2018 State Legislative Session

Health Care for the Homeless leveraged the 2018 session to advance a policy and advocacy approach that was targeted and strategic, and would position Health Care for the Homeless to advance and realize its 2018-2021 strategic goals.


SUMMARY

The 2018 state legislative session was a successful one for Health Care for the Homeless. The agency went into the session with a targeted legislative agenda that was very successful: Three of the agency’s four priority bills passed. And the agency’s advocacy strategy included extensive staff and client engagement and leadership: 12 clients and 21 staff members provided bill testimony and spoke publicly on specific bills, many of them participating in legislative advocacy for the first time.

APPROACH

In an effort to strategically position itself to advocate in areas highly relevant to its new strategic plan goals, the agency adopted an approach to the 2018 legislative session that:

  • aligned to its mission, spanning issues of housing, health and incomes
  • supported its strategic goals and direction
  • targeted issues with the broadest impact on the Health Care for the Homeless community
  • leveraged the unique perspective and value-added the agency has to offer
  • prioritized engaging and leveraging the expertise and experience of clients and staff
  • built on the agency’s legislative momentum during the 2017 session

PRIORITY BILLS

Health Care for the Homeless identified the following bills as advocacy priorities for the legislative 2018 session. Note: None of the housing-related bills introduced this past session aligned to the above approach, so we did not have a housing bill among our legislative priorities. That said, the agency did seek out and leverage opportunities to advocate for affordable housing in other ways throughout the session.

HEALTH

Community Health Workers—Advisory Committee and Certification (SB 163; HB 490)

Purpose: To establish the State Board of Community Health Workers (CHW) within the Maryland Department of Health and certify individuals to practice as community health workers

Strategic goal alignment: Supports strategic goals 1 + 3

Background: The bill grew out of a recommendation from a 2015 community health workers workgroup and was introduced first in 2017. Unsuccessful, it was re-introduced in 2018.

Outcome: There was a lot of debate throughout the session about whether or not to make certification of community health workers a requirement in Maryland. As amended and passed, the bill requires that certified CHW training programs be approved by the Maryland Department of Health; and establishes a voluntary certification program for individual CHWs within the Department. The legislation lays the groundwork that may eventually lead to reimbursement for CHW services. There will be an Advisory Board and other opportunities for stakeholder input.

Agency advocacy: The agency strategically pushed for mandatory certification, with the goal of getting a bill providing for at least voluntary certification to result, and it did. And four of the agency’s five CHWs advocated in Annapolis via testimony at hearings and the lobby day rally.

  • February 1: Community Health Worker Gregory Rogers submitted written testimony to and provided oral testimony before the Senate Finance Committee.
  • February 1: Lead Community Health Worker Lilian Amaya submitted written testimony to and provided oral testimony before the Senate Finance Committee.
  • February 12: CEO Kevin Lindamood participated in a meeting of the Health Subcommittee of the Senate Finance Committee to work through lawmaker differences, particularly around the need for certification.
  • February 14: Community Health Worker Angie West and her client, Charles “Tony” Parker submitted joint written testimony to and provided oral testimony before the House Health and Government Operations Committee.
  • February 21: Community Health Worker Angie West participated in a meeting of the Health Occupations Subcommittee of the House Health and Government Operations Committee.
  • March 1: Four teams of staff and client advocates lobbied 12 lawmakers on the bill.
  • March 1: Community Health Worker Briauna Wills and one of her clients, Ashley, led the agency’s CHW advocacy at the lobby Day rally.

Opportunity moving forward…

  • Explore possible advisory role for Health Care for the Homeless with the Advisory Committee
  • Support agency staff to become certified and capture their stories for future advocacy around Medicaid reimbursement for CHW services
  • Work with partners to determine whether there will be legislation in 2019 or 2020 to authorize Medicaid for clinical services provided by certified CHWs
  • Continue to engage the agency’s own CHWs in policy work related to CHW certification; they are a committed and eager group of staff advocates
Dental Coverage for Adults (SB 284)

Purpose: To establish an adult dental Medicaid benefit

Strategic goal alignment: Supports strategic goals 1 + 3

Background: A 2017 bill that sought to establish an adult dental Medicaid benefit was amended to request that the Maryland Dental Action Coalition (MDAC) study the Medicaid cost of emergency room visits by adult Marylanders with chronic dental health conditions and determine the advisability of expanding Medicaid benefits to include dental services for adult Medicaid enrollees. The bill passed and MDAC completed the study, showing a disproportionate impact on Medicaid of adult ER visits for treatment of chronic dental conditions. After efforts to get the dental benefit included in the governor’s 2019 budget were unsuccessful, SB 284 was introduced, again seeking to establish an adult dental Medicaid benefit.

