Current Projects

AIDSWatch 2010 086

STATE AND FEDERAL IMPLEMENTATION OF HEALTH CARE REFORM 

DISEASE-SPECIFIC INITIATIVES

PUBLIC HEALTH LAW AND POLICY

ADDRESSING SOCIAL DETERMINANTS OF HEALTH

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STATE AND FEDERAL IMPLEMENTATION OF HEALTH CARE REFORM 

Meaningful Access to Medications

People with chronic health conditions are increasingly gaining access to health care through Affordable Care Act Qualified Health Plans (QHPs) offered on federal or state health insurance exchanges. However, there is increasing evidence that some QHPs are structured to make specific medications, such as HIV and HCV medications, disproportionately expensive. This insurance practice has the discriminatory effect of discouraging individuals in need of specific medications from enrolling in these plans or of shifting the burden of the cost back to these enrollees. CHLPI, in conjunction with our state partners, analyzed the 2016 QHP offerings in sixteen states to assess the level of unfair and discriminatory practices taking place. CHLPI assessed the QHPs eligible for federal subsidies, designed to make these plans more affordable for those with low-income. Now CHLPI, along with our state partners, is seeking to use the information gained from plan analysis to advocate for an end to discriminatory insurance practices and for improved access to HIV and HCV medications.

Reports and resources:

Hepatitis C (HCV) Impact Litigation

Over the course of its work on the implementation of health care reform, CHLPI has achieved significant success with regulatory and administrative advocacy. This work has yielded significant regulatory guidance establishing important protections for vulnerable health care consumers, including low-income and chronically ill populations. In some cases, litigation is necessary to ensure that these regulatory achievements are properly enforced and their promise is made real to their intended beneficiaries. Impact litigation is implemented in coordination with CHLPI’s administrative and regulatory advocacy. Together these areas of law practice maximize the potential of abolishing discriminatory health insurance practices and ensuring broad access to care.

Reports and resources:

Providing Outreach and Technical Assistance to State Advocates and Government Officials on States’ Health Reform Progress

CHLPI is dedicated to ensuring that the Affordable Care Act will be implemented in ways that increase access to care for our most vulnerable residents, particularly for low-income people with chronic illnesses and disabilities.  Our work in this area involves national coalition building and leadership, as well as providing technical assistance to our state and community-based partners.  Many of our projects have involved responding to federal regulations and advocating for inclusive implementation policies at the state and federal levels.  CHLPI evaluated health plans to identify which best serve individuals living with chronic health conditions and created tools for monitoring and enforcement of anti-discrimination provisions of the law.  We are also building infrastructure to ensure feedback on implementation issues between state and federal governments and advocates; and continue to advocate for Medicaid expansion in every state.

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United States Conference on AIDS (USCA) Advocacy Trainings

The US Conference on AIDS (USCA) is the largest annual HIV-related conference in the nation, bringing together service providers, people living with HIV, community-based advocates, researchers, government officials, and private sector representatives. CHLPI has developed and presented various advocacy trainings at USCA for several years. These trainings have been designed to impart practical knowledge and help attendees better understand how to participate in the public policy process. Past topics have included, among others, an overview of federal health reform and implications for people living with HIV, protecting Medicaid and Medicare, making health reform work for women with HIV, and the impact of deficit reduction.

DISEASE-SPECIFIC INITIATIVES

Southern HIV Crisis: Technical Assistance for our Southern Community Partners

The Southern region of the United States is experiencing an unprecedented HIV burden, with nearly half (49%) of all new HIV diagnoses occurring in the South despite the region representing just 37% of the total U.S. population. CHLPI is working with community based organizations in several Southern states to improve access to care for Southern individuals living with HIV.

Improving Access to Hepatitis C Prevention, Care and Treatment Services

Hepatitis C virus (HCV) affects 4-5 million individuals in the United States, resulting in about 15,000 deaths per year, and yet 75% of individuals currently living with the virus do not even know they’re infected.  While traditionally affecting only those in the baby-boomer generation, over the past few years Massachusetts and several other states  have also documented an increase among youth ages 15- 24. Unlike other chronic illnesses, there is essentially a cure for many individuals living with HCV, but barriers to prevention, care, and treatment remain. CHLPI is working in partnership with the National Viral Hepatitis Roundtable and other state and local advocates to increase state and federal resources dedicated to this epidemic, and ultimately to improve access to prevention, testing, care and treatment for those affected by HCV.  This work includes analysis of, and advocacy for, health care policies, laws and regulations that expand access to HCV services, including opportunities through implementation of the Affordable Care Act. CHLPI also works to educate policy makers and other groups about these important issues through the creation of webinars, reports, comment letters, and other resources.

Reports:

 PATHS (Providing Access to Healthy Solutions): Analyzing Opportunities to Enhance Prevention and Management of Type 2 Diabetes

For the past four years, CHLPI has engaged in intensive diabetes research and advocacy at the state and federal level, with the goal of identifying and seizing opportunities for policy reform that will improve the lives of people at risk for and living with type 2 diabetes and reduce the incidence of obesity and obesity-related chronic illnesses. The PATHS team has written comprehensive reports about the state of the disease and policy opportunities to improve prevention and disease management in New Jersey and North Carolina, and worked with community partners in both states to build coalitions to advocate for key policy recommendations identified in the report.

