http://www.lgtinc.org en-us http://www.lgtinc.org N/A contact@lgtinc.org Fri, 30 Jul 2010 09:52:34 EDT 20 http://www.lgtinc.org/articles/236/1/Advocacy-%26-Medicaid-Information-from-Heidi-Moore May 1, 2007   Dearest Advocates:   A few weeks ago I gave a presentation to the Down Syndrome Association of Atlanta that I thought might be helpful to you.  The presentation has years worth of information in it thanks to many people that have worked with me on my advocacy efforts and trying to better understand the system  in order to help my family and thousands of others.    Please remember: I am just an informed parent and not an attorney. If you need legal advice, please contact an attorney. This information should be used for general information only!    In addition, starting the first of the year, I started a consulting business to help families with the Katie Beckett/Deeming Waiver and MRWP application process (as well as education and other advocacy issues for their child)  based on all the experience I have learned in the last 4 yrs of advocating for families and working with DCH/DHR and other non-profit organizations.  If you are interested in this service, please let me know.      In addition this year,  I started working part-time for B&B Care Services, Inc as their Community Relations Manager. For those that don't know- B&B Care Services, they help to provide services to families under the Mental Retardation Waiver Program (MRWP),Independent Care Waiver Program, Community Care Services Program and the SOURCE Program throughout the State of Georgia. Please let me know if you have any questions regarding this company and how I can help you with getting those services via B&B Care Services, Inc.   I must warn you....this is a very long email and you may want to print it out for future reference.   Hope you find this information helpful!   In addition, if you would like to see my previous advocacy email postings, please go to the following website: http://www.lgtinc.org/authors/41/Heidi-J.-Moore?Page=9   United... We WILL Make a Difference! Sincerely, Heidi ============================================ Medicaid Waivers and AdvocacyYour Child Needs YOU! Heidi J. Moore   Parent Advocate for Children and Adults with Disabilities   Proud Mother to Jacob- 7 yrs old with Down syndrome and Jared - 5 yrs old   The material contained in this presentation is for general information only. It is not intended in any way to provide or offer legal advice. To obtain legal advice, please consult with your attorney or qualified legal representative.   Agenda •Medicaid - Waivers and Supports. •Tips and Traps. •Networking and Building Alliances. •Advocacy •General Information - Things you should know!   Medicaid  Medicaid is a federal entitlement program of medical assistance for people of low-income who are: •Age 65 and older; •Blind or have other disabilities; •Children; •Pregnant women; •and families with children.   Medicaid Basics •Funding for Medicaid comes from both state and federal dollars. •Each state's Medicaid program is unique. (must be in compliance with federal guidelines.) Medicaid Eligibility •Individual must meet both "categorical" and "financial" requirements. •In Georgia, the following categories of people are eligible for Medicaid: •Parents and children, •Pregnant women and infants, •Children through age 18, and •The aged, blind and disabled   •In Georgia, SSI recipients are  automatically eligible for Medicaid.   What is the Katie Beckett / Deeming Waiver ? •Category for Medicaid eligibility based on the Tax Equity & Fiscal Responsibility Act (TEFRA) 1982. •State's are allowed to make Medicaid available to a child with a disability if: -18yrs old or younger, AND -Meet federal criteria for childhood disability, AND -Meet institutional Level of Care, AND -Can safely be served at home, AND -Cost does not exceed the applicable institutional cost.   What is the KB Waiver criteria based on? •Federal Regulations established general requirements in 42CFR 435.225. -Requires institutional level of care: nursing home, hospital, or intermediate care facility- mental retardation.   1. Intermediate Care Facility - Mental Retardation - 442CFR440.150 & 42CFR483.440 •Requires 24 hour supervision AND active treatment. 2. Hospital Level of Care - 42CFR440.10 •Georgia uses Interqual. 3. Nursing Home LOC - 42CFR440.155 •DHR Rules 290-5-8 & OCGA 31-7-1(1)(b). •Requires 24 hour nursing care.   