Nebraska Supreme Court Rules In Favor Of Low-Income Parents Dropped from Medicaid

Last week Appleseed won a lawsuit in the Nebraska Supreme Court which restored Medicaid benefits to hundreds of low-income parents unlawfully dropped from the program by the Nebraska Department of Health and Human Services (HHS). In the suit, Davio v. HHS, 280 Neb 263 (2010), class members challenged HHS’ policy of terminating a person’s Medicaid benefits as the result of a sanction under the Aid to Dependent Children (ADC) program. The ADC program provides monthly cash assistance to very low-income families (a family of three earning about $9,000 per year). The vast majority of people participating in the ADC program must do a work activity for a set number of hours per month, usually an average of 120. If they do not do the activity, they lose the cash assistance. But HHS went one step further and took away the ADC’s recipients Medicaid as well.

On Friday, the Nebraska Supreme Court found that HHS “unlawfully enlarged upon authorizing statutes and violated the principles of separation of powers,” when it stripped poor families of vital Medicaid coverage by approving a policy that allows HHS to impose a harsher sanction than specified by state law.

This decision is good news for more than 6,000 low-income Nebraska parents that participate in the Employment First Program, which is intended to help families attain economic self sufficiency. Nebraska families that qualify for ADC depend on Medicaid coverage to access needed preventative and medical treatment. Indeed, providing consistent health care coverage allows families to be healthy, retain employment, and become self sufficient. The HHS policy of removing Medicaid only made it more difficult for families to work towards economic independence, contrary to the goals of ADC. In other words, economic independence and access to health care go hand-in-hand. The Legislature recognized this principle in setting its policy and the Davio decision maintains that policy. This means that today, those working hard towards self sufficiency can be assured they will have access to health care, a good thing for many Nebraskans in need.

Read Press Coverage…

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An Urgent Conversation: The 2010 Building Nebraska’s Future Workforce Forum

Nebraska is at a crossroads.

The choices we make today about building and supporting our workforce will impact quality of life in our state for years to come.

According to the Georgetown University Center on Education and the Workforce, Nebraska ranks 7th in the nation for future need for workers with post-secondary education, yet only 36% of our workers have any post-secondary education.  And while Nebraska was not as deeply impacted by the recession as other states, our capacity to come out ahead in the economic recovery is limited by the skills of our current workforce.  In fact, the Nebraska Department of Economic Development found that “workforce availability” was one of the top concerns of businesses.

Nebraska’s working families of today need new opportunities to increase their skills to contribute to these workforce needs.  Fortunately, many entities are stepping up to contribute to solutions: targeted job training programs are moving forward in health care and “green” industries and the statewide Community College system is serving significantly more students.

Yet, more can be done – but only if we make strategic choices.  On a local scale, we must remember that job training programs are crucial, but are not the whole solution.  This New York Times article “The New Poor – After Training, Still Scrambling for Employment” cautions that job training must link up to in-demand jobs in order to be successful.   On a state scale, we must make strategic choices in the upcoming budget conversation to protect programs that contribute to the long-term economic well being of our families and our communities.

Our state must make strategic choices today to build our worker’s capacity to fill current jobs, grow Nebraska businesses, and attract industries. We’re reminded of the importance of this discussion on a daily basis. That’s why Nebraska Appleseed, in partnership with our sponsors The Federal Reserve Bank of Kansas City, Opportunity@Work, and the Center for People in Need, will host the 2010 Building Nebraska’s Future Workforce Forum featuring keynote speaker Margaret Simms of the Urban Institute’s Low Income Working Families Project.

Join us and register today to lend your voice to the conversation about Nebraska’s future workforce!

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Hunger Doesn’t Take a Vacation

Pages-from-summer_report_2010Ahh, summertime.  For me, summertime in Nebraska brings back memories of swimming lessons, playing with kittens, and eating picnics of sandwiches, peaches and popsicles on our front porch.  Unfortunately, for too many kids in Nebraska, summertime is a time of hunger, rather than one of carefree days and picnic meals.

According to a new report, “Hunger Doesn’t Take a Vacation:  Summer Nutrition Status Report 2010” Nebraska reached only 1 in 10 low income children in our state with meals during the summer.  In other words, of the kids that access free and reduced price lunch during the school year, only one in ten receive meals through the Summer Food Service Program – the program meant to stave off hunger for kids during the summer.  Paradoxically, this results in hunger for some kids, and more weight gain for other children that eat lower-quality, less expensive foods instead of the nutritious meals they receive in school.  And, this year, the recession has meant that there is growing need for summer food assistance. The Lincoln Journal Star ran this story: “Report: Fewer summer meals programs in time of greater need” , which outlines the experiences of families in Nebraska and across the nation.

