Medical Marijuana: A Post-Election Update

medical marijuanaOn Election Day, voters across the country showed they were in favor of legalizing medical marijuana, and in some states, recreational marijuana as well. California, Maine, Massachusetts, and Nevada voted to legalize the recreational use marijuana, while Arkansas, Florida, and North Dakota passed ballot initiatives legalizing medical marijuana.

Marijuana, whether used recreationally or for medical reasons is still illegal under federal law. However, over the last few years, the federal government has opted to let states pass laws in this area and not to prosecute people who are following those state laws.

We have posted previously about the laws related to medical marijuana, which you can read more about here.

President-elect Donald Trump has nominated Senator Jefferson Sessions for Attorney General of the United States. If confirmed, it is likely that Senator Sessions will take a different approach towards state laws on medical and recreational marijuana.

To learn more about Senator Sessions’ views on marijuana, read this informative article: http://www.politico.com/magazine/story/2016/12/jeff-sessions-coming-war-on-legal-marijuana-214501.

Medical Marijuana: A Guide to Navigating Employment

A few months ago, we posted a blog about the legal and practical issues of medical Triage Cancer Blog Medical Marijuanamarijuana. This blog follows up on the challenges facing employees who are using medical marijuana to address their side effects from cancer treatment.

Legal Cases, Updated Laws, and Employment Issues

Currently, 25 states and the District of Columbia allow for the use of medical marijuana. In an article written by Jon Woodruff, a legislative attorney for the National Alliance for Model State Drug Laws, it is estimated that about 70-80% patients using marijuana are between the ages of 18 and 60. These numbers indicate that many of those patients are currently in the workforce. With more and more state laws increasing the availability of medical marijuana and recreational marijuana, new legal issues are occurring at the workplace between employers and employees.

Despite the state-by-state legalization, the fact remains that marijuana is still illegal under federal law. This makes treading the employment waters very tricky for both employers and employees.

This leads to the biggest question, can an employee be terminated or have a job offer rescinded based on their use of medical marijuana? The answer is . . . it depends. Under most state laws, an employer is not required to accommodate an employee’s use of medical marijuana, but there are some exceptions to this.

Breakdown of Requirements for Employers to Accommodate Employee Use of Medical Marijuana by State

  States
State law does not explicitly address employer accommodation Hawaii, Louisiana, Maryland, New Mexico, Vermont, and the District of Columbia
Employers are NOT required to accommodate Alaska, California, Colorado, Maine, Massachusetts, Michigan, Montana, New Jersey, New Hampshire, Oregon, Pennsylvania, Rhode Island, and Washington
Employers cannot discriminate against or terminate a registered patient (other than a federal employee) Arizona, Delaware, Minnesota, and Connecticut*
Employers are required to make attempt to accommodate use Nevada, New York, and Illinois
Pending bills requiring more employer accommodation Hawaii, Michigan, New Jersey, and Rhode Island

*Connecticut statute does not address accommodation, but states that employer cannot refuse to hire based on status as a “patient.”

Court cases in New Mexico, Colorado, and Oregon aren’t making it any easier to understand when and where it is acceptable to work as an employee using medical marijuana. In New Mexico, a court ruled that it would not require employers to accommodate the use of “a drug that is still illegal under federal law” (Garcia v. Tractor Supply Co.). Meanwhile, in Colorado, one of the states that has legalized marijuana for recreational use, a court ruled that termination of an employee is valid because marijuana is still classified as illegal under the federal Controlled Substances Act (Coats v. Dish Network). Brandon Coats, a quadriplegic, licensed to use medical marijuana after his painkillers used to treat muscle spasms had lost effectiveness, was terminated from his job when failing a mandatory drug test. The termination was deemed valid in Colorado’s Supreme Court. Finally, in a court case in Oregon, a state that does not require employers to accommodate medical marijuana use, an arbitrator reinstated a Lane county employee that was fired for medical marijuana use outside of the workplace, while off-duty.