Background on Katie Beckett-Deeming Waiver for Georgia •KB Waiver was created to waive income limits of parents to establish eligibility for Medicaid in 1982. •This is an optional Medicaid Program for Georgia. •In 2001, the only national study ever conducted concluded that 20 states enrolled approximately 25,000 children in Medicaid through the KB waiver option. Georgia was the second highest ranked State for KB waivers. •Increase in KB Waiver denials since May 2005. No specific disability has been targeted. •Over 6,200 families had the KB waiver before the new guidelines were implemented on 11/15/04. Over 2,400 children have been denied since that time.   How is the Level of Care determined for the KB Waiver? •Initial application made to DFCS. -Clinical detail is sent to and reviewed by Georgia Medical Care Foundation. -If Level of Care is satisfied, DFCS does cost neutrality assessment. •Georgia Medical Care Foundation does clinical review. -A certified Prospective Review Organization. -Co-Medical Directors and nurse reviewers.   What is the Appeal process for KB Waiver? •An  initial administrative appeal can be requested from GMCF. You have 30 calendar days to supply additional information. •A 2nd appeal can be made by requesting a hearing directly from the DCH. (Fair hearing in front of a judge) •As of 1/17/07, DCH is currently conducting fair hearings for January 2006 requests! DCH has limited any patient liability to 3 months, should the hearing not turn out in the parents favor.   Appealing…..Tips & Traps •Tips for Appealing: -In the original denial letter, the parents have 30 Calendar days to appeal. -Resubmit any Medicaid documents that you feel you may have not filled out properly based on the new eligibility criteria. -Prepare a 24 hour Care Plan going into detail about your child's day. Explain everything you do as a parent that goes beyond a "typical" child's duties as a parent. -Have all your doctors, therapists and any other professional that works with  you child submit a letter explaining why your child needs the waiver. -Contact your local State Senator and Representative and send copies of e-mails to the Governor. -Detailed information on the procedural aspects of a fair hearing and instructional video on representing yourself in a hearing without an attorney can be found at: www.osah.ga.gov/   Tips and Traps •Review the eligibility criteria by going to www.communityhealth.state.ga.us or http://dch.georgia.gov/00/channel_title/0,2094,31446711_31946814,00.html   •All applications have new forms which include the following: -Pediatric DMA6(A). -Care Plan (DMA 706). -Cost-Effectiveness Form (DMA 704 which replaced the Deeming waiver Physicians Referral Form). -3rd Party Liability Health Insurance Info. Questionnaire (DMA 285).   Tips and Traps •Fill out all forms out as a "Provider" NOT as a "Parent". •Always send everything to GA Healthcare Partners / DCH by certified mail / return receipt. •#1 Reason for denials is an administrative denial (lack of paperwork and incomplete package). •Submit ALL the forms and supporting documentation in one application. •Put together a Table and Contents and tab each document. •Question #7 on DMA6(A) "Does guardian think the applicant should be institutionalized? Yes or No".  •Don't date the DMA6(A) until submitting the entire application package. (Form only good for 30 days!) •Include a picture of your child. Make it personal!   Home and Community Based Service Waivers •Section 1915c of the Social Security Act allows the federal government to "waive" (ignore) certain Medicaid rules to enable states to cover home and community-based services as an alternative to institutionalization. •These are called Home and Community Based Service Waivers.   Service Waivers "Waive" Medicaid policies that require institutionalization of an individual before non-medical services can be provided.   •This allows states to offer programs that provide additional services to Medicaid eligible individuals in their home and/or community.               Georgia's Service Waiver Programs •CCSP (Community Care Services Program) •ICWP (Independent Care Waiver Program) •CHSS (Community Habilitation Support Services) •MRWP (Mental Retardation Waiver Program)   Community Care Services ProgramThe Community Care Services Waiver (CCSP) is for the elderly with disabling conditions and people with severe physical disabilities who need in-home support services.             To apply:  CCSP Intake Unit (Atlanta Regional Commission)  (404) 463-3244 www.agewiseconnection.com             Eligibility: Must have a functional impairment. • Require nursing home level of care • Medicaid eligible • Any age             May include cost share which is determined by individual's monthly income Resource limit.  Individual may have up to $2,000 in resources.              