TMC Medicaid Appeals Project Follow-Up

Gregg Lombardi - Executive Director

There was a great article in the Kansas City Star this morning about the Medicaid Appeals partnership that Legal Aid of Western Missouri has with Truman Medical Center.

http://www.kansascity.com/2012/10/04/3848419/alan-bavley-hed-like-to-lose-this.html
 

As the article pointed out, the project has gotten more than 1,000 Truman patients who are permanently and totally disabled access to long-term, proactive medical care. It has also generated more than $11 million in sorely needed revenues for Truman.

 

The article, however, failed to mention the tremendous team that does this work. Effie Day as Project Director and Stacy Schaub as Supervising Attorney of the Public Benefits teams have done excellent work in making sure that when Truman’s patients are wrongly turned down for Medicaid, they have the best possible representation they can have to make sure that they get the benefits they deserve. And the same holds true when the patients come from our other referral partners, including K.C. Free Health, KU Medical Center and St. Luke’s Hospital, as well as when the wrongfully denied client just calls us on the phone.

 

The fact that Legal Aid wins more than 85% of all of the Medicaid Appeals cases is the result of the excellent work of everyone on Legal Aid’s Public Benefits team, including the case handlers: Effie Day; Stacy Schaub; Karen Karnes; Katie Wood; Maura Weber; and, Megan Simpson and our talented paralegals: Tracie Griddine and Kim Morris, along with the team’s legal secretary—Sandy Kincaid.

 

We also could not get the results we get at Truman without the excellent work of the Financial Counseling Center staff, the assistance of the social workers and medical staff at Truman and the support of Lydia Jones and Bill Colby who oversee the project at Truman.

 

It’s a wonderful project and the true credit should go to the front line staff who get the job done.

 

Scooter Commuters

Gregg Lombardi - Executive Director

I’m working on becoming a scooter-commuter. This spring I started riding a scooter to work once or twice a week.  Over the summer, I’ve racked up over 1,000 scooter miles and my goal is to ride it over 2,000 miles per year. If you drive down Gillham Road during rush hour, I’m the guy with a button down shirt and khaki’s riding a little, red, Buddy scooter.

I figure that scootering combined with my switch to a Prius will save about 250 gallons of gas per year. By itself that won’t have a lot of impact on global warming, depletion of fossil fuels and U.S. energy dependence on Middle Eastern oil.

But, if you think of 1,000 K.C. area commuters making a similar switch (that’s well under 1% of the commuting population), then we’d be talking about saving a quarter million gallons a year. And if the same change happened in 50 other cities around the country, then we’d be turning at least a few super-tankers of oil back to the Middle East every year.  The price of oil might even go down and the air might just be a little easier to breath.

That’s a nice thought to enjoy while I scooter around.

Legal Aid's Fight to Re-purpose West High School

Gregg Lombardi - Executive Director

31 years ago this month, the Kansas City Missouri School District closed West High School.  Ever since the District closed West, Michael Duffy, who leads Legal Aid’s Economic Development team, has been fighting to either get it re-opened or repurposed.

Thanks in good part to Michael’s work and the work of the many other people and organizations that Michael has partnered with, Kansas City’s West Side has been revitalized and is now a wonderfully vibrant community. Through all this time, however, West High has been a decaying eye sore in the middle of the neighborhood.  Still, Michael has never given up the fight to get West High redeveloped.

Five years ago, Michael and Westside Housing Organization (WHO) approached the District with an acquisition and financing proposal that would have redeveloped the building as a mixed use apartment complex with low-income and market rate apartments.  A similar project that Michael helped create nine years ago at Villa Del Sol on the West Side is a national model for urban core redevelopment.  The District, however, turned down the Michael’s West High School redevelopment proposal three times.

Finally, last night, with the building in much worse condition than it was five years ago, the District preliminarily accepted a new, similar plan that Michael and WHO put together.  Again, the project would be mixed use revitalization of the buildings and will require Michael and WHO to assemble roughly $40 million in funding to make it work.

I am confident, that they are up to the task.  The result will be one of the biggest improvements in the urban core of Kansas City in a long time.  Congratulations to Michael, his partners at WHO and to everyone else who has worked on this project.

Effie Day

Gregg Lombardi - Executive Director

Effie Day

39 years and 364 days ago, a young lawyer, fresh out of law school, started as a $4 per hour attorney for Legal Aid of Western Missouri.  She was smart, fiery and full of passion about the cause.



Tomorrow marks Effie Day’s 40^th year with Legal Aid.  In those years, Effie has litigated thousands of cases protecting the rights of low-income people to access healthcare through Missouri’s Medicaid program.  As prevailing counsel in numerous appellate cases, she has, for all practical purposes, written Missouri’s Medicaid law.  As a result of her successful appeals, Missourians now have the right to challenge the denial of Medicaid and to be informed why their claim was denied (Grant v. Toan).  The state can no longer use hearsay, out-of-court statements of non-examining physicians to support a denial of benefits (Bell v. Missouri State Division of Family Services) and Missourians with disabilities can qualify for Medicaid on the basis of multiple maladies (Crudup v. Missouri State Division of Family Services).