A Lack of Research Findings

Medical marijuana has become a hot topic for legalization for a number of different reasons. The reported ability to help reduce pain and nausea and to increase appetite are the major contributing factors to its promotion, particularly in the cancer community. However, despite the attention, the research on marijuana’s ability to control pain, nausea, and stimulate appetite is severely lacking. In an article published in Cure Magazine, the author summarizes what studies have been conducted and why it has been so difficult to develop better studies in recent years. The major issue facing medical marijuana research is the classification of marijuana as a Schedule I substance with “no medical uses,” under the Controlled Substances Act. This makes it difficult to get funding or materials to conduct research or a clinical trial. The Journal of the American Medical Association (JAMA) and CA: A Cancer Journal for Clinicians have both published articles attempting to summarize the research that has been done, but combined found a total of nine studies that looked into the use of inhaled cannabis for pain and even less (only two) met inclusion criteria for studying the effect of inhaled cannabis on chemotherapy induced nausea and vomiting. While each of these studies did find that marijuana use decreased the effects of pain, the study size and duration leaves much to be desired in terms of power. Outside of established medical journals, trials have found that smoking cannabis does help chemotherapy patients with controlling nausea and vomiting better than a “no treatment” test group and the ingestion of a purified active ingredient of cannabis.

There are other concerns about the use of medical marijuana, including a lack of regulation of quality, dosage, and a lack of understanding of how it may interact with other treatments, such as chemotherapy.  Testing of available medical marijuana has found fungus, bacteria, and other ingredients which could be unhealthy.

The minimal research that has been done so far does show promising results with data concluding that inhaled cannabis helps with pain, nausea and vomiting, and increased appetite in chemotherapy and AIDS patients. Current FDA approval exists for pill forms of medical marijuana in Marinol (dronabinol) and Cesamet (nabilone), for the treatment of nausea and vomiting in patients with AIDS or who are undergoing chemotherapy, respectively. However, we now need higher quality studies of medical marijuana to fully understand its benefits and determine whether the benefits do outweigh the risks, such as paranoia, anxiety, irritability, lethargy, acute increase in blood pressure, cognitive impairment, and other possible side effects.

What Does This Mean for Employees and Patients?

As an employee, it is important to make sure that you know your employer’s policies on drug use. Some employers have a “zero tolerance” policy, because it makes managing employees simple or it may be a company that is in multiple states. Other companies take a more relaxed approach, by delegating certain “safety-sensitive” positions that do allow for termination if an employee is found under the influence. For example, you probably wouldn’t want your school bus drivers or your airline pilots to come to work under the influence.  Employers also need to know their legal responsibilities under relevant state laws or they may find themselves in violation of disability laws for not reasonably accommodating their employees. As always, if you have any questions, it is best to seek legal advice from a professional in your area.

The Legal and Practical Issues of Medical Marijuana

Triage Cancer Medical MarijuanaUnderstanding the legal and practical issues surrounding medical marijuana can be a bit confusing and if you look at the history of marijuana (cannabis) use and regulation in the U.S. it is easy to see why. Cannabis was considered a legal medicine in the U.S. from 1850 to 1942. Then, in 1937, President Roosevelt enacted the Marijuana Tax Act of 1937, which made the prescription of cannabis illegal. The efforts to pass this law were rooted in immigration and discrimination issues at the time. Fast-forward to 1969, in the case of Leary v. U.S. Supreme Court, this Act was ruled as unconstitutional, so, in 1970 Congress repealed the Marijuana Tax Act and replaced it with the Comprehensive Drug Abuse Prevention and Control Act.

Title II of this federal law, referred to as the Controlled Substance Act (CSA), classified certain drugs into “schedules.” Marijuana is classified as a Schedule I substance, a substance on par with heroin, LSD, and ecstasy. A Schedule I substance is a drug or other substance with a high potential for abuse and has no currently accepted medical use in treatment in the U.S., and has a lack of accepted safety for use.

Over the last two decades, states have passed legislation to legalize possession and use of marijuana, not only for medical purposes, but also for recreational use.  Colorado, Washington, Oregon, Alaska, and DC have passed laws that allow for the legal use of small amounts of marijuana. In addition to these states, many others have followed a trend legalizing marijuana for medical use. The first state to allow for medical marijuana use was California in 1996. Although many states have passed this legislation, there are significant differences among those laws. For example, some states require patient registry or ID cards, some allow for dispensaries or retail sales, and some states only allow use for specific medical conditions, such as epilepsy. Some states do not actually legalize medical marijuana, but allow it to be used as legal defense to criminal possession.

So is marijuana legal or illegal?

Possessing or using marijuana is still illegal under federal law, even though some states have legalized it.  Now if you are thinking, how does that work? You are not alone.

This conflict between laws has certainly led to some confusion and challenges in the legal arena. In 2005, the U.S. Supreme Court ruled that the federal government has the right to regulate and criminalize cannabis in states, under the commerce clause. However, by 2009, the U.S. Attorney General announced that it was no longer a “priority to use federal resources to prosecute patients with serious illness or their caregivers” regarding medical marijuana.