Outcome: As amended and passed, the bill requires the Maryland Department of Health to apply to the federal government for a demonstration waiver to implement a pilot program that would provide limited dental coverage to adults in Medicaid. It also requires the department to meet with interested stakeholders to obtain input on the design of the pilot.

Agency advocacy: Health Care for the Homeless partnered closely with the Maryland Dental Action Coalition in advocating for the adult dental benefit. While MDAC leveraged its study to show from a numbers perspective the need for an adult benefit, Health Care for the Homeless made the case through personal stories and an emphasis on whole-person care. The agency was an important source of consumer testimony, in particular, for the bill. The bill was also the most popular of all four priority bills among staff on lobby day, and generated a lot of enthusiasm among staff members.

  • February 2-5: Staff worked to identify clients to speak with the Baltimore Sun for an article on the dental benefit that ran the day of the first hearing on the bill; Health Care for the Homeless Board of Directors member and client Athena Haniotis was quoted in the article.
  • February 5:  Health Care for the Homeless provided links to its fall and winter newsletters to MDAC for its own February newsletter; both featured articles on dental.
  • February 7: Clients Christopher Mehl, Armstead Hetherington and Mary Beth Dobrzynski submitted written testimony to the Senate Finance Committee.
  • February 7: Clients Elizabeth Skate and Athena Haniotis submitted written testimony and provided oral testimony before the Senate Finance Committee.
  • February 7: Dental Assistant Shannon Lake provided both written and oral testimony to the Senate Finance Committee.
  • March 1: Four teams of staff and client advocates lobbied 12 lawmakers on the bill.
  • March 1: Dental Director Parita Patel and client Elizabeth Skate co-led the agency’s dental advocacy at the lobby day rally.
  • March 1: CEO Kevin Lindamood submitted written testimony for the Medicaid budget hearings in the Subcommittee on Health and Human Resources of the House Appropriations Committee and the Subcommittee on Health and Human Services of the Senate Budget and Taxation Committee. Upon learning that the Medicaid budget analyst was partial to the dental benefit, we made access to dental care through an adult dental benefit a focus of Kevin’s testimony. 
  • April 3: Clients Christopher Mehl, Armstead Hetherington, Mary Beth Dobrzynski and Athena Haniotis submitted written testimony to the House Health and Government Operations Committee.
  • April 3: Dental Assistant Shannon Lake provided both written and oral testimony to the House Health and Government Operations Committee.

Opportunity moving forward…

  • Provide pilot design input to the Maryland Department of Health
  • Work with the department and MDAC to explore the possibility of a Health Care for the Homeless role in the pilot

INCome

Payment of the Minimum Wage Required (SB 543/HB 664)

Purpose: To increase the state minimum wage from $10.10/hour in 2018 to $15/hour by 2023

Strategic goal alignment: Supports strategic goals 2 + 3

Background: An unsuccessful minimum wage bill was re-introduced in 2018, a state election year. The bill was backed by a strong, statewide coalition and garnered a lot of attention, quickly becoming a priority issue among candidates vying for the Democratic nomination in the governor’s race.

Outcome: Despite the advocacy momentum, the bill failed—likely due to election-year dynamics.

Agency advocacy: Health Care for the Homeless advocated on the minimum age bill in coalition with the Fight for $15 coalition and campaign. The agency’s advocacy strategy focused on the importance of a minimum and livable wage from an employer’s and nonprofit’s perspective, as employers and nonprofits were vocal opponents of the minimum wage bill. Health Care for the Homeless leveraged its own experience and throughout its advocacy emphasized the critical benefits of having a wage floor.

  • February 27: Behavioral Health Therapist Nikki Klock submitted written testimony to the House Economic Matters Committee.
  • February 27: Client Jeff Garrett provided oral testimony to the House Economic Matters Committee.
  • February 27: VP of Communications Molly Rath submitted written testimony to and provided oral testimony before the House Economic Matters Committee.
  • March 1: Four teams of staff and client advocates lobbied 12 lawmakers on the bill.
  • March 1: CEO Kevin Lindamood led agency minimum wage advocacy at the lobby day rally
  • March 1: Client Bill Price advocated for the minimum wage bill at the lobby day rally
  • March 1: Chief Financial Officer Tom Welliver spoke at the Fight for $15 rally in Annapolis; he was one of just four speakers and represented the employer perspective.

