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Congress sends stopgap spending bill to Biden’s desk, averting shutdown for now

2 years 4 months ago

WASHINGTON — U.S. senators voted 87-11 to approve legislation Wednesday that would fund the government into next year, clearing the measure for President Joe Biden’s signature. The stopgap spending bill, sometimes called a continuing resolution or CR, would fund part of the government until mid-January and the rest of the programs within the annual appropriations […]

The post Congress sends stopgap spending bill to Biden’s desk, averting shutdown for now appeared first on Missouri Independent.

Jennifer Shutt

Biden administration’s limit on drug industry middlemen backfires, pharmacists say

2 years 4 months ago

The Biden administration’s first major step toward imposing limits on the pharmacy benefit managers who act as the drug industry’s price negotiators is backfiring, pharmacists say. Instead, it’s adding to the woes of the independent drugstores it was partly designed to help. The so-called PBMs have long clawed back a fee from pharmacies weeks or […]

The post Biden administration’s limit on drug industry middlemen backfires, pharmacists say appeared first on Missouri Independent.

Arthur Allen

Child Welfare Officials Have Searched Her Home and Her Son Dozens of Times. She’s Suing Them to Stop.

2 years 4 months ago

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up for Dispatches, a newsletter that spotlights wrongdoing around the country, to receive our stories in your inbox every week.

It was 5:30 a.m. Flashlights beamed in through the windows of the ground-floor apartment in East Flatbush, Brooklyn. Police officers and child welfare caseworkers were ordering a woman to open her front door.

When she did, the first thing she saw was that the police had their guns drawn. Her hands flew up into the “don’t shoot” position; she was well aware of the recent stories of cops “shooting first and asking later.” She prayed that her 7-year-old son was still asleep in his room.

“I was beyond scared. I literally started shaking,” said L.B., the mom, who is Black and asked to be referred to by her initials for her child’s safety and privacy.

Enabled by the police officers’ show of force, the caseworkers from the Administration for Children’s Services, New York City’s child welfare agency, entered L.B.’s apartment without a warrant that day in January 2021. Before she knew it, they were scrutinizing the contents of her refrigerator and cabinets, examining her bed and bathroom, and rifling through her personal belongings. They also had her lift up her son’s shirt so they could inspect his torso.

They found nothing. The boy was safe and unharmed, living in a clean, well-organized home with his mom and his adult sister, according to case records.

The allegations against L.B., made by an anonymous caller at 4:45 a.m. that day, were false. These included that she was a stripper (she worked at a home for people with disabilities); that she used drugs (none were found, and a drug test was negative for all substances); and that an abusive man lived with her and that she owned “machine guns” (after an exhaustive search and interrogation, both claims were deemed baseless).

In fact, L.B. has never been found to have committed any type of child maltreatment, ACS and court records show.

Yet the anonymous caller, whom L.B. believes to be a former acquaintance with a grudge, has continued to dial in to New York’s state child welfare hotline. Each time, this person or possibly people make outlandish, often already-disproven claims about her, seeming to know that doing so will automatically trigger a government intrusion into her domestic life.

And ACS obliges: Over the past three years, the agency either has inspected her home or examined and questioned her son at school more than two dozen times. Caseworkers have sought a warrant for only three of these searches, most recently in August. All of those requests have been rejected by judges, according to court records.

Still, it keeps happening, and it’s nearly always the same routine, records show. The caseworkers demand entry into her apartment, ringing her doorbell and, embarrassingly, sometimes those of her neighbors as well, at all hours of the day and night. They observe her child’s unclothed stomach and thighs, and sometimes take pictures. And they interrogate him without her consent, covering topics like whether she has sex around him.

At one point he said to her, crying, “Mom, you told me they wouldn’t come back,” L.B. said.

“I’m still trying to make it up to him,” she added, “even though I didn’t do anything wrong.”

L.B. this week filed a federal lawsuit against the commissioner of ACS and the city of New York, arguing that her Fourth Amendment right against unreasonable searches and seizures has been repeatedly violated by the agency’s warrantless incursions into her family’s private sphere. She is not primarily alleging that caseworkers committed specific unlawful acts, although several ACS staff members are also named in the suit. Rather, her contention is that three years of the same type and scope of investigation — no matter the source or credibility or repetitiveness of the accusations against her — is indiscriminately and thus unconstitutionally invasive.

Legal aid lawyers in New York had said that more lawsuits like this one might be coming after a ProPublica and NBC News investigation last year found that ACS caseworkers search more than 50,000 typically low-income households every year, obtaining a warrant less than one half of 1% of the time. (L.B. is represented by Brooklyn Defender Services as well as a private law firm, and her complaint cites our reporting.) The agency finds a safety situation requiring removal of a child from a home in only 4% of these cases.