Similarly, in 2013, the Department of Justice announced that it would continue to enforce CSA with regard to 8 priorities, including: preventing distribution to minors and preventing revenue from being directed into illegal enterprises or using marijuana as a cover for other illegal drug activity. Then, in 2014, Congress passed a law prohibiting the federal government from using its resources to impede state medical marijuana laws.

How does this affect you? What issues may arise?

As a patient, you may face issues with access to care or quality control. In some cases a positive drug test may impact treatment decisions and there is little regulation of the medical marijuana industry.  So, you may not be aware of the potency, quality, effects, or potential contamination of the medical marijuana you are using. Bacteria, fungus, and other dangerous substances have been found in medical marijuana.

The use of medical marijuana may also affect your ability to remain employed or gain employment. Employers have a right to have a drug-free workplace policy and enforce it. This means that an employee can still be fired if they test positive on a drug test, despite having a prescription or physician recommendation for the use of medical marijuana. Earlier this year in New Mexico, a federal court dismissed a case brought against a company by a newly hired employee who was fired for failing a drug test for marijuana. This case and several others have set precedent in some states that a reasonable accommodation to allow use of medical marijuana, is not required.

As a healthcare professional, you also face some practical problems when discussing medical marijuana with your patients. Issues may arise with how to adequately advise patients, or if you may be advising your patient to do something illegal. It is important to stay up-to-date on your state laws regarding medical marijuana use and how it may affect your patients’ health.

Whether you are a patient or healthcare professional, navigating the legal and practical issues surrounding medical marijuana can prove to be an overwhelming task. Visit our website for updated State Laws and other resources that can help answer your questions or lead you in the right direction.

Cancer Survivor Prevails in Disputed Embryos Case

Recently, the Supreme Court of the United States refused to take up a widely-publicized Triage Cancer Blog Supreme Courtcase, Szafranski v. Dunston, involving disputed embryos.

Karla Dunston, a doctor, was diagnosed with non-Hodgkin’s lymphoma in 2009. Because her treatment presented the risk of infertility, Ms. Dunston took steps to preserve her fertility. She asked her boyfriend, Jacob Szafranski, to help her by allowing her to use his sperm to create embryos before she had to start her cancer treatment. He agreed, and they went to a fertility clinic where she underwent a cycle of IVF and successfully froze three embryos.

Ms. Dunston completed her cancer treatment and went into remission. However, she was left infertile, and the embryos that were frozen are now her only option for having biological children. Unfortunately, in 2010, the couple broke up, and in 2011, Mr. Szafranski sued to prevent Ms. Dunston from using the embryos to have a child.

This case presented complicated issues about embryo disposition that state of Illinois had not addressed before, and it highlights subjects that cancer patients need to think through when considering fertility preservation. It isn’t clear how courts will decide if one person can use their embryos to become a biological parent if the other person involved objects. Should the embryos be destroyed? Kept frozen until agreement is reached? Given to whomever the court believes has more at stake?

Before Szafranski, cases in other states had been decided in different ways, but no clear approach had been established. Some states looked at whether there had been a contract formed about the disposition of the embryos when they were created, and strictly upheld any such agreement between the parties, even if circumstances and wishes had changed. Some applied a “balancing” test where the court weighed the interests of each person to decide the best outcome, even if there had been a contract. One court created a standard called “contemporaneous mutual consent,” which basically said that even if the couple agreed when they created the embryos, they had to also be in agreement at the time that the embryos were to be used or destroyed. This approach essentially allows either party to change their mind and have “veto” power over the other.

This case worked its way through the Illinois courts, and ultimately, the Illinois Court of Appeals adopted a hybrid approach. It said that if the facts showed that a contract – oral or written – existed, this should be controlling. But absent a valid contract, a trial court could consider the individual facts of the case and apply the balancing test. The trial court had found that when Ms. Dunston asked, and Mr. Szafranski agreed to create the embryos, a valid oral contract had been formed. That discussion included an understanding that Ms. Dunston would be able to use the embryos after cancer treatment in order to try to get pregnant, since that was the entire purpose. The court rejected Mr. Szafranski’s argument that an informed consent document from the fertility clinic (which stated that the embryos could not be used or disposed of unless both parties were in agreement) changed their verbal agreement.

The Supreme Court’s unwillingness to review this case means Mr. Szafranski cannot block Ms. Dunston from using the embryos to try to become pregnant. But it also leaves the law around disputed embryos unsettled, creating uncertainty about what types of agreements either between couples or between couples and their fertility providers will be recognized as binding, or whether compelling interests of one party will tip a court’s ruling in their favor.