Opportunity moving forward…

  • Work with partners, namely the Fight for $15 coalition, to determine whether there will be legislation in 2019 to increase the state’s minimum wage. The issue has good momentum and the worst of the election-year politics will have passed, and Health Care for the Homeless has an important perspective on this issue that should be front and center.
Temporary Disability Assistance Program (TDAP) (HB 1615/SB 1232)

Purpose: To codify TDAP and gradually increase the benefit to match the TCA family of 1 benefit level (which is currently $306 per month and generally increases by 1-2% each year) 

Strategic goal alignment: Supports strategic goals 2 + 3

Background: Last year, the Welfare Advocates coalition, led by Catholic Charities, succeeded in getting a $10-a-month increase (from $185 to $195) written into the budget, but the governor never acted on it. While the governor included a TDAP increase of $10-a-month starting July 1, 2018, in his 2019 budget, advocates sought to increase the benefit further and make the TDAP program statute—so it would no longer be subject to the vagaries of governor and Department of Human Services budgetary and eligibility decisions. As introduced, the bill sought to bring TDAP in line with Temporary Cash Assistance (TCA)—specifically $306, the amount afforded TCA recipients for families of 1.

Outcome: Thanks to both a hard advocacy push down to the wire by the coalition and broad lawmaker support, the bill passed with amendments that codify the TDAP program and create an eight-year incremental increase that will bring the TDAP benefit to the level of TCA for a household of one and tie it to that level moving forward.

Agency advocacy: Health Care for the Homeless advocated in coalition for this bill, with the coalition effort being led by Catholic Charities. The advocacy strategy was to push for near-term alignment with TCA with goal of getting longer-term, incremental alignment, and to emphasize that the TDAP benefit amount had not increased in 15 years.

  • February 1: VP of Communications Molly Rath and Ann Ciekot met with Del. Geraldine Valentino-Smith, House sponsor of the TDAP bill, to discuss Health Care for the Homeless support for the bill and to educate her more broadly about the agency.
  • February 27: Director of Supportive Services Chauna Brocht submitted written testimony to and provided oral testimony before House Appropriations Committee.
  • February 27: Disability Outreach Specialist Patricia Nwakuba submitted written testimony to the House Appropriations Committee.
  • March 1: Four teams of staff and client advocates lobbied 12 lawmakers on the bill.
  • March 1: Client Joe Funn led the agency’s advocacy on TDAP at the lobby day rally.
  • March 14: Communications team members and lobby day TDAP captains—Chauna Brocht, Erica Brown, Tristan Roberts, Patricia Nwakuba—emailed all Appropriations Committee members, urging them to vote in favor of the TDAP bill later that day.
  • March 20-22: Staff collected photos of clients with quotes about why the TDAP increase was important, contributing a dozen “testimonies” from Baltimore City and Baltimore County to the larger coalition campaign; the testimonies were submitted to the Senate Finance Committee at March 22 hearing.
  • March 22: Advocacy alert went out to staff and board to email and urge Senate Finance Committee members to support the TDAP bill in the week leading up to the final March 29 vote.
  • March 22: Director of Supportive Services Chauna Brocht submitted written testimony to the Senate Finance Committee.
  • March 22: Disability Outreach Specialist Patricia Nwakuba submitted written testimony to the Senate Finance Committee.
  • March 26: CEO Kevin Lindamood and Catholic Charities Director of Advocacy met with Sen. Thomas Mac Middleton to discuss TDAP.
  • Week of April 9: CEO Kevin Lindamood will send a letter to the governor, urging him to sign the TDAP bill into law.

Opportunity moving forward…

  • Work with Public Policy Partners and the TDAP coalition to determine whether there will be legislation in 2019 to accelerate the TDAP increase.

OTHER BILLS WE ACTIVELY SUPPORTED

Ending Youth Homelessness Act of 2018 (HB 1224/SB 1218)

Background: The bill sought to require the Department of Housing and Community Development to administer an “Ending Youth Homelessness Grant Program” to prevent and end youth homelessness in the state and address related disparities based on race, ethnicity, sexual orientation and gender identity by providing funds to housing and supportive services for unaccompanied youth experiencing and at risk of homelessness.