Fortunately, Congress has an opportunity with Child Nutrition Reauthorization to ensure that millions of children in this country, particularly low-income children, have consistent access to nutritious food.  Rule changes expanding the eligibility for communities to access the Summer Food Service program could help our state serve thousands more children.  Additional changes, such as implementing a nationwide after school meals program, could help serve children during other out-of-school periods as well.  See details about the potential for positive legislative change from our friends at the Food Research and Action Center.

So what can you do?  We need organizations to SIGN ON here to a memo supporting a robust child nutrition reauthorization bill.  The sign-on deadline is July 23.

THANK YOU for supporting the vision of summertime as a time of fun and sun, not a time of hunger, for children.

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Will You Stand Up to Anti-Immigrant Sentiment In Our State?

DiAnna SchimekYou’ve seen how over the past few months a few members of our state and communities have pursued misguided and harmful public policy designed to create fear and division and turn neighbor against neighbor:

  • Governor Heineman’s administration eliminated pre-natal care for children of undocumented women
  • Fremont voters passed a divisive and unconstitutional anti-immigrant ordinance, creating a climate of fear and distrust
  • And now State Senator Charlie Janssen of Fremont has announced plans to introduce an Arizona-style anti-immigrant bill in the coming legislative session [1]

This simply can’t continue.

Will you donate $25, $50, $100 or more to help Nebraska Appleseed:

  • Restore prenatal care to all pregnant women in Nebraska

  • Ensure no other communities follow in the steps of Fremont

  • Stop an Arizona-style copycat bill from passing in Nebraska


Read more about Appleseed’s work on these issues here

Now is the time to take a stand against anti-immigrant sentiment in our state.

Each day Nebraska Appleseed staff are developing legal strategies, providing positive policy options and educating community members about their rights and opportunities to build strong, integrated communities.  Together, you and Nebraska Appleseed will stand strong with new immigrants and longtime community members, faith groups and community organizations, union workers and small business owners to challenge anti-immigrant proposals head-on in the coming legislative session.

Will you donate $25, $50, $100 or more to help Nebraska Appleseed challenge the anti-immigrant forces in Nebraska that seek to alienate and divide our communities?

But stopping divisive, punitive legislation is only one part of a greater fight.  We need rational and humane federal immigration reform that reflects our values and moves us all forward together.

Nebraska Appleseed is aggressively working with our state and national partners to accomplish common-sense and comprehensive immigration reform that reflects our shared values of community, equality, opportunity, and justice.

Whether you donate $25, $50, $100 or more you will show that anti-immigrant laws are not tolerated in Nebraska and that we are stronger when we stand together.

Thank you for your support and helping to build a more just and humane immigration system.

Sincerely,

DiAnna Schimek
Nebraska Appleseed Board Member

[1] “Lawmaker plans Arizona-style immigrant bill for Nebraska” Lincoln Journal Star, 18 May 2010

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Comprehensive Immigration Reform Urgently Needed

flag-and-immigrantsYesterday, the President gave a long-awaited public speech on immigration. The speech reflected what we know first hand here in Nebraska; the need for common-sense immigration reform is urgent.

Describing a “creaky system” of “patchwork fixes and ill-conceived revisions,” the President affirmed his commitment to an immigration reform package that provides a path to citizenship for the millions of immigrant working families who are an important part of our communities and economy, as well as reforms to address the long backlogs, waiting periods, and other problems family members face in a system that no longer lives up to our values. The

President’s speech now must be followed by action.

We need to see that our members of Congress and the Administration are serious about tackling this tough issue creating order out of the chaos of the current immigration system. The lack of federal action has created a vacuum that contributed to the choice of Fremont voters to enact an unconstitutional, expensive, and divisive ordinance and to similar actions by the State of Arizona. We cannot have a patchwork of 50 or more different immigration laws for different states and communities. Our broken system is a national crisis that requires strong and relentless presidential leadership and bold action from the United States Congress.