Provides Adult Day Health • Personal Support Services • Out of Home respite care • Home delivered meals • Home delivered services, e.g. nursing, PT, OT, ST • Alternative Living Services • Emergency response services   Independent Care Waiver Program The ICWP is for adults between ages 21 and 64, with physical disabilities or traumatic brain injury.   •Individuals must be able to direct their own care. Must be at risk of nursing home or hospital placement.   •Services include: case management, companion services, including homemaker services, personal support services, environmental modification, skilled nursing, specialized medical equipment and supplies, personal emergency response systems,  counseling, occupational therapy, adult day services, respite care,  physical therapy, and speech therapy.   Community Habilitation Support Services   §        This waiver program was created to serve individuals in institutional settings to facilitate their move back into the community. §        Individuals are not being added to this program. §        Individuals must be Medicaid eligible; have mental retardation since birth or before age 18, or another developmental disability since birth or before age 22, which requires services similar to those needed by people with mental retardation. §        Services are residential supports, day habilitation and supported employment.     Mental Retardation Waiver ProgramThe MRWP provides a wide array of community based services to individuals with developmental disabilities.   To be eligible for an MRWP, an individual must: •be Medicaid eligible; •Have mental retardation or another developmental disability which requires services similar to those needed by people with mental retardation; •Be at risk for going into an institution for people with mental retardation if unable to get the services you need in the community. The MRWP is available to all ages.   MRWP Services •Natural Support Enhancements •Respite Care •Specialized Services •Medical Equipment •Personal Support •Day Support •Day Habilitation •Supported Employment •Home Modifications •Support Coordination •Residential Training and Supervision   Support Coordination •Support coordination is a separate State contract- it does not use an individual's waiver money. •Support Coordination is for those on the Short Term Planning List and for those enrolled in the program. •The regional office contracts for support coordination.   MRWP +The largest service waiver program in Georgia.             +The largest waiting list for services (over 6,000 people statewide)   +Georgia has had this waiver since 1989.   MHDDAD Regional Offices Region 1: (706) 802-5272 or toll-free 1-800-646-7221.   Region 2: (706) 792-7733 or toll-free 1-866-380-4835.   Region 3: (770) 414-3052. Clayton, Cherokee, Cobb, DeKalb, Douglas, Fayette, Fulton, Gwinnett, Henry and Rockdale   Region 4: (229) 225-5099.   Region 5: (912) 303-1670 or toll-free 1-800-348-3503.   NOW Waiver will likely replace MRWP on 7/07 •Behavioral support up to $2,460 max a year •Community access •Community Guide services up to $ 2000 max a year •Community living support •Community residential •Dental services for adults up to $ 500 a year •Environmental accessibility adaptations up to $ 10,000 lifetime •Financial support services •Natural support training and individual directed goods and services •Professional therapeutic services up to $ 1800 a year •Respite •Specialized medical equipment and supplies •Support coordination •Transportation up to $ 2800 a year •Vehicle adaptation up to $ 6,240 max lifetime cap   Medicaid Covered Services •GAPP (Georgia Pediatric Program) •SOURCE (Service Options Using Resources in Community Environments)   The above are services (not waivers) covered under Medicaid.   Things to Know…. For those who already have a waiver •Individuals who have a Medicaid waiver are entitled to ALL the necessary services provided in that waiver program. •Waivers can be used anywhere in the state of Georgia but cannot be transferred out-of-state.   For those who are waiting for a waiver. •Parents and family members need to advocate for services.    Networking & Building Alliances •Contact Governor's Council on Developmental Disabilities (GCDD) via e-mail (vmsuber@dhr.state.ga.us) regarding being placed on their "Moving Forward" e-mail update during the legislative session. •Contact your State Senator and Representative's by going to www.vote-smart.org and inputting your zip code.  They need to hear from you about your situation and how it impacts your family. •Contact Governor Perdue:  Georgia.Governor@gov.state.ga.us .   Networking & Building Alliances •Stress when talking to your legislators that the majority of the our families are hardworking, middle class, tax paying, voting citizens that have never asked from anything from the State until they had a child with a disability.   •Atlanta Alliance on Developmental Disabilities (AADD) is also involved in advocating for the disability waiting list. http://www.unlockthewaitinglists.com/   •Work with the media to get the message out and to help educate the general population of our concerns and abilities of our children (given the right resources)!   Networking   •Get Involved! Advocating is the key to success in getting the services we need for our children. Send on e-mail to : heidijmoore@comcast.net if you would like to be placed on my advocacy distribution list. (over 2,500+ members)   •My goal: Make the issues easy to understand and explain to advocates what they can do to influence change in this State.   •Additional information can be found at: -www.kidshealthcarega.org -http://www.lgtinc.org/authors/41/Heidi-J.-Moore   •Effective February 2007, Heidi now provides fee based consultation services for the Medicaid application process for the Katie Beckett Waiver and MRWP and other advocacy issues including education, healthcare and general information.  Please contact her for additional information.   More Helpful Website Information •GCDD guide to waivers :   http://www.openminds.com/indres/111306gawaivers.pdf •Summary of GA Medicaid waivers  :  http://www.unlockthewaitinglists.com/pdf/summaryofwaivers.pdf •Medicaid's Main ICF-MR page:          http://www.cms.hhs.gov/medicaid/icfmr/default.asp •Parent to Parent of GA KB Waiver Information: http://www.parenttoparentofga.org/roadmap/insurance/insurancedeemingcover.htm •Unlock The Waiting Lists website : •http://www.unlockthewaitinglists.com/  •ICF-MR level care and "persons with related conditions":             http://www.healthlaw.org/library.cfm?fa=download&resourceID=61843&appView=folder&print •Great site to find current lawsuits in other states re: disabilities: http://www.healthlaw.org/ •When you see a code w/  "CFR" go here to look it up.  Most healthcare is in title 42.  Medicaid's definitions are listed here.             http://www.gpoaccess.gov/cfr/retrieve.html •An appeals decision re: 24 active care vs. 24 supervision.  This is the court's breakdown of the fed regs and how they interpreted them.           http://www.state.in.us/judiciary/opinions/previous/archive/02280101.nhv.html •Autism Handbook http://www.usd.edu/cd/autism/Autism%20Handbook.pdf                                                                          Update : Strengthening Families of Children with Disabilities (SFCD)- KB Waiver Foundation. •In April 2006, the legislature approved $7.6 million to go towards families that have been denied from the KB waiver. •A foundation was formed to manage this process. (Community Foundation of Greater Atlanta-CFGA) •Eligibility: Families that were denied the Katie Beckett Waiver from Oct 2005 - to date. •One time prepaid debit card will be paid in the amount of $2,600/child expires March 31, 2007. •Funds are being set aside to address the long-term needs of medically fragile children and their families •Currently, DHR is finalizing the Advisory Committee members. •Contacts: Lita Ugarte- Program Officer- CGGA (404) 688-5525 and Brian Dowd with DHR bddowd@dhr.ga.gov 404-657-3592..   Advocacy Issues Therapy Issues- -Starting Sept. 1, 2006, Prior Authorizations are needed for more than 8 units/month for ST, PT, OT. -Starting Nov. 1, 2006, CHOA no longer accepts outpatients for therapy. -HB 549 - Defines "Medically Necessary Services" and being prescribed by Physician not defined by DCH. Also changes process and need for prior authorizations. Currently awaiting Governor's signature!   Other Advocacy Issues:   •Administrative Service Organization (ASO) coming in 2007 for all disability waivers. •SB 10 Voucher program for children with IEP's. Waiting Governor's signature. •Get involved and monitor your child's Medicaid card. -www.ghp.georgia.gov and request a password from GA Health Partnership to be able to track Medicaid charges to your child's account. -This is very important in order to verify and report problems. You can report a complaint via the website as well. -Only through education, accountability and communication are we going to be able to make a difference in the process.   Be Prepared, Advocate, and Win…… YOUR Child Depends on YOU! --Heidi J. Moore (Proud Mother to Jacob - 7 years old with Down syndrome & Jared - 5 years old) For more information about how you can get involved regarding advocating for children, please visit us at www.kidshealthcarega.org "Help The Children Now, So They Can Help Themselves Later!" The material contained in this e-mail is for general information only. It is not intended in any way to provide or offer legal advice. To obtain legal advice, please consult with your attorney or a qualified legal representative. Heidi J. Moore Tue, 01 May 2007 00:00:00 EDT http://www.lgtinc.org/articles/234/1/Advocacy-THANK-YOU-%21 April 22, 2007   Dearest Advocates:   I just wanted to say a big THANK YOU to everyone that participated in making this a very successful legislative session this year for individuals with disabilities.   