Of Service - National Health Law Program protects health care for

Joe Surkiewicz

Have you seen the bumper sticker that says, The next time you need a doctor, call a lawyer?

It's no joke. If you're poor, that may be exactly what you need to do to get medical help.

Luckily, there's an outfit that specializes in preserving health care for the poor across the U.S.: the National Health Law Program (NHeLP).

NHeLP is simply the single best source of good thinking and good information on what's going on with Medicaid in Washington and throughout the country - and what the implications of actual or proposed developments are for beneficiaries and providers, said Bruce C. Vladeck, Ph.D., former director of the U.S. Health Care Financing Administration. In short, NHeLP's Medicaid work is indispensable and irreplaceable.

Larry Lavin, NHeLP's executive director since 1989, points out that while the current health care crisis is now affecting the middle class, low-income people have been vulnerable for years.

Our program seeks to help them better understand their choices in the complex health care system, and to preserve public health care programs increasingly threatened by cost-cutting efforts throughout the country that have devastating effects on our children, the elderly and disabled people, Lavin said.

When NHeLP was founded at University of California-Los Angeles in 1969, its mission was to provide research, consultation and technical expertise to legal aid attorneys throughout the U.S. on legal aspects of health services for low-income people.

The program soon began to focus on Medicaid implementation and similar broad public health issues. Medicaid, the largest public health insurance program in the U.S., now insures more than 51 million low-income people - primarily children, people with disabilities, and the elderly.

Because the program requires state matching funds, Medicaid's services are frequently not provided by the states as federal law requires.

That's where NHeLP comes in.

With offices in Los Angeles, Chapel Hill, N.C., and Washington, D.C. and 11 lawyers on staff, NHeLP protects the right of Medicaid recipients to maintain affordable access to services in the face of increasing federal and state efforts to reduce health care services to the poor.

The organization monitors public policy developments on Medicaid, reproductive health, and various other programs, and reports its findings though its websites, email reports, a quarterly newsletter, legal guides, and conferences.

As a lawyer in the Medicaid field, I rely heavily on NHeLP on complex issues, said Regan Bailey, assistant director of advocacy for public benefits and economic stability at the Legal Aid Bureau in Baltimore. You can always trust what they say on emerging issues, they're always on the side of the client - and they've always looked at the issue.

Added Laurie Norris, a staff attorney at the Public Justice Center in Baltimore: NHeLP is a critical ally to Maryland's health care advocates. We call them whenever we need deep expertise on health care issues. They are always there for us.

On the political side, NHeLP also serves as a resource to legislators and other policy makers, and acts as an advocate in administrative rulemaking, lobbying, and litigation.

Since its creation, NHeLP has served as counsel with legal aid and other public interest law programs around the country in a range of cases to protect citizen rights under Medicaid and other health care programs. A few recent successes:

*In 2003 NHeLP and two other groups filed suit after Arizona increased the co-payments of Medicaid beneficiaries for prescriptions, office visits and other medical services. Newton Nations v. Rodgers alleges that the state's action denied approximately 100,000 of Arizona's low-income citizens access to health care. A federal judge granted a preliminary injunction against the state's action.

*NHeLP and the Welfare Law Center won a final judgment in a 2003 suit (White v. Martin) requiring Missouri to provide transitional Medicaid to more than 17,000 working parents. The court found that if Medicaid were abruptly withdrawn, many of the women in the class would have become so ill they could have lost their jobs. In January 2004 NHeLP and Nebraska Appleseed accomplished the same result in Kai v. Ross for over 10,000 working women in that state.

*NHeLP and other organizations represented children against North Carolina for failure to ensure that dental services were adequately available and accessible. In 2003 the parties reached a settlement that included an agreement to raise the dental reimbursement rates. Since the settlement, the number of dentists participating in Medicaid has increased substantially.

*NHeLP was co-counsel in Vinson v. Barbour (2004), in which the U.S. District Court restored Medicaid benefits (including prescription drug coverage) to 50,000 elderly and disabled people in Mississippi following their elimination by the state legislature.

Recently NHeLP has devoted increasing attention to supporting advocacy efforts by health care consumers through a range of services. The organization received a grant from the W.K. Kellogg Foundation in 2004 to support participation by Medicaid beneficiaries in promoting and protecting Medicaid services at the federal and state levels.

NHeLP is working with state Medicaid Advisory Committees mandated by federal law across the country, as well as many other community and consumer groups, to support Medicaid advocacy efforts with administrative agencies and legislatures.

In Maryland, for example, NHeLP helped to provide legal counsel to state legislators on a bill to strengthen Maryland's Medicaid Advisory Board and is advising local advocates.

There's never any ego with them, noted Legal Aid's Bailey, who has worked with NHeLP since 1998. They make the issues less complex so you can hold your own with the state on Medicaid issues. NHeLP is always up-to-date and out there sharing with everyone.

That includes online. NHeLP's Web site, www.healthlaw.org, provides timely information and analysis to advocates, lawyers, and community organizations on health law issues concerning low-income and other disadvantaged people.

The organization also provides another Web site, HealthCareCoach.com, to help consumers select and use insurance to get the best health care they can.

A nonprofit, NHeLP received most of its funding from the U.S. Legal Services Corp. until 1995, when Congress eliminated funding for it and similar national support law centers.

Today, NHeLP now relies on grants from private foundations and individual contributions from lawyers and others around the country.

Robert J. Rhudy, the former executive director of the Maryland Legal Services Corp., is a consultant and attorney private practice in Baltimore. He can be reached at bobrhudy@yahoo.com. Joe Surkiewicz is communications director at the Legal Aid Bureau. He can be reached at jsurkiewicz@mdlab.org.

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