Outcome: The bill passed.

Advocacy:

  • March 13: Director of Pediatrics Lisa Stambolis submitted written testimony to the House Appropriations Committee.
  • March 13: Community Relations Coordinator Gerardo Benavides attended the House Appropriations Committee hearing, sporting the coalition yellow t-shirt to help create visible support for the bill.
Maryland Medical Assistance Program – Clinical Services Provided by Certified Peer Recovery Specialists (HB 772/SB 765)

Background: The bill sought to authorize coverage by the Maryland Medical Assistance Program of clinical services provided by certified peer recovery specialists to individuals with substance use disorders or behavioral health disorders.

Outcome: As amended and passed, the bill requires the Secretary of Health to convene a stakeholder workgroup to study issues related to the reimbursement of certified peer recovery specialists; requires the workgroup to include representatives of certain constituencies; and requires the Secretary to submit a report with workgroup findings and recommendations to the Governor and General Assembly by December 1, 2018.

Advocacy:

  • February 27: Lead Peer Recovery Specialist Nate Thomas submitted written testimony to and provided oral testimony before the House Health and Government and Operations Committee.
  • March 7: Lead Peer Recovery Specialist Nate Thomas submitted written testimony to and provided oral testimony before the Senate Finance Committee.
  • March 7: Client Sidney Bond provided oral testimony before the Senate Finance Committee.
Maryland Medical Assistance Program and Health Insurance – Coverage – Hepatitis C Drugs (SB 943)

Background: The bill sought to require Medicaid and commercial insurance to cover FDA-approved and necessary medications for the treatment of hepatitis C. For commercial carriers, it would have prohibited any liver damage severity restrictions.

Outcome: The bill died.

Advocacy:

  • March 7: Director of Compliance Margaret Flanagan and Public Grants Coordinator Bilqis Rock wrote and submitted on behalf of Health Care for the Homeless testimony to the Senate Finance Committee.
Access to Maryland Courts Act (HB 1270/ SB 1042)

Outcome: The bill died.

Advocacy:

  • February 21: Health Care for the Homeless submitted written testimony in support of its partners to the Senate Judicial Proceedings Committee.
Earned Income Tax Credit – Individuals Without Qualifying Children – Expansion (HB 856/SB 647)

Outcome: The bill passed.

Advocacy:

  • February 28: Health Care for the Homeless submitted written testimony in support of its MAP partners to the House Ways and Means Committee.
  • March 27: Health Care for the Homeless submitted written testimony in support of its MAP partners to the Senate Budget and Taxation Committee.
Maryland Medical Assistance Program – Work and Community Engagement Requirements – Waiver (HB 1477/ 886)

Outcome: The bill was withdrawn.

Advocacy:

  • March 14: Barbara DiPietro wrote and submitted on behalf of the National Health Care for the Homeless Council written testimony to the Senate Finance Committee.
Maryland Healthy Working Families Act – Delay of Effective Date (SB 304)

Outcome: The bill died.

Advocacy:

  • February 13: Community Relations Coordinator Gerardo Benavides submitted written testimony in support of its Working Matter Coalition partners to the House Economic Matters Committee.
Criminal Law – Comprehensive Crime Bill of 2018 (SB 122)

Health Care for the Homeless was focused on the provision within the omnibus bill that would have criminalized addiction by imposing a mandatory minimum of 5 years for possession of 5 grams of fentanyl or 28 grams of any mixture containing any detectable fentanyl.

Outcome: The bill died, but two bills emerged in its wake with certain provisions of the original bill. It is not yet clear whether one of the bills includes the fentanyl provision.

Advocacy: There has strong advocacy by the Drug Policy Alliance, and Health Care for the Homeless has signed on in support of the alliance’s efforts.

  • Week of March 26: CEO Kevin Lindamood sent a letter to the Baltimore City delegation, asking members to oppose SB 122.
Medicaid budget

Advocacy: We focused on the adult dental benefit and acces to hep C treatment

  • March 1: West Baltimore Medical Director Tyler Gray and Board of Directors member and client Grady Butler testified at the Senate budget hearing.
  • March 1: CEO Kevin Lindamood submitted written testimony for the Medicaid budget hearings in the Subcommittee on Health and Human Resources of the House Appropriations Committee and the Subcommittee on Health and Human Services of the Senate Budget and Taxation Committee.