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Specialty Care and Bridging Cancer Care for Vulnerable Populations

For racial and ethnic minorities and individuals with lower socioeconomic status, large disparities in incidence, diagnosis, access to appropriate treatment, and mortality rate exist for lung cancer, skin cancer, and HIV/AIDS. CHLPI has launched a new initiative to provide legal and policy analysis and technical assistance to major national advocacy organizations and centers of medical excellence that are working to close gaps in diagnosis and treatment for vulnerable populations. From the American Cancer Society to Farmworker Justice to the Washington AIDS Partnership, these entities are piloting innovative projects that will test new methods and practices for ensuring delivery of high-quality lung cancer, skin cancer, or HIV/AIDS care to marginalized groups. CHLPI will assist these entities in achieving sustainability and scalability for projects that have positive outcomes for our target populations.

PUBLIC HEALTH LAW AND POLICY

The Future of Public Health

With ongoing implementation of the Affordable Care Act and Chapter 224 (the Massachusetts legislation designed to contain healthcare costs), the landscape of healthcare financing and service delivery is changing rapidly. Understanding the nature and scope of these changes, and how they are playing out in practice, is important to defining the evolving role and functions of the Massachusetts Department of Public Health’s Bureau of Infectious Disease (MDPH BID), which encompasses, among others, HIV, viral hepatitis, tuberculosis and sexually transmitted infections. CHLPI is working to engage with Massachusetts stakeholders to assess how well (or not) public and private health plans and MDPH programs meet the service needs of the relevant populations and to identify local, state, and federal legal and policy factors affecting access to and use of prevention, care, and treatment services for infectious diseases.

Data Privacy and Security

Medical information security and patient privacy are critical components of a well-functioning healthcare environment. The rise of electronic medical records (EMR) increases the chances that patients’ privacy and data security will be violated, either through intentional breaches or accidents. CHLPI seeks to determine whether the current data privacy and security regulatory regime, including the Health Insurance Portability and Accountability Act and provisions of the ACA, adequately protect the privacy needs of vulnerable populations while at the same time promoting use of EMR across all socio-economic levels.

 Chronic Illness and Disability Partnership

CHLPI coordinates and provides staff support for the Chronic Illness and Disability Partnership. The Partnership Project connects national HIV/AIDS healthcare reform advocates to other national and state chronic illness, disability, and poverty-related advocacy groups engaged in the healthcare reform agenda. Partnership members include the American Diabetes Association, the Coalition for Whole Health, the HIV Medical Association, AIDS United, the Consortium for Citizens with Disabilities, the American Association for People with Disabilities, Trust for America’s Health, and the National Association for Community Health Centers. The Partnership educates members of Congress, White House and Health and Human Services staff, and state policymakers on implementing the Affordable Care Act in ways that will benefit people living with chronic illness and disability.

ADDRESSING SOCIAL DETERMINANTS OF HEALTH

Facilitating Community Use of Public and Private Space to Prevent Childhood Obesity (the Joint Use Project)

CHLPI is partnering with the Massachusetts Department of Public Health (MDPH) to investigate and facilitate community use of school and other recreational facilities during non-school hours, with the aim of increasing leisure time physical activity and combating and reducing rates of childhood obesity. The Joint Use Project has worked with stakeholders in Massachusetts communities to design and implement effective Joint Use Agreements (JUAs) between schools and municipalities. CHLPI has also developed a state-specific toolkit to guide communities across Massachusetts in replicating best practices as they develop their own joint use initiatives and produced a paper on policies, law, and regulations that could be changed in order to facilitate joint use.

Reports and Resources:

Food is Medicine: Addressing Social Determinants of Health by Integrating Access to Nutrition as a Core Component of Health Care

While nutrition services are an essential component of high-quality, holistic care, they have not traditionally been considered reimbursable “core medical services.” The ACA and other recent reforms in our health care system provide opportunities to incorporate nutrition providers into newly-created insurance-based systems and structures. Through our Food is Medicine initiative, CHLPI will work to establish law and policy reforms that integrate food and nutrition services providers into newly created coordinated health care systems and to provide them with public and private insurance-based sustainable funding.

Reports and Resources:

Housing is Medicine

Access to stable housing and supportive housing services is a core determinant of health for people living with HIV and is critical for reducing health care costs. Housing and supportive housing services are often funded through discretionary programs rather than health insurance. The ACA can benefit HIV housing providers by offering opportunities for integration of housing providers into new delivery and reimbursement systems.

Community Benefits

Nonprofit hospitals are required by federal tax law to spend some of their surplus on “community benefits,” which are goods and services that address a community need. They must report this spending to the Internal Revenue Service (IRS) each year in order to stay exempt from paying federal income taxes. The allowable purposes of community benefits are to improve access to services, enhance the health of the community, advance medical knowledge, and reduce government burden. The overall business model for hospitals is changing with the implementation of the Affordable Care Act (ACA). As more patients have insurance, medical institutions have an opportunity to increase their investments in community-centered activities, including opportunities for reimbursement of housing and housing-related services.

Reports and Resources: