Medical Legal Partnership News
Summer 2019
Highlights of 2019 Connecticut General Assembly Legislative Docket Children’s Health and Well-Being

Director's Message
Jay Sicklick, Esq.

This edition of MLP News looks at recent legislative initiatives brought by our Medical-Legal Partnership and highlights of the 2019 General Assembly’s legislative docket relating to children’s health and well-being. 

This was an extraordinarily productive session for our MLP. We were proud to be part of a large team that successfully worked to enact legislation that provides adolescents with the legal right to consent to HIV prophylaxis, or PrEP. 

In addition, we initiated a movement of advocates, medical providers, healthcare establishments and consumers to expand the state’s Medicaid program to provide coverage to undocumented children and youth under age 19.  

We welcome your comments, suggestions and feedback. And we welcome a guest to this page – our friend and colleague Dr. Krystn Wagner, who writes this edition’s “Medical Director’s” column. 

 

Medical Director's Corner
Guest Columnist – Krystn Wagner, MD

Physicians are accustomed to health care barriers faced by patients on a daily basis. Within community health centers, we work as teams and it is often our medical case managers who help patients navigate the challenges of housing, food, jobs, and other essential resources.

In 2015, I confronted a patient access question that couldn’t be solved by our health care team. For the past year, I had prescribed HIV pre-exposure prophylaxis (PrEP) to adults at risk of HIV infection. 

Data from Connecticut’s Department of Public Health, as well as information from our adolescent and young adult patients, told me that adolescents urgently needed PrEP. 

Could I prescribe PrEP to teens, particularly gay and bisexual youth, without parental consent under the same Connecticut laws that allow physicians to provide HIV testing and treatment and other sexual health services to adolescents? Given the risk, I hoped the answer was yes. 

I called the Center for Children’s Advocacy's MLP to ask. Their response triggered an immediate and energized action plan. Although HIV prophylaxis was not addressed under existing law, MLP Director Jay Sicklick saw an opportunity for legislative change. Thus began a four-year partnership to propose a bill, inform legislators, provide testimony, and engage advocates. Our partnership evolved into a team of lawyers, interns, legislators, patients and advocates.

On July 5th 2019, Governor Lamont signed the legislation and adolescents across Connecticut may now receive PrEP without parental consent.

Physicians often face patient access barriers that seem insurmountable within the context of the health care team and center. The CCA Medical-Legal Partnership introduced me to another avenue: the power of working with passionate and committed lawyers for health care change.

It can begin with a phone call.

Dr. Krystn Wagner is an infectious disease specialist at Fair Haven Community Health Center in New Haven. Her areas of expertise focus on prevention, care and treatment of HIV and Hepatitis. She is a graduate of the Yale University School of Medicine, where she received her medical and doctoral degrees, and the Johns Hopkins University School of Medicine, where she completed her internship, residency and fellowship. Dr. Wagner was instrumental in raising the issue of adolescent access to PrEP, and her relentless advocacy and clinical leadership proved insurmountable in achieving the goal of expanding HIV prevention to adolescents. 

PrEP for Adolescents – Legislative Victory Assures Greater Access for Life-Saving Care

After four years of strenuous advocacy, Public Act 19-109, An Act Concerning Prevention of Human Immunodeficiency Virus was signed into law. CCA MLP attorney Alice Rosenthal, Fair Haven Health Center’s Dr. Krystn Wagner, ACT (formerly AIDS Connecticut), and legislative champions Representatives Jeff Currey and Raghib Allie-Brennan, saw their efforts realized on the last day of the legislative session when the Senate passed the final bill at 11:10 pm. 

Effective July 1, 2019, the law provides minors with the confidential right to access PrEP. Medical providers must determine that notification to a parent or guardian would result in denial of consent, or that the minor would not seek, pursue or continue PrEP.  For more information, please see our PrEP information sheet.

Medicaid Expansion for Undocumented Children: Big First Step

The MLP’s first venture into expanding healthcare coverage for undocumented immigrant children had extraordinarily positive results. The General Assembly’s Human Services Committee raised House Bill 1053, An Act Expanding Medicaid and HUSKY B for Children, which sought to expand state-funded medical insurance coverage (HUSKY A - Medicaid, and HUSKY B - CHIP) to otherwise eligible undocumented children and youth residing in Connecticut under the age of 19. 

At a powerful public hearing on March 19, 2019, advocates, immigrant parents and healthcare experts testified in favor of the bill that sought to open the door to approximately 17,000 children and youth who are presently ineligible for Medicaid or HUSKY B due to their immigration status. At a contentious but equally powerful follow up meeting, the Human Services Committee voted favorably to send the bill to the House Floor, where it remained for the duration of the legislative session. 

One of the most positive aspects of this critical advocacy was the groundswell of support generated through CCA’s outreach. MLP Director Jay Sicklick indicates that the MLP and its partners remain committed to this key policy initiative in the coming years. “We realized that it would be unlikely that the bill would succeed in year one – but the proposal went much further than we anticipated. We were overwhelmed by the support of key legislators, and look forward to working with them once again next session.”  Sicklick noted that fiscal implications will always be present for healthcare expansion proposals, but that “projected downstream savings will provide the incentive for the state to support what is essentially a healthcare access proposal.” If you have expertise in the area of immigrant healthcare access or would like to join this initiative, please contact MLP Director Jay Sicklick. 

More News from the MLP  

  • 2019 Adolescent Health Care: Legal Rights of Teens Addendum is available and can be downloaded here. The Addendum focuses on changes to state law and policy since the 2016 publication, and provides a brief summary of key legislative initiatives regarding children’s health and welfare. 
     
  • Our Medical Director, Dr. Ada Fenick, is on sabbatical. We welcome Dr. Marjorie Rosenthal, a frequent MLP colleague, who will be our clinical partner at Yale-New Haven Hospital during Dr. Fenick's absence.
  • The MLP will present at the upcoming National MLP Summit in Maryland on September 19-20, 2019. Dr. Ada Fenick and attorney Alice Rosenthal will headline a workshop entitled, "CBAs of the ABCs: clinical collaboration, basic training, and advocacy around education." Dr. Krystn Wagner, Dr. Julia Rosenberg, advocate Sam Smith, and MLP director Jay Sicklick will present with a MLP group from Atlanta, “Moving Upstream: Case Studies on Partnering for Legislative Change.” 

 

Comments, questions or suggestions? 
We welcome your feedback.

Center for Children's Advocacy
65 Elizabeth Street, Hartford, CT 06105
211 State Street, Bridgeport, CT 06604
CCA MLP at Connecticut Children's Medical Center
CCA MLP at Yale New Haven Hospital
cca-ct.org/mlpp

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