Our country desperately needs an immigration system that works. Nearly a thousand families are being torn apart every single day by a broken immigration system that wastes our tax dollars. In Fremont, Nebraska, a climate of fear, distrust and division has taken over the community and will not soon pass. Tax dollars will be spent defending an unconstitutional ordinance and at the end of the day, no real solutions will result until action is taken at the federal level to repair our immigration system. In the meantime, Nebraskans of all backgrounds lose out on the opportunity immigration represents for the future of our communities, the opportunity to build upon the good will, skills, and talents we have together.

As Bishop Wester, Chairman of the U.S. Conference of Catholic Bishops, has asked, for how long will we continue to invest enormous resources in a system that makes us less safe? And for how long will we continue to prioritize using our manpower, weaponry, and resources to separate powerless mothers and fathers from even more powerless children? Our current system is illogical.

Our Congressional delegation must join the communities of faith, business, labor, and law enforcement across Nebraska to find common ground and finally solve this problem once and for all for the future of our state. Our Senators and members of Congress must step up now and tackle one of our State’s and our country’s most pressing issues.”

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Healthcare.gov Web Portal is Here!

Healthcare.govToday is an important day for those Nebraskans looking for health care coverage. Today was the launch of a web portal created by the federal Department of Health and Human Services which will help people find health care coverage options in their local areas. The web portal is one of the consumer benefits required by the new health reform law, the Affordable Care Act. The goal was to simplify and make more accessible, information about health care coverage for consumers.

People can log onto the site, www.healthcare.gov, and choose their state. They are next prompted to answer a few questions to make the information more specific to each person’s circumstance. Then the site provides several options for potential coverage. The options can range from new provisions under the health reform act like the ability to keep children on family coverage until age 26, to a list of private health insurance plans offered in your area, or even public health insurance options like Medicaid. There are links from the list of options for more information, applications, etc.

The website is easy and accessible (I’ve tried it). But they are still working out some kinks and are eager to get user feedback. The banner on the top notes how people can provide feedback to the Department of Health and Human Services which runs the site.

The site will also keep evolving so that more detailed information is included. This is a great first step in making sense of the options out there for people seeking coverage and putting information in the hands of the consumer so they have more control over their choices. Try it!

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Crying Wolf

Written with Robert McEwen
stethoscopeThis week marks the three month anniversary of the passage of the health care reform bill. In just that short time we have already seen positive changes. Parents can keep their children on their family coverage until age 26, seniors have begun receiving checks to help them fill the donut hole that occurs in their Medicare Part D coverage, a new web portal is going to be launched on July 1st to help families and small businesses figure out what coverage might be available to them in Nebraska right now, and a new high risk insurance pool will also be launched on July 1st which will provide coverage to some uninsured Nebraskans.

Unfortunately, before many other health reforms take effect, the health insurers are taking the opportunity to raise premiums even while they enjoy record profits. The insurance industry is crying wolf and blaming the premium increase on healthcare reform, but Health Care for America Now (HCAN) released a report earlier this week which provides information to the contrary. First, premium increases are generally set in the fall, long before the health reform bill was even passed. In fact, health care reform wasn’t passed until the end of the first quarter of 2010 when insurers has already seen an increase in profits of 31% over the first quarter in 2009. Second, 2009 was a also a record profit year for most of the major insurers while most spent less on paying actual medical claims. What were the premium increases for if profits are high and insurers are using less and less of people’s hard earned premium dollars on actual medical care?

The claims that insurance rates are going up because of health reform don’t hold water. In fact, the health care reform law will do more to reign in the troubling practices of insurance companies.

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Smart Choices in Hard Times

Nebraska State CapitolNebraska’s budget should reflect Nebraska’s priorities.

This seems like a simple statement, but really, it says quite a lot. It says that Nebraska values of family and community should drive our budget choices, it says that our shared resources should be directed at strengthening our families and workers, and it says that we should invest in opportunities that allow people in our state to build a better future.

Today, Nebraska Appleseed and a group of organizations from across the state representing interests ranging from elder affairs to child welfare, made that statement together. This is an important step as the state legislature prepares for a discussion about how to address the state’s budget shortfall. An Ad Hoc Committee of the State Legislature will meet on June 29 to address LR 542 and the budget process which will begin in the interim. Click here for more details

The recession has increased the need for critical services with fewer resources, putting new importance on the need to focus on our state’s values and priorities. However, Nebraska does have an opportunity to take a balanced approach that considers a variety of options to draw in more revenue and create cost-savings in our budget. If we make Smart Choices, Nebraska can address budget concerns and prepare our state for recovery.