ProPublica’s investigation tracked the case of Ronisha Ferguson, a Bronx mother who sued the city of New York after ACS removed her children from her because she refused to let caseworkers search her apartment without a warrant. (Court records indicate that the city this August agreed to settle that case with Ferguson.)

In response to a detailed list of questions, an ACS spokesperson did not address any aspect of how the agency has handled L.B.’s case. She said that ACS is required under New York law to investigate all reports of child maltreatment that are forwarded from the state hotline, including ones that are anonymous, and that every investigation must include “evaluating the home environment.” The agency has “no discretion” if the hotline operator deems the call worth passing along, she said.

L.B.’s attorneys counter that caseworkers, once they have observed a child to be safe, actually do have discretion under state law not to conduct the same full search that they have completed before. Continuing to follow these procedures over and over causes concrete harm, they say.

L.B.’s child now suffers from severe anxiety, a doctor’s note confirms, which she said is the direct result of ACS’ constant intrusions. (He has even asked her to have the doorbell dismantled.) Her employment has been affected, including when she had to take multiple months of unpaid leave to make sure that she was available for her son. Her landlord has complained to her that the situation is troubling other tenants, causing her to consider moving to a different neighborhood even though she has lived in her apartment for a decade.

Yet for a long time, it was a struggle for her to fight back. When caseworkers arrived at her door, she’d allow them to enter in part because they had the power to remove her son from her custody. They also never told her, she said, that without her consent, they would need a warrant.

They often told her that letting them in was the only way to get them to stop coming, she said.

Finally, in 2022, a co-worker convinced her that she had the right to say no. Anxiously, she started doing just that.

That February, ACS, for the first time, applied for a warrant, stating in court papers that L.B. now knew her rights but that her home still needed to be entered “immediately at any hour.” But a judge, after learning about the case’s history and realizing that L.B.’s child had been observed in his home multiple times and interviewed multiple times with no evidence that any of the allegations against his mom were true, and that all of this was causing him trauma, denied the agency’s request. (The order additionally instructed ACS to refer the matter to the Brooklyn District Attorney’s Office for investigation of an apparent pattern of false hotline calls.)

The judge told ACS that its procedures “have to be adjusted when following them is more likely to do harm,” adding that “showing up in the middle of the night is traumatic; taking off kids’ clothes is traumatic.”

Yet caseworkers kept trying to get inside L.B.’s home whenever they received anonymous reports, including a patently false claim that she lived in a bar with multiple small daughters. She kept saying no.

They applied for a warrant again. A second judge denied them, calling the whole matter a “horrible intrusion” as well as a “waste of state resources.”

So ACS took a different tack: showing up at her son’s school and calling him to the office to interrogate him there, without her knowledge let alone consent. Caseworkers did this repeatedly for many months, making him miss class, and without telling him that he was free to leave at any time.

He used to love school — his gifted and talented program, culinary arts, using the computers, playing ball outside, seeing his friends. But now he often tells L.B. that his chest hurts so he has to stay home.

He has been especially sensitive about having to lift up his shirt for strangers, she said. And about the other kids who have started to tease him about it all. He comes home crying.

Advocates for families facing ACS investigations like L.B.’s point to two pieces of legislation that the New York State Assembly could pass next year. One would create a “family Miranda warning” that caseworkers would have to read to parents at their door, informing them of their right to deny entry into their home and to have a lawyer present.

That bill nearly became law this past spring but failed in part due to opposition from ACS, as ProPublica reported.

The second is an “anti-harassment in reporting” bill that would seek to reduce false and malicious calls to the state child welfare hotline by no longer allowing these tips to be anonymous. Under the current law, anyone can report any parent without so much as leaving a name or phone number.

The new legislation would require that callers at least provide basic details about themselves so caseworkers can follow up, gather more information, make sure the accusation has some basis and consider how intrusive of an investigation is needed. Hotline and ACS staff would still be legally required to keep the caller’s identity confidential.

The ACS spokesperson said the agency is “very concerned about false and malicious reporting and the impact it has on families.” She also said ACS “supports eliminating most anonymous reporting,” with rare exceptions including when it is a child calling the hotline.

L.B., whose son is now three years older than when these searches started, agrees.

by Eli Hager

A Number of Tragedies

2 years 4 months ago

Laumeier Sculpture Park’s 2023 Visiting Artists in Residence are Pittsburgh-based artists Lenka Clayton and Phillip Andrew Lewis. This collaborative duo utilizes innovative approaches to conceptualism and minimalism to realize their […]

The post A Number of Tragedies appeared first on Explore St. Louis.