Here is a short list of just some of the issues that have been addressed this legislative session due to our efforts in advocating for change:   1. The Aged, Blind and Disabled populations were being proposed to be placed in a "Managed Care" model.  This has been REMOVED from the budget being submitted to the Governor for signature!   THIS IS BIG NEWS.  The last thing we need for this vulnerable population is be placed in a managed care model that does not work and just adds additional layers of management without benefit to those individuals that need the care. (Again, thank you so much for those 25 people that came out to the Capitol on Monday morning to help in this effort, as well as, those that made the necessary phone calls and emails to the legislators).  We need to continue to make sure our voices are heard on this issue i n the future!   2. House Bill 549 was approved in the House and Senate and is now at the Governor's office for signature.  Basically, House Bill 549 will help alleviate many of the issues with the prior approval process for therapy in the Medicaid system.  It streamlines the paperwork, defines medical necessity, changes the prior approval process to every six months instead of three and allows 16 units of therapy per discipline before the prior approval process kicks in.  There were some changes in the original language but overall this is a step in the right directions.   I do want to clarify that there is mention of a Care Managed Organization (CMO) in the final version of this bill. This DOES NOT mean that those families with disability waivers will be in care management. They just placed this language in there for those that have Peachcare that are under the CMO's.    Many thanks to everyone that flooded key legislators phone lines on Friday morning in support of this bill!  Our voices were heard loud and clear!    3. SB 10- Basically, this is the bill that would allow families to be able to use vouchers for their children's education. I have not been as involved with this bill since others have taken the lead of advocacy for this.  This Bill is now at the Governor's desk for signature as well.   I hope you can see that our voices are being heard.  I hope that in the future more people get involved.  Keep up the great work.    Our children's Healthcare/Education and Future depend on our advocacy efforts of today.   UNITED… WE WILL MAKE A DIFFERENCE!   Sincerely, Heidi   --Heidi J. Moore (Proud Mother to Jacob - 7 years old with Down syndrome & Jared - 5 years old) For more information about how you can get involved regarding advocating for children, please visit us at www.kidshealthcarega.org "Help The Children Now, So They Can Help Themselves Later!" The material contained in this e-mail is for general information only. It is not intended in any way to provide or offer legal advice. To obtain legal advice, please consult with your attorney or a qualified legal representative. For previous advocacy email's, please go to the following website: http://www.lgtinc.org/authors/41/Heidi-J.-Moore Heidi J. Moore Tue, 01 May 2007 00:00:00 EDT http://www.lgtinc.org/articles/203/1/NBC-Channel-11-Coverage-of-Medicaid-Situation-TONIGHT%21 October 18, 2006   Dearest Advocates:   Atlanta NBC Channel 11 did run more coverage of the Medicaid situation on their 7:00pm news tonight.   You can see that coverage by going to the following website: http://www.11alive.com/news/news_article.aspx?storyid=86266   PLEASE take a minute and thank the reporter, Denis O'Hayer at dohayer@11alive.com  for his coverage of this important issue in our State......Healthcare has to be a priority for our children!     NBC needs to hear from us and how appreciative we are of dealing with these important issues our children face and the providers that service them.     United... WE WILL MAKE A DIFFERENCE!   Sincerely, Heidi   Please join us for the Healthcare for Kids Rally to be held on November 4, 2006 at 9:30am at the GA State Capitol. For more info., please go to: www.kidshealthcarega.org   --Heidi J. Moore (Proud Mother to Jacob - 6 years old with Down syndrome & Jared - 5 years old) "Help The Children Now, So They Can Help Themselves Later!" The material contained in this e-mail is for general information only. It is not intended in any way to provide or offer legal advice. To obtain legal advice, please consult with your attorney or a qualified legal representative. Heidi J. Moore Tue, 31 Oct 2006 00:00:00 EST http://www.lgtinc.org/articles/194/1/URGENT%3A-Did-YOU-receive-this-from-Heidi-J.