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.

 

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.

Good News for Legal Aid Clients

Gregg Lombardi, Executive Director

There’s good news from Washington, DC: Missouri Senator Kit Bond announced on Thursday that he is co-sponsoring a bill to provide $10 million of federal funding for a Medical-Legal Partnership demonstration project.

Medical-Legal Partnerships are collaborations between healthcare providers and Legal Aid programs in which medical staff work with legal staff to resolve the legal problems of low-income patients (e.g. guardianship, Medicaid denials, domestic violence and housing issues, etc.). The Medical-Legal Partnership concept started in Boston and has been so successful that it has now been replicated in over 180 hospitals and health centers around the country.

Studies have found that even when a legal problem does not appear to be directly related to a health issue, resolving the legal problem often has health benefits. For example, a mother in a domestic violence situation whose son is diabetic may be so focused on keeping her family safe that she doesn’t monitor her son’s insulin intake and diet. When Legal Aid helps the mother obtain a protective order or divorce, her ability to tend to the child’s treatment for diabetes greatly improves.

Legal Aid of Western Missouri has a tremendous network of Medical-Legal Partnerships, making our MLP one of the 5 largest MLP’s in the country. Our MLP began with our partnership at Children’s Mercy Hospital and its clinic at Operation Breakthrough. Legal Aid also has a partnership with Swope Health Services and a new partnership with KC Free Health Clinic. We also have a collaborative partnership with Kansas Legal Services (KLS) at KU Medical Center’s Department of Family Medicine, in which we represent KU’s patients who are Missouri residents and KLS represents the Kansas residents.

In terms of hospital staff training, outcomes tracking, Medicaid appeals success, and collaboration with other programs, our medical legal partnerships are on the cutting edge.

Katie Cronin has done a tremendous job in creating and growing the medical-legal partnerships at Children’s Mercy, Operation Breakthrough, Swope Health Services and KU Medical Center. Effie Day also has done excellent work in building our Medicaid Appeals project at Truman Medical Center. Although this is technically not a Medical-Legal Partnership because the medical staff is not involved in the program, it is now one of the largest Medicaid Appeals partnerships (and probably the largest) in the country and is the envy of MLP’s across the country.

The other reason why these programs are such a success is because of our partners. Dr. Jeffrey Colvin at Children’s Mercy Hospital worked for the original MLP at Boston Medical Center. He has been a tireless advocate for MLP at Children’s Mercy and throughout the area. Dr. Colvin recently met personally with members of Senator Bond’s staff to encourage the senator to sponsor the MLP demonstration site legislation. Lydia Jones at Truman and Lewis Popper, the former General Counsel at Truman have also been tremendous, tireless advocates for that program.

I believe, if the demonstration project is created, Legal Aid of Western Missouri would be a leading contender to be one of the demonstration projects. So, this is very good news.

Effie Day

by Gregg Lombardi, Executive Director

I am pleased to announce that Missouri Lawyers Weekly has selected Effie Day, the Director of Legal Aid of Western Missouri’s Medicaid Appeals Project at Truman Medical Center as a winner of one of its Women’s Justice Awards for 2010. And it’s no surprise as to why Effie won the award.

For the last 37 years, Effie has devoted herself and her career to improving the lives of low-income Missourians and improving their access to healthcare. Through her persistent and tenacious representation of her clients, she has improved the lives of thousands of low-income Missourians.

In 1972, Effie was one of seven women to graduate from the University of Missouri School of Law and once she got her degree, she went straight to work for Legal Aid of Western Missouri for about $5.50 per hour. (The following year Legal Aid reduced attorneys’ salaries even further to keep the agency afloat.)

She has become one of the most effective litigators to ever work for Legal Aid. In her career, Effie has litigated thousands of cases asserting the rights of low-income people to access healthcare through Missouri’s Medicaid program. As prevailing counsel in numerous appellate cases, Effie has, for all practical purposes, written Missouri’s Medicaid law. She has been counsel in most of the major appellate cases that define the rights of Medicaid beneficiaries in Missouri, including:

--Grant v. Toan, (United States District Court for the Western District of Missouri) (established the right of Medicaid beneficiaries to challenge the denial of services and required the Division to inform beneficiaries if it had denied claims);

--Savage v. Stangler, 795 F.2d 643 (8th Cir. 1988) (challenging a Division proposal that the home of institutionalized Medicaid applicant may be considered in determining financial eligibility for Medicaid benefits. The publicity surrounding this case led to a change in law in Missouri, exempting the homes of nursing home patients, when determining eligibility for Medicaid).

Effie was also prevailing counsel in Slayden v. Stangler, (United States District Court for the Western District of Missouri) (the Division is required to establish a process for replacement of stolen and lost AFDC checks within a reasonable amount of time) and in Thompson v. Toan, (United States District Court for the Western District of Missouri) (established the process for prompt processing of AFDC benefits statewide in Missouri).

Although she has proven 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 nights and weekends. Over her career at Legal Aid, Effie has represented more than 5,000 clients. She prevails in at least 90% of Medicaid appeals cases she handles and obtained Medicaid benefits for over 400 clients in the last ten years.

For the last five years, Effie has led Legal Aid’s Medicaid Appeals Project, which is a collaboration with Truman Medical Center, Kansas City’s primary public hospital. The staff at Truman refers patients to Legal Aid who have been denied Medicaid benefits and who the staff at Truman believes should receive those benefits. Legal Aid then appeals these decisions. The project has led to over 1,000 Truman patients, who are permanently and totally disabled, receiving Medicaid benefits after having had those benefits improperly denied. As a result of having Medicaid benefits, Effie’s clients have access to ongoing, proactive medical care, which substantially enhances their quality of life.

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