “five-year bar” has denied lawfully present immigrant families access to critical health and social services. The LIFT the BAR Act would end this unjust provision and restore eligibility to federal public benefit programs that provide essential support. FHJP and partners met with members of the Florida Congressional delegation to educate them about this issue, and to urge them to co-sponsor the legislation.

FHJP and our coalition partners have responded nimbly to the varied threats presented to Florida’s immigrant communities. One example: after a Gubernatorial Order that all Florida hospitals publicly report on the federal and county funds spent caring for undocumented residents, FHJP, together with Catalyst Miami, the Office of New Americans of Miami-Dade, and Southern Birth Justice Network, met with the Mayor of Miami-Dade County and the Regional Director of the U.S. Department of Health and Human Services. We urged the County and the federal government to take steps to reassure immigrants that they were safe seeking hospital care, and encourage them to apply for needed services for which they are eligible. 

Preparing for the End of the Public Health Emergency

In March 2020, the federal government declared a Public Health Emergency (PHE). The first COVID aid package then gave states additional Medicaid dollars in exchange for pausing Medicaid disenrollment for the pendency of the PHE. When the PHE ends, likely in early 2023, hundreds of thousands of Florida Medicaid enrollees will be found no longer eligible for benefits, leading to unprecedented coverage loss. 

While the PHE has been continually extended, FHJP has played a leadership role in preparing for the eventual end. We have launched a webpage with Q&As, fact sheets targeting implicated subpopulations, stories of those potentially impacted, and a uniquely informative training video, produced by Jay Jefferson, that fellow social service providers have raved about. 

We have also provided numerous trainings for other providers (some with our colleagues at Florida Policy Institute), and were featured speakers in trainings hosted by Catalyst Miami, the National Health Law Program and the Georgetown Center for Children and Families. And together with a coalition of allies, we gathered an audience of over 50 providers to a convening in which high level representatives from the FL Department of Children and Families, as well as Florida Healthy Kids were asked to present about their plans for the unwinding of the PHE, and to respond to participants' recommendations, concerns, and questions. We are grateful for the support of this work by the Florida Bar Foundation and the Health Foundation of South Florida.

Awards

For the second time, FHJP was awarded first runner-up for the Florida Bar Foundation’s prestigious Goldstein-Van Nortwick Award for Excellence for Legal Director Katy DeBriere’s work enforcing the Medicaid rights of former foster youth. (Not too shabby for an organization that’s not yet five years old, and an award that’s given biennially!) This award recognizes high level legal work that affects a substantial number of low-income people and addresses important poverty law issues. 

Miriam Harmatz, FHJP Founder and Director of Advocacy, was named as one of the Second Annual Inspiring Women of Health by the Health Foundation of South Florida. (Again, we’re on a roll: FHJP Executive Director Alison Yager received the award last year!)

And Alison Yager, Executive Director, was named to City and State's Florida Health Care Power 100!

Media 

FHJP team members and clients continue to make regular appearances in the news. Most recently, over 15 news outlets covered the case brought by FHJP together with Southern Legal Counsel, Lambda Legal, and National Health Law Program against the state’s Medicaid agency for denial of coverage of gender-affirming care for transgender individuals covered by the state program. And four FHJP storytellers were featured in this blog post by Georgetown’s Center for Children and Families.  

Enhancing Our Website

FHJP continues to improve our communications and educational content through innovative enhancements to our website and through expanded social media outreach. This year, FHJP began the work of translating much of the content of our website into Spanish. Ensuring that our website is accessible to Spanish speakers is critical.

Our new litigation page highlights one essential tool in our proverbial toolbox. Led by Legal Director Katy DeBriere, and in partnership with National Health Law Program’s Health Law Partnership, our legal actions help secure health care rights by holding the state Medicaid program accountable to their obligations under federal law.

We're grateful to have you by our side. Thank you for all that you do to further health justice.

With best wishes,
Alison Yager
Executive Director

p.s. Give Miami Day is November 17th! Want to become a champion for health justice and help FHJP raise funds vital to our mission? Contact our Program Administrator at ortiz@floridahealthjustice.org to find out how.