-Moore-directly October 11, 2006   Dearest Advocates:   Unfortunately, I had another "Computer Malfunction".  Somehow Comcast deleted a some of my advocacy distribution lists.  As you can imagine this has been a nightmare for 3 days now! I have been working for hours and hours trying to recover as many names as possible BUT I NEED YOUR HELP!   When you receive this e-mail, please distribute ASAP to anyone you might think would have been on my distribution list letting them know about this problem.   If you received this e-mail from someone else and not directly from me, that means you are no longer on my advocacy distribution list.    If you would like to be added back to the advocacy distribution list, please submit the following information: 1. E-mail. 2. Full name. 3. If you are a provider, parent (child's disability), therapist, or why you want to be on the list, etc   If you received this e-mail in error, please let me know that you want to be taken off the advocacy distribution list as well.   I have been working for hours trying to recreate the information, but I'm sure I still have a number of email addresses deleted.   Thanks in advance for your cooperation in this matter. As always, you can review my past e-mails by going to the following website: http://www.lgtinc.org/authors/41/Heidi-J.-Moore?Page=6   (Please remember that there are multiple pages so page down or go to another page if you can't find the information you are looking for).   Thanks again for your cooperation in this matter, Sincerely, Heidi   Please join us for the Healthcare for Kids Rally to be held on November 4, 2006 at 9:30am at the GA State Capitol. For more info., please go to: www.kidshealthcarega.org --Heidi J. Moore (Proud Mother to Jacob - 6 years old with Down syndrome & Jared - 4 years old) "Help The Children Now, So They Can Help Themselves Later!" The material contained in this e-mail is for general information only. It is not intended in any way to provide or offer legal advice. To obtain legal advice, please consult with your attorney or a qualified legal representative. Heidi J. Moore Wed, 11 Oct 2006 00:00:00 EDT http://www.lgtinc.org/articles/188/1/Media-Attention%3A-CBS-WCTV6-in-Valdosta%2C-GA October 1, 2006   Dearest Advocate:   I was just informed that CBS WCTV 6 in Valdosta covered the meeting families and providers had with Lt. Gov. Mark Taylor over the weekend regarding concerns with children's healthcare and the Medicaid system.    Here is the link: http://www.wctv6.com/ (go to "Featured Videos" and click on "Lt. Governor Mark Taylor Campaign".)   Please take a moment to thank the reporter, Roxanna Haynes (roxanna.haynes@wctv6.com) and cc: news@wctv6.com for their continued coverage of this very difficult situation for families and providers in the State!   As I stated before, education and awareness is the key to making our issues known and hopefully resolved.   Healthcare must be a priority for our children and the providers that service them!   Thanks to Sara for letting me know about the coverage. Keep up the great work everyone!   Sincerely, Heidi   Please join us for the Healthcare for Kids Rally to be held on November 4, 2006 at 9:30am at the GA State Capitol. For more info., please go to: www.kidshealthcarega.org   --Heidi J. Moore (Proud Mother to Jacob - 6 years old with Down syndrome & Jared - 5 years old) "Help The Children Now, So They Can Help Themselves Later!" The material contained in this e-mail is for general information only. It is not intended in any way to provide or offer legal advice. To obtain legal advice, please consult with your attorney or a qualified legal representative. Heidi J. Moore Mon, 02 Oct 2006 00:00:00 EDT http://www.lgtinc.org/articles/187/1/Advocacy-Update-and-History.......... October 1, 2006   (Please note: This is a long e-mail…you may want to print out to read!)   Dearest Advocates:   As we have started down this path of having a Healthcare for Kids Rally, I've discovered that not everyone has been aware of all the activity that has happened in the last few months…….   Since June 2006, we have met with Dept. of Community Health's Director of Medicaid, Commissioner, as well as, the Governor's office to discuss the concerns and solutions associated with healthcare for children in this State.  Unfortunately, NONE of the recommendations were implemented nor discussed any further for consideration.   