NoHLA's Impact

Northwest Health Law Advocates is the consumer voice in the health care debate. We aim to improve access to health care for all Washington residents in furtherance of health as a human right. Here are some examples of our recent advocacy efforts:

Refining and Improving Health Reform

Ever since the January 2014 launch of Medicaid Expansion and new health insurance marketplace, NoHLA has been at the forefront of efforts to ensure Washington State’s new health system attracts enrollees and that it works for all residents, including those who are low-income. We’re working to:

• Communicate the value of the new options to potential enrollees. Our media effort, focused on women, has spread the word about Washington’s Exchange extensively and effectively through a broad range of print, radio and social media outlets.

• Promote state policy options for affordable coverage, including easier access to Medicaid, better options for pregnant women, a confidential program for pregnant teens, and development of the Basic Health Option. NoHLA has been leading the push for the state to adopt these options and provides input into the policy choices that will create equitable coverage for all. Over the past two years, we have provided extensive comments as the Medicaid regulations were restructured to adapt to the ACA.

• Advocate for comprehensive benefits in public and private coverage, particularly considering the needs of low-income women. NoHLA offered in-depth comments on state proposals for benefits packages and provided in-depth input as Washington developed its Medicaid Expansion program and parameters for Qualified Health Plan benefits. We are now working to increase the reach and effectiveness of these systems so enrollees can get the care they need.

• Monitor service delivery innovations to prevent harm to vulnerable populations as the state restructures its public programs to comply with the ACA. NoHLA is advocating for needed protections for populations at risk, such as seniors and those with disabilities and chronic conditions.

• Build a consumer-friendly system by tracking the new Exchange marketplace to make sure that it works for all Washington residents, particularly those with access barriers. NoHLA is offering recommendations on how best to offer consumer assistance and assure that there is “no wrong door” to getting and maintaining coverage. We are working to remove barriers to coverage for vulnerable groups including low-income disabled immigrants, parents and incarcerated persons about to re-enter the community.

• Improve Medicaid renewals. The process for current Medicaid enrollees to annually renew their coverage was shifted to a new agency, using an automated process and Exchange call center. Many found this new renewal process confusing and hard to navigate. Unexpectedly large numbers of eligible individuals lost coverage. We are pursuing advocacy toward solutions that restore the coverage of those known to qualify and that simplify the renewal process.

Promoting Language Access in the Exchange

When NoHLA learned that Washington’s new Health Benefit Exchange marketplace was not prepared to serve our state’s diverse population, we sprang into action. We partnered with the Washington State Coalition on Language Access to issue a report highlighting the 200 languages spoken in our state and legal obligations to serve all residents. Because of our efforts, the Exchange has developed a Language Access Plan that begins to address the interpretation and translation needs of immigrants. We also worked with the Exchange to develop outreach materials for uninsured immigrants.

Success in Restoring Health Care for Immigrants

In September 2011, NoHLA and co-counsel Riddell Williams, P.S. received a favorable ruling in a 
class action suit on behalf of low-income immigrants who challenged their disenrollment from Washington State’s Basic Health program. Federal District Court Judge James Robart issued a preliminary injunction, ordering the State to re-enroll thousands of immigrants whose coverage was terminated in March due to budget cuts. The judge ruled on two constitutional grounds:

• Disenrollment based on immigration status likely violated the plaintiffs’ Equal Protection rights.


• The notice of disenrollment that plaintiffs received was likely inadequate, violating their Due Process rights. 

The Health Care Authority immediately restored coverage to all affected immigrants and sent them improved notices describing the new eligibility criteria, in order to give them an opportunity to pay their premiums and demonstrate a “lawfully present” immigration status in order to retain coverage in the future.  (The Basic Health Program was superseded in 2014 by the ACA; lawfully present immigrants not eligible for Medicaid were offered QHP subsidized coverage through the Washington Health Exchange).

2014 Social Justice Champion Award
Teresa Mosqueda, Coalition Chair, WA State Labor Council

Janet Varon (NoHLA’s Executive Director) & Sarah Kwiatkowski, co-chairs of the Low-Income Populations committee

Julie Severson, formerly Neighborhood House, co-chair of the Insurance & Exchange

Some other milestones in NoHLA’s fight for health care justice include:

Ensuring that the Affordable Care Act will be implemented in the best interests of women, vulnerable populations, and consumers generally – providing reproductive and preventive service, language access, appeal rights, and other important protections. Many of NoHLA’s suggested improvements to agency rules and procedures affecting consumer rights have been adopted.

  • Working with our Healthy Washington Coalition partners to achieve the Medicaid expansion in Washington.

  • Reaching a legal settlement with the Washington Health Care Authority guaranteeing that Basic Health program enrollees are given adequate time to provide renewal documentation and avoid disenrollment. 

  • Preventing harmful restrictions in the state’s process for determining what health care services are “medically necessary,” by advocating that “evidence-based” rules must be balanced with individualized consideration of patient needs.

  • Working in partnership with the Health Coalition for Children and Youth toward Washington’s landmark “Cover All Kids” legislation, now considered a national model.

  • Persuading the state to protect Medicaid for newborns children of immigrant women. Based on our legal analysis, the state sued the federal government, who then backed down and reversed its original decision.  Thanks to NoHLA’s advocacy, all states may now deem these newborns eligible for a year.