Although she has proven herself to be a talented appellate advocate, Effie’s passion is in helping individual clients obtain the benefits they deserve under the law.  She patiently and tirelessly assists her clients, often working well into the night and on weekends.  In the last twenty years alone, Ms. Day has provided representation for over 4,200 clients, winning well over 90% of the Medicaid appeals cases that she handles.

For the last seven years, Effie has also led Legal Aid’s Medicaid Appeals Project, at Truman Medical Center.  The staff at Truman refer patients to Legal Aid who have been denied Medicaid benefits and who the staff at Truman believe should receive those benefits.  Legal Aid staff then appeal these decisions.  The project has led to over 1,400 Truman patients, who are permanently and totally disabled, receiving Medicaid benefits after having had those benefits improperly denied.  The project has also generated well over $10 million in revenues for Truman for services, which the hospital would otherwise have had to write off.

Effie Day has brought justice to thousands of people throughout the state of Missouri.  Many of her clients had never had any one fight for their rights before Effie took their case.  By steadfastly protecting her clients’ most fundamental rights, Effie has given them faith that the justice system in Missouri can work for them.  She has taken away pain and given access to basic care to them and, in doing so, has made the state a better place to live for all of us. 

For Effie, tomorrow will be like any other day here.  She’ll come to work and devote herself completely to her clients’ cause.  If you get the chance, I hope that you will interrupt Effie’s work for a moment tomorrow and thank and congratulate her for the tremendous job that she continues to do for her clients.

A New Player Joins the Fight to Save KC's Urban Core

Gregg Lombardi-Executive Director

Odds are that you saw last week that the Kansas City Chamber of Commerce has announced a major urban core initiative to improve the quality of life in neighborhoods along the Troost Street Corridor from 21^st Street to 51^st Street.

The Chamber’s focus on this work is fantastic news. The Chamber and its members have access to tremendous resources and the ability to influence major decision-makers in a way that can help transform these neighborhoods. 

Legal Aid has been doing community development work to improve these neighborhoods for more than 25 years. Every year we work with neighborhood associations, the City, individual homeowners and other not-for-profits to transform 80-100 blighted and abandoned properties in the urban core of Kansas City into high quality, occupied, tax-paying housing. That work has been critical in helping neighborhoods like the Ivanhoe neighborhood greatly improve themselves and in keeping other neighborhoods that will be a part of the Chamber initiative from falling into irreversible disrepair.

Because of limits on our resources, however, the work that we do leaves thousands of blighted and abandoned properties untouched.  According to the most conservative estimates, there are now approximately 7,000 abandoned properties in the City’s urban core. 

So, having the Chamber join the fight is a breath of fresh air.  We will collaborate with the Chamber and its partners in every way that we can to make sure that the new urban core initiative is a success.  As part of this, among other things, we will assist in acquiring blighted properties for rehab for Chamber projects. We will also recruit for-profit law firms to work on the project on a pro bono basis. 

We welcome the Chamber to the battle against urban core blight in Kansas City and look forward to working with them on their wonderful, new initiative.

An Alternative to Pay Day Loans

Gregg Lombardi-Executive Director

I am pleased to announce that, as a result of the work of volunteer attorneys at three major law firms, low-income Kansas Citians now have an alternative to Pay Day loans.

For many years Pay Day loans have been the scourge of low income neighborhoods.  The average interest rate on these short term loans is 450% APR.  Although the default rate on these loans is about 6% and they are obscenely profitable, traditional major banks have, to date, not offered competitive alternatives and efforts to find a legislative solution to the problem in Missouri have failed.

About two years ago, CCO, a local community organizing group, started working to create a competitive alternative to Pay Day loans.  Legal Aid joined the effort about 18 months ago.  Our Volunteer Attorney Project has recruited talented volunteer attorneys including Adam LaBoda from Spencer Fane Britt & Browne, Kyle McCurry from Stinson Morrison Hecker and Tom Schenkelberg of Polsinelli Shughart to work on the project. Kyle initially provided pro bono representation in support of the project generally and subsequently represented Central Bank, which will actually be making the loans.

Other partners in the project include the FDIC, Commerce Bank, United Way and numerous other community stakeholders.

As a result of the attorneys' work, a new not-for-profit-- Fair Community Corporation-- has been formed, complex banking regulations have been navigated, funds raised and FCC is now taking applications for loans.  The loans will be at 36% APR and will come with the opportunity for financial education to allow the borrowers to gain access to even lower interest loans.  A set of referring agencies will be referring qualified, low-income borrowers to the project for loans.  For now at least, borrowers will have to go through a referring agency. 

If the project is as successful, as we think it will be, it is likely to be a powerful tool in driving Pay Day lenders out of Kansas City and may well be replicated elsewhere.

The project is also an excellent demonstration of what talented pro bono attorneys working through VAP can accomplish.  We are tremendously grateful for the excellent work that Adam, Kyle and Tom have done on this project.