This is exactly why it has come to a point where we need to get our elected officials attention on healthcare and making it a priority in this state! Working with the media, having the rally, educating the public on our issues is the only other alternative we have in making the necessary changes needed for our children.    This is an election year…..we are hardworking, tax-paying, voting citizens and we don't want our tax $$$ wasted on red tape, non-productive processes that add no value to the system and continue to decrease the amount of services our children need, as well as, access to providers due to these processes.   Here is an example of some of the concerns and solutions that were discussed in these meetings……. -Implement a 1-800 number to call to check on status, enter your ref # for information on your current status. (Submission approval, deadlines, receipt, denial, appeal status, etc). -Have DFCS caseworker on the phone prepared to help parents walk through the paper work or tell them resources they can utilize to find answers instead of yes and no answers which lead to no assistance in filing out paper work or meeting criteria. -Have more explicit instructions on how to fill out all the forms. -Change renewals from every year to every 3 yrs (depending on the child's functional / behavioral needs, independence, medical needs, diagnosis, etc).   -Parents should receive in writing if they are re- approved or denied. Currently, families only receive notices if they are denied. This will eliminate families wondering and unnecessary calls to GMCF or their DFACS caseworkers.   -Fair treatment of providers.   Provide a fair and equitable payment to providers on a timely basis.   -Do not require IEP's.   -If a child is denied, make the reasons very clear.  It will make it easier to everyone and for the parent to accept the ruling is correct or appeal if warranted.  The information submitted during the appeal would be more accurate and with necessary specifics.   -Independent Advisory Committee:  A panel of families who can act as an advisory committee/clearing house for issues and feedback for the Director of Medicaid.  This could provide tremendous support and guidance to the entire Medicaid System.     -Having psychological evaluation done on children (sometimes every year) even though it is very obvious the child qualifies due to the child's diagnosis and ability to not function on their own at all is just another expense Medicaid will pay for with no value added.  Need to really look at the "value" of having psychological evaluations done on an on-going basis (very expensive).   -Streamline paperwork - many forms are repetitive information.  Make forms relevant for waivers and not generic across Medicaid.   -Having a way to find out the status of our renewal application - whether online or via our caseworker.   -Parents would like to receive an Explanation of Benefits (EOB) from Medicaid for services charged to their child's account. We realize that this is available on the web but it's hard to get a password and remember to check the account. A quarterly statement would be helpful to make sure the services have been provided. Therefore, possibly saving Medicaid money with less fraudulent charges to the system   (Please note: Many of the suggestions were compiled from the 250+ families and providers that submitted their ideas last spring to me specifically in the disability community.  I put together an actual 4 page report that was given to DCH, DFCS and Governor's office on all those suggestions. The three primary areas of concern were: Communication, Training and Process issues.  The goal is to maximize our resources to better service children with and without disabilities in the State of Georgia.  Thank you so much for everyone that participated in these suggestions)   As you can see, I have personally tried very hard to work within the system, but it has not worked. We have to UNITE our voices for OUR children!  I know not everyone feels  that a Rally is going to make a difference but what other options do we have at this point?    We must continue to work with the media to educate the State on our issues and hopefully help our elected officials understand how important this issue is to us!   I hope this clarifies some of your questions. Please understand, I am just a parent like many of you (and do not get paid for my advocacy efforts for our children)……..Right now I'm averaging over 400 e-mails a day so please understand that I can not respond to everyone.    I'm very excited about the Rally and hope everyone will participate in the largest grassroots effort this State has ever seen.  