Public health is for the public: Rafael Del Castillo for Congress

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Rafael Del Castillo is a lawyer who follows his conscience.  The Honolulu attorney has been working as much as fifty hours a week for free since January 1.

 

His clients are twelve families appealing health insurance company denials of services for their children with disabilities.  Many of the denials are life-threatening, as the children, ranging in age from 4 to 19, are medically fragile.

He is working for free because a new law went into effect that destroyed appeal rights patients had had for a dozen years which reimbursed them for any legal fees in their appeals. 

Del Castillo is running for Congress, for the seat in the U.S. House of Representatives being vacated by Mazie Horono.  His web site details his positions better than I can here, but I am writing this because I believe actions can speak as eloquently as words.

I can think of no higher recommendation for a politician than someone who will follow his conscience as Del Castillo has been doing.

My medically fragile daughter Hannah is one of Del Castillo’s clients.  Over the past couple of years, I’ve come to know some of the other families who rely on Del Castillo to keep our children safe, at home, and as healthy as possible.

The law depriving our children of a level playing field against a $110 billion a year Wall Street giant actually covers all 270,000 or so people in Hawaii enrolled in Medicaid.

The law was intended to be the final step in the effective block-granting of Hawaii’s Medicaid program.   Cutting off access to lawyers was a simple way to deny 270,000 people access to the protections of federal law.   It gave the state ultimate power over how federal Medicaid funds are spent, accomplishing overnight what the US Congress has blocked for the past thirty years.

What neither the state nor the health insurance companies planned on was Del Castillo continuing to represent his clients, whether he would be paid or not.

The law was introduced by Hawaii’s first Democratic Governor in eight years, and passed within his first seven months in office.  In a meeting with the families last August, the Governor admitted the law was intended to save the insurance companies money on legal fees.

The company saving the most from the law immediately was Unitedhealth.  At the time, Del Castillo had over a dozen cases just against that company, and a record of winning 90% of all cases.  By May 2011, Del Castillo was estimating Unitedhealth’s legal costs defending its unreasonable denials of care at around half a million dollars for the year to date.

Ironically, Unitedhealth’s Medicaid and Medicare operations in Hawaii had been under some form of federal or state oversight since April 2010 for violating the legal rights of these same children. Federal Medicaid and Medicare laws were broken every time Unitedhealth denied services to the children that their doctors had prescribed as “medically necessary.”

So the Governor knew Unitedhealth was violating federal regulations by cutting services for our kids when he told us point blank that he was “a failure” if any of us needed a lawyer.

The Governor was also aware the services are not being denied because the state lacks the money to pay for them.  They are being denied so Hawaii’s two for-profit Medicaid managed care companies can sustain twenty percent operating profits.

After all, what does a $9.4 billion “savings” from its federal Medicaid and Medicare contracts mean to Unitedhealth compared to a few hours of nursing care here, or a speech therapy session there?

Del Castillo has been so busy working for our children for free that he has done little fundraising for his Congressional campaign.  That was one of the reasons cited by Hawaii’s biggest media outlet in their refusal on Friday to include Del Castillo in their upcoming Congressional debate.

For years, the media has blackballed Del Castillo.  Over a decade ago he was told the health insurance companies had linked pulling their advertising with news coverage of Del Castillo’s work on behalf of patient healthcare rights.  Unlike, apparently, the Governor, he is not willing to play ball with one of the state’s biggest federal contractors.

Government needs to be taken away from the corporations and given back to the people.  Public health funds need to go to the public, not Wall Street.

This is why I support Rafael Del Castillo for Congress.

Disability Rights Action Alert for National Health Care Reform activities

Two national disability groups have released petitions on the internet. Each petition addresses a different aspect of national health care reform, and both petitions affect the medical civil rights of our children. Please help spread the word of both petitions to all the groups that you participate in. The petition sign up sheets can be submitted over the internet, or you can print them and take them to your local meetings. These both have tremendous implications for our children's futures, and we need to get involved and let our voices be heard. The National Organization to End the Waitlists is focusing their efforts on the waiting lists for entry into the Medicaid waiver programs that plague so many states, and prevent hundreds of thousands of our kids from receiving the medical rights they're entitled to. If you're not familiar with the Medicaid waiver programs, qualification is based on the income and assets of the individual with the disability, and don't take into account any assets or income of the family. A primary focus of the waiver programs is to provide the appropriate in-house medical supports that will enable our kids to stay at home while receiving the appropriate professional medical supports. Once our kids get into these programs, they are pretty much there for life, which for me, at least, provides a sense of relief about my daughter's future. Nowait is also pushing that once an individual is finally placed in a medicaid waiver program, their medical rights don't follow them if these move to another state, and sometimes, just another country. Their petition is here: http://www.gopetition.com/petitions/noewait.html The Center for Self Determination's goals are much broader: reform Medicaid to ensure that home professional supports are available for those who need them. They're speaking for the wider community of individuals with special health care needs, which includes the elderly, people sufferering from chronic health problems, as well as our kids. I've uploaded to Scrib the Executive Summary of their goals. Signatories already include all the major disability and senior citizen rights groups. The more in-depth reports upon which this summary is built are all linked to here. Their petition is here.