Interestingly, this case is only the second of twelve disputed embryo cases in which the person seeking to have a biological child prevailed over the person seeking to avoid parenthood. In both cases, for the infertile female cancer survivors who won, the disputed embryos represented their only possible chance at biological motherhood. In the words of the Illinois Court of Appeals, “Karla’s interest in using the pre-embryos is paramount given her inability to have a biological child by any other means.

 

Joyce Reinecke, JD, is the Executive Director of the Alliance for Fertility Preservation, a 501c3 charitable organization whose exclusive focus is fertility preservation for cancer patients. Joyce is also a cancer survivor who became a parent after undergoing fertility preservation. A version of this blog originally appeared here.

National Healthcare Decisions Day: Saturday, 4/16!

National Healthcare Decisions Day, or NHDD, is a national call to action, to build awareness and spark conversation on the importance of advance care planning. The theme for 2016 is “It Always Seems Too Early, Until It’s Too Late.”

The main goals of NHDD are to make the topic of advanced care planning something more frequently discussed and to open the lines of communication on a topic that can sometimes be difficult to talk about.

There are so many reasons why it is important to think about and take steps to complete advanced care planning, but in particular, it allows you to:

  • Clearly document your wishes
  • Avoid burdening your loved ones with having to guess what you would want
  • Avoid conflict among your loved ones

NHDD focuses on documenting your decisions related to how you would want to receive health care, in case you are unable to make health care decisions for yourself.  The most effective way to document your decisions is through an advance health care directive.

An advance health care directive is a legal document that is specific to your state.  Click here to download your state’s advance health care directive form.

There are typically 3 parts to an advanced health care directive form.

Part 1: A Health Care Proxy

A health care proxy is someone you choose to make health care decisions for you if you are unable to make them for yourself.  For example, you may choose your spouse or your sibling to make those decisions for you.

Part 2: A Living Will

A living will focuses on identifying specific types of health care you do or do not want to receive.

Part 3: Organ Donation or Anatomical Gifts

This section allows you to make general or specific decisions about organ donation or anatomical gifts.  For example, if you would like to donate your body for research.

Once you have an advance health care directive completed, you should share your decisions with your loved ones and your health care team, so that they know your wishes.

The best time to complete an advance directive is now.  We never know what tomorrow will bring and it’s so important to be prepared.

Medical decision making is just one part of the estate planning process.  You may also want to consider completing other documents, such as a will, trust, or power of attorney for financial affairs. For more information about estate planning, visit www.lawhelp.org, and then pick your state.

Get involved in National Healthcare Decisions Day this year!

  • Learn more about the steps you may choose to put in place for your own medical decisions or talk with family members and loved ones.
  • If you are a health professional or advocate, there are valuable resources and ideas provided by NHDD.org here!

On Saturday, April 16, 2016, be a part of the movement to demystify healthcare decision-making!

Calling All Advocates: Insurance for Fertility Preservation

By Alice Crisi

For years, California advocates have struggled to secure fertility preservation insurance coverage for cancer patients. A 2013 bill even made its way to the Governor’s desk only to be vetoed because of the one penny per member per month it would cost to implement this important insurance reform.

California only requires insurers OFFER infertility coverage as a potential benefit, but it does not include In Vitro Fertilization (IVF), nor does this mandate require employers provide infertility coverage to their employees. If you read the aforementioned sentence and thought “That sounds pointless,” then you would have the same thought as most fertility advocates.

The mandate itself set up a loophole in the system for insurers to tell enrollees diagnosed with cancer, “Infertility services are not a covered benefit and fertility preservation is an infertility service.” The bottom line is fertility preservation historically was lumped in with traditional infertility services rather than being considered a part of cancer care.

And the story is still shared over and over and over again. “I checked on your insurance and infertility/fertility preservation isn’t a covered benefit.” Some physicians preemptively tell their patients, “Insurance doesn’t cover it,” further perpetuating the idea of lack of coverage.

But that isn’t 100% true.

We now know some companies cover fertility preservation for all their employees in California. We also know from informal surveys and patient feedback that some insurers cover fertility preservation as part of the standard of care for cancer.

But, due to mistaken beliefs about coverage, many patients were not asking their Triage Cancer Blog - Independent Medical Review Fertilityphysicians for help with submission of prior-authorizations for coverage of fertility preservation treatment, or not appealing when the prior-authorization is denied. Records show only one patient has ever utilized California’s Independent Medical Review (IMR) process for fertility preservation. That patient, asked the California Department of Managed HealthCare (DMHC), the agency that oversees 25 million plans in California, to overturn a decision to deny her embryo freezing procedure before breast cancer treatment.

And she won.

She won.

You got that, right?

She Won.

The DMHC agreed with her, her physicians, the American Society of Reproductive Medicine, the American Medical Association, and the American Society of Clinical Society, whom all state fertility preservation is standard treatment when diagnosed with cancer during reproductive years. She, as a newly diagnosed cancer patient, was granted the right to have her insurance cover her embryo freezing procedure prior to cancer treatment.

This is a clear path forward, underutilized by patients, advocates and physician offices. Armed with this information, patients can move forward and challenge the old notions.

In fact, 60% of individuals who use the IMR process have their insurance company’s denial overturned. Once a pattern ensues, the DMHC will regulate a formal change.

Our joint goal is to work with the DMHC to write a letter informing insurance companies they need to cover fertility preservation for patients diagnosed with cancer. But, we need more complaints filed in the system before that happens. We need every patient to ask their insurer for coverage and then file a request for an IMR, if their insurance company denies the treatment.

Here’s how it works:

  1. Your reproductive specialist’s billing manager will request a prior-authorization from your insurance company to cover your fertility preservation procedure. (Your insurance company may say yes!)
  2. If your insurance company denies the prior-authorization, you then file an expedited appeal through your insurance carrier (usually an online form through your own insurance company). Request an expedited review on account of your cancer diagnosis.
  3. If your insurance company upholds their original denial, you may then request an expedited IMR online through the DMHC (even if your plan advises you there are multiple levels of appeals). http://www.dmhc.ca.gov/FileaComplaint/IndependentMedicalReviewComplaintForm.aspx#.VspUlfkrKc0
  4. DMHC is required by federal law to address your request for fertility preservation insurance coverage within 30 days, but with expedited cases to be addressed within one week.

To better be able to help patients, oncologists and reproductive professionals (along with their billing personnel) may request an educational webinar via email acrisci@cryobank.com.

A great website to help you navigate the system is http://mypatientrights.org.

Check with www.OncofertilityUniversity.org for more information.

As the de-identified IMR cases will be publicly available on the DMHC website, eventually we will be able to see the cases and assess the outcome. But, if you’re comfortable, we would really benefit from you contacting us at info@fertileaction.org to let us know how the process worked for you. It would be helpful to know if you were able to get coverage right away, through the insurer’s appeals process or the IMR process. The more people use the system, the clearer it will be to regulators there is an issue they can and should address.

We’re so close to permanently changing this story in California, let’s solve this problem this year!

West Coast Conference on Work & Cancer

Triage Cancer is excited to partner with Cancer and Careers for the first-ever West Coast Conference on Work & Cancer, next Friday, November 13th!

This free, daylong event explores the challenges of balancing treatment and recovery withWest Coast Conference Flyer 2015 employment and is open to patients, survivors, healthcare professionals* and anyone else touched by cancer.

Our CEO, Joanna Morales, and Rebecca Nellis, chief mission officer of Cancer and Careers will present on topics including:

  • Disclosure
  • Working through treatment
  • Health insurance options
  • Legal issues
  • Job-search
  • …and more!

Below are more details about the event. Space is filling up, so be sure to register today!

Date: Friday, November 13, 2015
Time: 8:30 AM – 4:30 PM (breakfast & lunch provided)
Location: The Center at Cathedral Plaza, 555 W. Temple St., Los Angeles (Free parking)

Website for more information: www.cancerandcareers.org/en/community/events/westcoast-conference

*Free CEUs are available for oncology nurses and social workers.

If you’re in the Midwest, save the date for our Midwest Conference on Work & Cancer on Friday, April 8th in Chicago!

“Lawfully Present”. . .“Permanent Resident”. . .“Deferred Action”. . . Oh my!

These are all terms related to an individual’s immigration status in the United States.Immigration Stamps

Do you fit into one of these categories?  Trying to help someone who might?  Not sure?

Depending on your immigration status, you may be eligible for health insurance benefits under the Affordable Care Act (a.k.a. health care reform or ObamaCare).

Here are some excellent resources from the National Immigration Law Center (NILC) to help you figure out whether or not you, or someone you know, might be eligible:

Here is additional information about: Medical Assistance Programs for Immigrants in various States.