And that’s what organizations in Nebraska came together today to say. Click here to read the statement

Our vision is that with a balanced approach, we can build a budget that reflects our priorities and ensures that state government has the resources to meet the needs of families struggling through the recession and build a better future for Nebraska.

We believe that we can build a budget that will work for all of Nebraska, and we’ll continue this work as the process continues.

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Sometimes Historic Change Takes Heroic Acts

DREAM Walk

The DREAM Walk - www.passthedreamact.org

Last week, Nebraska student and wrestling champion Daniel Dominguez walked from O’Neill to Lincoln – covering 200 miles on foot – to raise awareness about the federal DREAM Act. To learn more about his incredible journey and the critical importance of the legislation, go to www.passthedreamact.org.

The DREAM Act is federal legislation that would allow talented students without legal status who have grown up in the U.S. to continue their education, paying in-state rates (similar to Nebraska’s in-state tuition law). Importantly, it would also provide a means to apply for legal status for those who graduate from college or complete two years of military service (this cannot be done at the state level).

Appleseed was proud to join Daniel and approximately 100 supporters from his school and others for the final walk to the Capitol. Dan, his teachers, and other school administrators provided inspiring words about the need for this common-sense legislation and its importance for Nebraska’s future and our incredible students. They are an inspiration to us all. Learn more about Daniel’s walk and the DREAM Act at www.passthedreamact.org.

Press Coverage:

Teen Runs to Support the DREAM Act – KLKN TV
100 Rally for Immigration Reform – Omaha World-Herald
Walking for a Dream – Omaha World-Herald
Students Rally at Nebraska Capitol in Support of DREAM Act – Lincoln Journal Star
O’Neill Student walks to Lincoln to rally to support DREAM Act – Lincoln Journal Star
Audio Slideshow: DREAM Act Rally at Nebraska Capitol – Lincoln Journal Star
Student Hopes to Promote Awareness for Undocumented Students – Norfolk Daily News
Dream Act Interview – KBRX Radio
Midland Voices: DREAM Act not Amnesty – Omaha World-Herald
Poll:  Do you Support the DREAM Act? – 10/11 News
NE Students March in Support of Immigration Legislation – 10/11 News

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To Serve or Save? How About Both?

Managed CareLast week Appleseed testified on a major shift in Nebraska’s Medicaid program. The state is moving to a “full-risk” managed care program in ten counties contiguous to Omaha and Lincoln on August 1. For over a year Appleseed has been expressing serious reservations about this change. (You can read our testimony here) The fundamental orientation of full-risk managed care is the bottom line, not on the care of the client and yet ironically, this may not be the most cost-effective way to run a Medicaid program. While many states have moved to managed care in their Medicaid programs, the states showing the greatest success and savings have abandoned full-risk managed care in favor of managed care focused on care coordination, especially chronic care management. These states have found that working with providers and Medicaid patients on preventative care and disease management not only saves them millions of dollars, but ensures that Medicaid meets its mission of providing necessary health care to its clients.

In contrast, full-risk managed care, even if it includes some care coordination, still manages to be about profit and savings rather than the patient. Under this new system Medicaid recipients will choose between two Managed Care Organizations (Coventry and United Healthcare) as their health plan provider. With full-risk managed care, the state pays the Managed Care Organizations (MCO) a certain amount per Medicaid recipient enrolled with the MCO each month. As the name indicates, this model shifts the risks (and the benefits) of the costs of care to the MCO. So, if a Medicaid recipient needs a great deal of unexpected care, the MCO rather than the state bears the burden of paying for that care, even if the cost exceeds the monthly fee the MCO received for that patient from the state. Conversely, if a Medicaid client remains healthy and does not have health care costs equal to the monthly fee the MCO receives for that client, the MCO pockets the profits.

In addition to being concerned that full risk managed care is not patient centered or cost-efficient program, Appleseed has some specific concerns about how it is being implemented, specifically the lack of accountability for both the managed care organizations and the Department of Health and Humans Services. (Again, find our testimony here)

As other states have shown, saving money while serving Medicaid clients is possible. There is a way to manage the care in Medicaid to minimize the unanticipated costs to the state, create taxpayer savings that actually redound to the taxpayer not an insurance company, and serve Medicaid patients well. Appleseed will continue to work to move our Medicaid system in a direction that works for all Nebraskans.

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