Rachel Huffman

Hearing on challenge to Missouri abortion ban

2 years 4 months ago
A crucial court hearing on a lawsuit challenging Missouri’s controversial abortion ban is set to take place on Thursday. The case could have major implications for the future of Missouri’s law, which bans most abortions.
Chris Regnier

Dumplings and Tea Offers Delectable Dumplings and Bao in Chesterfield

2 years 4 months ago
Weiquan Jiang and Zixuan Hu, co-owners of Dumplings and Tea (137 Chesterfield Towne Center, Chesterfield; 636-778-9090), both hail from the southern part of China. Though their hometowns are in different regions — Jiang is more from the center-south and Hu is from the southeast — they take pride in the area's unique culinary heritage and have fond memories of the particular style of bao and dumplings they grew up eating.
Cheryl Baehr

Health Insurers Have Been Breaking State Laws for Years

2 years 4 months ago

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.

This story is part of a partnership with Scripps News.

In North Carolina, lawmakers outraged that breast cancer patients were being denied reconstructive surgeries passed a measure forcing health insurers to pay for them. In Arizona, legislators intervened to protect patients with diabetes, requiring health plans to cover their supplies. Elected officials in more than a dozen states, from Oklahoma to California, wrote laws demanding that insurance companies pay for emergency services.

Over the last four decades, states have enacted hundreds of laws dictating precisely what insurers must cover so that consumers aren’t driven into debt or forced to go without medicines or procedures. But health plans have violated these mandates at least dozens of times in the last five years, ProPublica found.

In the most egregious cases, patients have been denied coverage for lifesaving care. On Wednesday, a ProPublica investigation traced how a Michigan company would not pay for an FDA-approved cancer medication for a patient, Forrest VanPatten, even though a state law requires insurers to cover cancer drugs. That expensive treatment offered VanPatten his only chance for survival. The father of two died at the age 50, still battling the insurer for access to the therapy. Regulators never intervened.

These laws don’t apply to every type of health plan, but they are supposed to provide protections for tens of millions of people. AHIP, a trade group that used to be known as America’s Health Insurance Plans, said new mandates are costly for consumers and states, “tie insurers’ hands and limit plan innovation” by requiring specific benefits. Nevertheless, its members take steps to make sure they are following these mandates, the trade group said.

State insurance departments are responsible for enforcing these laws, but many are ill-equipped to do so, researchers, consumer advocates and even some regulators say. These agencies oversee all types of insurance, including plans covering cars, homes and people’s health. Yet they employed less people last year than they did a decade ago. Their first priority is making sure plans remain solvent; protecting consumers from unlawful denials often takes a backseat.

“They just honestly don’t have the resources to do the type of auditing that we would need,” said Sara McMenamin, an associate professor of public health at the University of California, San Diego, who has been studying the implementation of state mandates.

Agencies often don’t investigate health insurance denials unless policyholders or their families complain. But denials can arrive at the worst moments of people’s lives, when they have little energy to wrangle with bureaucracy. People with plans purchased on HealthCare.gov appealed less than 1% of the time, one study found.

ProPublica surveyed every state’s insurance agency and identified just 45 enforcement actions since 2018 involving denials that have violated coverage mandates. Regulators sometimes treat consumer complaints as one-offs, forcing an insurer to pay for that individual’s treatment without addressing whether a broader group has faced similar wrongful denials.

When regulators have decided to dig deeper, they’ve found that a single complaint is emblematic of a systemic issue impacting thousands of people.

In 2017, a woman complained to Maine’s insurance regulator, saying her carrier, Aetna, broke state law by incorrectly processing claims and overcharging her for services related to the birth of her child. After being contacted by the state, Aetna acknowledged the mistake and issued a refund.

That winter, the woman gave birth to a second child, and Aetna did it again. She filed another complaint. This time, when the state made Aetna pay up, it also demanded broader data on childbirth claims. Regulators discovered that the insurer had miscalculated claims related to more than 1,000 births over a four-year period. Aetna issued refunds totaling $1.6 million and agreed to pay a $150,000 fine if it failed to follow conditions listed in a consent agreement.

It was a rare victory. The potential fine, though, constituted less than .002% of the $6.63 billion in profit recorded by Aetna’s parent company, CVS Health, that year.

Aetna spokesperson Alex Kepnes said the company resolved the matter in 2019 to the state’s satisfaction. Kepnes declined to answer why the insurer failed to fix the issue after the first complaint.

Watch the Scripps News Report “Hope Denied”

Patients often don’t know what care they’re entitled to under state mandates. And one survey found that 86% of people with health insurance don’t know which government agency to call for help. Knowing how to navigate the system can make all the difference to patients socked with giant medical bills.