For more information about visas, visit: http://travel.state.gov/content/visas/english/immigrate.html.

For more information about green cards, visit: www.uscis.gov/greencard.

For general information about immigration in the United States, visit: www.uscis.gov

Disclaimer

Getting Started with Estate Planning

Willby Michelle Shagenov, Esq. 

Over the years, I have had numerous clients who avoided estate planning until they faced a health emergency or another crisis. When I asked them why they put off estate planning, I heard varied responses; including the assumption that estate planning is only for the wealthy and the elderly.

However, the reality is that everyone needs a basic estate plan, particularly those people who face a chronic illness like cancer.  A basic estate plan ensures that YOU make the important decisions about your medical care, your financial affairs, and your family’s future.  If you fail to plan or plan inadequately, a third party may be appointed by a judge to make these decisions for you and your family.

Each person’s plan is different and depends on his or her own unique life circumstances. The first step in estate planning is to reflect on your needs, values, and lifestyle.

Here are some questions and tips to get you started:

1. What are your values and beliefs? What is most important to you? Estate planning documents require you to make decisions about your medical and end-of-life care, donation of your organs, your funeral wishes, and inheritance of your assets.  Your decisions will depend on your values and beliefs.

2. Inventory your assets.  What do you own? Your assets include bank accounts, investments, insurance policies, real estate property, vehicles, jewelry, collections, and on-line accounts.

3. Review your financial documents. Do you own any of your property jointly with another person? The distribution of some assets is not covered by the terms of a will. Jointly titled assets or those with designated beneficiaries (“Payable On Death,” “Transfer On Death,” and “In Trust For” accounts) are known as testamentary substitutes.  Upon an individual’s death, these assets are distributed directly to the joint title holder or designated beneficiary

It is important to review your financial documents, at least annually. This is to ensure that your joint title holders and designated beneficiaries are your intended beneficiaries. A common mistake is the failure to remove an ex-spouse as a joint account holder or beneficiary!

4. Whom do you want to inherit your assets? What are their ages, needs, lifestyles, health situations, income?  Without a will, only your immediate family members receive an inheritance. However, a will allows you to give your property to whomever you choose, including family members, friends, and charity.

Your choices regarding the amount of an inheritance, if any, will depend on your beneficiary’s age, need, lifestyle, and health situation. You may wish to consider a trust for the care of minor children, family members with special needs or chronic illnesses, and pets.

5. Whom do you want to make to medical decisions if you are unconscious or uncommunicative? Whom do you want to manage your financial affairs if you are no longer able to do so? Whom do you want to handle the affairs of your estate? Whom do you want to care for your minor children and/or your pets?  There are three basic estate planning documents: the health care proxy, the power of attorney, and the will. These documents allow you to designate an agent of your choice to make medical decisions for you, manage your financial affairs, handle the affairs of your estate, and care for your minor children and pets. If you do not have these documents in place, a judge may appoint a stranger to handle your affairs.

6. Communicate your wishes. It is very difficult for family members and friends to follow your wishes if they do not know what your wishes are! In addition, you can prevent disputes like the Terry Schiavo case if you clearly communicate your wishes, in writing.

Stay tuned for the next installment on estate planning from Michelle, covering health care directives and communicating your wishes regarding end-of-life care.

Michelle Shagenov is a NY and NJ licensed attorney with a solo New York City based practice, focused on wills, trusts, estates, and guardianship. For more information, please contact Michelle at michelle.shagenov@gmail.com or (347) 618-1454.

Health Care Reforms are Moving Along at the State Level

CoveredCalifornia1Our health care system is undergoing significant changes over the next four months and into next year.

On October 1, 2013, individuals and small business with fewer than 50 full-time employee equivalents will have the option to buy health insurance coverage through the state health insurance marketplaces. Marketplaces will be available in every state, but some states will run their own marketplace, some states will have marketplaces run by the U.S. Department of Health & Human Services (HHS), and some states will partner with HHS to run their marketplace.

To learn more about the marketplaces and your state-specific information, visit www.HealthCare.gov/marketplace.  Our website also has state-specific information that can be found here.

Breaking News . . .

Just last week, California’s exchange released information about the 13 plans that will initially be available to people throughout the state.  For more information, visit www.CoveredCA.com or click here to view the plan booklet.

Also this week, Illinois’s legislature passed a bill to expand Medicaid to individuals who are at or below 138% of the federal poverty level ($15,856 in 2013).  Governor Quinn is expected to sign this bill soon.

As you can see things are changing on a daily basis so please check back for more updates!