MA, MI and NY facing cuts in programs for people with developmental disabilities

An April 20 email newsletter put out by the ARC of Colorado summarized budgets for services for individuals with developmental disabilities in six states.

state legislative funding situations for DD services: MN is looking at graduated sales tax increases to particularly benefit persons with developmental disabilities and the elderly. In MD, a legislative proposal to increase the state alcohol tax to deal with the WL was defeated in the last days of the session. MA is expecting severe cuts in family support programs. MI is experiencing devastating reductions in state revenue and program funding. VA is restoring cuts previously made to waiver programs as a result of an overturn of a gubernatorial veto and The Arc in VA is working on a new Autism waiver (Carol—Betty, you may get a call.) NY is still waiting for the last shoe to drop re: state funding for DD services. They do not expect any outright reductions but, for the first time in 25 years, do not expect any increases.

Disability rights action alert for Louisiana

Lousiana is threatening a second set of cuts affecting solely the disability community in Louisiana. In February Governor Jindal (yes, the same Governor Jindal who wants to turn down federal stimulus funds) cut 35% from the budgets of some of the state's programs for individuals with disabilities. A second round of cuts in the state legislature would raise that figure to 7.5% to 12.5 % in cuts for those same programs, plus all other disability programs facing a new 4 to 7 % cut. What's important to remember is that everytime a state cuts $1 from services for its population with disabilities, they are also giving up more than that in matching federal funds. For Louisiana, the state loses $4 in federal funds for every $1 in state budget cuts. How does this make sense???

Idaho takes a swing at the Olmstead Act

The big thing in state cuts seems to be aimed at reducing the services that allow kids as well as adults with disabilities on Medicaid to stay in their family homes. Back in 1999, the Supreme Court stated people with disabilities could not be segregated in institutions, and the states must fund supports and services that allow these individuals to be cared for at home, in their own communities. It's referred to as the Olmstead Decision, and Idaho appears to be trying to violate it. According to this article, there's a court case in Idaho in response to the state's attempt to cut home services to individuals with disabilities. The article says that approximately 900 individuals with disabilities will be at risk of institutionalization if the state does not reverse its position. It also mentions, and this is the really important figure, that It makes absolutely no financial sense to reduce these services. The state (Idaho presumably) spends $200,000 per year per person in an institution, versus a cost of $20,000 to $50,000 per person per year to provide home based services. If you know anyone in Idaho who could be affected by this court case, please pass this information along to them.

Action Alert for Texas

Essential state legislation to benefit 88,000 state citizens with special health care needs has apparently been put on the back burner. Here are the links to the legislation in question. http://www.legis.state.tx.us/BillLookup/History.aspx?LegSess=81R&Bill=HB1589 http://www.legis.state.tx.us/BillLookup/History.aspx?LegSess=81R&Bill=SB1060

How EPSDT is supposed to guarantee services from your school

In 2004, a brochure was published by the US Department of Health and Human Services explaining to the parents of children with disabilities how EPSDT would help them. EPSDT - Supporting Children with Disabilities was published in September of 2004. Flip to page 17 and you'll find the following rather extended quote:

A special case of how EPSDT covers medically necessary services occurs in the education system – where many children receive their services. Many children with special needs receive a wide variety of services through the public school system. They range from academic services, such as reading and math instruction, to more health-related services, such as physical therapy and personal care. Trying to figure out who is responsible for paying for which services can be very confusing. However, schools can (and many do) bill Medicaid for reimbursable services under EPSDT. Medical necessity is just as important here as it is outside the school system. According to the federal government, “Medicaid is the payer of first resort for medical services provided to children with disabilities pursuant to the Individuals with Disabilities Education Act (IDEA).”5 In other words, Medicaid eligible children with disabilities are entitled to receive medical services in the school setting, paid for by Medicaid, if two important requirements are satisfied. First, the school/school district must be a participating Medicaid provider. Second, the services must be written into the child’s IEP/IFSP, which automatically makes them considered medically necessary.

My child's school district is a Medicaid provider. Assuming this is true, then how on earth can they justify denying services requested by her doctors over and over again? If you're the parent of a child within the special education system, you may or may not be having difficulties with your school system. Many of us have experienced the feeling of walking into a room with 15 or so teachers, and the only chair left is one that's kid-sized. It usually doesn't bode well for the rest of the meeting. Be that as it may, the point is that the Federal government appears to be saying that our children are entitled to everything that one of their service providers says is medically necessary. The list is extensive, and it's on page 14 of the brochure. Take this brochure and give it to every caregiver and parent of a child with special health care needs. Please.