In December 2022, Samantha Slabyk felt a sudden sharp pain in her lower right abdomen. The San Marcos, Texas, resident took herself to an outpatient emergency clinic, but after a CT scan revealed she had appendicitis, doctors sent her in an ambulance to a nearby hospital. “Everyone indicated that this was an emergency situation that needed to be dealt with promptly,” Slabyk said.

Texas has long had a law requiring insurers to cover medical treatment needed by patients in emergencies. Yet that month, her insurer, Ambetter, wrote in a letter that it would not pay the $93,000 bill because the appendectomy took place at an out-of-network facility.

Slabyk was studying to be a physician’s assistant and had been an EMT. Her fiance’s brother-in-law worked in medical billing and gave her advice on how to push back, as did her mom — whose cancer diagnosis meant she often interacted with health insurers. These connections and experiences gave Slabyk an unusual grasp of her rights and how the system works. Still, every time she reached someone at Ambetter, she felt like she was being stonewalled. Slabyk felt lost.

You can find more information about your state's laws on the Centers for Medicare & Medicaid Services website.

By June, she was so fed up she decided to submit a complaint to the Texas Department of Insurance. Five days later, she received a call from an Ambetter employee apologizing and saying they would process the procedure as an emergency and pay up.

Centene, Ambetter’s parent company, did not respond to emailed questions or a phone call seeking comment. (The state informed Slabyk it closed the complaint.)

“I was around a lot of people who were knowledgeable and giving me very good advice,” Slabyk said. “And so if you’re just like, on your own, not in the health care system whatsoever, I mean, I just, I can totally see giving up.”

California had to pass not one but two laws to compel insurers to pay for infertility treatments. And one lawmaker said insurers are still saying no often enough that he’s considering introducing a third.

After legislators began requiring such coverage in 1990, some health plans took a narrow view. They refused to pay to preserve eggs, sperm or reproductive tissue for patients facing treatments for diseases like cancer that could impair their fertility. Some patients were delaying chemotherapy to try to get pregnant beforehand or going into debt to pay for treatments out-of-pocket. Regulators forced insurers to pay in some cases, but elected officials worried that other patients were being denied this care.

State Sen. Anthony Portantino worked with colleagues to amend the law in 2019, clarifying that these treatments must be covered. Even so, insurers have been putting up roadblocks.

“Some of the insurers are taking a very strict approach that it has to be chemo,” said Portantino, who is a Democrat. For instance, patients who need cancer surgeries that could leave them infertile have faced denials.

Portantino said he plans to work with California’s largest health insurance regulator to clarify that fertility preservation must be covered more broadly. If that does not work, he said he will turn to legislation once again.

Other regulators are trying to bolster enforcement on the front end. Health insurers submit annual filings to the states where they operate, detailing the treatments and services the company will and won’t cover. Regulators check these policies to figure out whether an insurer is complying with state mandates. In Vermont, the insurance department is using federal grant money to work with an outside company to improve these reviews. Through staff training and education, the department hopes to catch insurers not following state laws before Vermont residents face wrongful denials.

Not all health plans have to follow state mandates. About 65% of employees who get insurance through their jobs work for companies that pay directly for health care. Those companies often hire insurers solely to process claims. Known as self-funded plans, they are regulated by the federal government and exempt from state coverage requirements. Employers increasingly are turning to these types of plans, which tend to be cheaper, partly because they don’t have to cover care that states require. (The federal government also imposes coverage mandates, but state laws can be more robust.)

For patients, this can mean fewer protections from denials.

When 57-year-old Sayeh Peterson, a nonsmoker, was diagnosed with stage 4 lung cancer, her doctors ordered genetic testing to identify the cause. Those tests revealed that a rare gene mutation was, in fact, the culprit for Peterson’s disease and gave doctors the information they needed to create a treatment that targeted the mutation. Her state, Arizona, requires insurers to cover such testing, but Peterson’s UnitedHealthcare plan was self-funded by her husband’s employer, so the law didn’t apply. She and her husband were left with more than $12,000 in bills.

In response to questions, UnitedHealth spokesperson Maria Gordon Shydlo wrote that “there is not enough medical evidence to support use of all those tests.”

As Peterson undergoes a treatment plan tailored to the genetic test results, she is continuing to appeal the denials months later. “We’re told that we have this great insurance,” Peterson said. “But then they deny coverage for the testing that determined what my treatment would be. How do you even get your head around this?”

Do You Have Insights Into Dental and Health Insurance Denials? Help Us Report on the System.

Doris Burke contributed research.

by Maya Miller and Robin Fields