We are starting to get the media coverage we deserve on the issues  and need to let the media know we appreciate their continued coverage of these issues like the CBS investigative report and the AJC article this weekend and FOX's report a few weeks ago on the therapy situation.   We need to be a part of the solution and work with our elected officials on getting the services and processes we need for our children's healthcare!   Please go to our website at www.kidshealthcarega.org for more updates. It is currently under construction but more content will be posted very soon. We will be issuing a press release very soon on the full intent our advocacy group….Stay Tuned for further information……..   UNITED…WE WILL MAKE A DIFFERENCE!   Sincerely,   Heidi   --Heidi J. Moore (Proud Mother to Jacob - 6 years old with Down syndrome & Jared - 5 years old) "Help The Children Now, So They Can Help Themselves Later!" The material contained in this e-mail is for general information only. It is not intended in any way to provide or offer legal advice. To obtain legal advice, please consult with your attorney or a qualified legal representative. Heidi J. Moore Mon, 02 Oct 2006 00:00:00 EDT http://www.lgtinc.org/articles/186/1/AJC-Article--%26quot%3BMedicaid-Rolls-Decline.....%26quot%3B--Need-Your-Help-Educating-the-AJC%21 September 30, 2006   Dearest Advocates:   There was an article in the AJC newspaper today on the Medicaid situation written by Andy Miller (jamiller@ajc.com ).  Although I appreciate the coverage of the Medicaid situation, I do not think this article really explained the urgency and concern families and providers have within the Medicaid system (difficulty in getting services, paperwork, lack of providers due to the amount of paperwork, people being denied, etc).    Here is the AJC article ....Just in case you missed it: http://www.ajc.com/news/content/metro/stories/2006/09/29/0930MESHmedicaid.html   In addition, there was a comment in the article about Katie Beckett Waiver families having primary insurance (which kind of makes it sound like it's not a big deal if they don't have Medicaid).......We all know how important having Medicaid as secondary insurance is because most of our primary healthcare insurance companies do not pay for a lot of the services needed (especially for children with disabilities - which includes therapy).   PLEASE take a minute to help the AJC newspaper understand the urgency and need for reform in the entire Medicaid system. Explain to them that they need to have more in-depth articles done about this situation!   This is why we are having the Healthcare for Kids Rally on November 4th.........To make healthcare a priority in this state!    Send your e-mails to Andy (jamiller@ajc.com) and the editor ( letters@ajc.com) .   We need to continue to educate the State on the issues impacting our children and the media is a great tool to do so. Please let the AJC know how this has impacted your family!   Thanks again for your continued efforts in making the "real" issues known.   United...We Will Make A Difference!   Sincerely, Heidi   --Heidi J. Moore (Proud Mother to Jacob - 6 years old with Down syndrome & Jared - 5 years old) "Help The Children Now, So They Can Help Themselves Later!" The material contained in this e-mail is for general information only. It is not intended in any way to provide or offer legal advice. To obtain legal advice, please consult with your attorney or a qualified legal representative. Heidi J. Moore Mon, 02 Oct 2006 00:00:00 EDT http://www.lgtinc.org/articles/185/1/CBS-46-is-re-running-the-Investigative-Report-today%21 September 29, 2006   Dearest Advocates:   I just got confirmation from CBS 46 that they are going to re-run the Medicaid Investigative Report  that was aired last night.....It will air today at 12:00 and again on Sunday at 11:00pm.   We are getting their attention (both the media and the Governor's office).   Keep up the great work! Sincerely, Heidi   Here is the link to CBS 46: http://www.cbs46.com/Global/story.asp?S=5473158     --Heidi J. Moore (Proud Mother to Jacob - 6 years old with Down syndrome & Jared - 5 years old) "Help The Children Now, So They Can Help Themselves Later!" The material contained in this e-mail is for general information only. It is not intended in any way to provide or offer legal advice. To obtain legal advice, please consult with your attorney or a qualified legal representative. Heidi J. Moore Mon, 02 Oct 2006 00:00:00 EDT http://www.lgtinc.org/articles/173/1/More-Media-Attention-to-Therapy-and-Healthcare%21 September 16, 2006   Dearest Advocates:   I just wanted to let you know that our advocacy efforts are continuing to paying off....   NBC WALB from Albany aired on September 15th  a segment regarding the therapy changes in prior approvals and other healthcare issues that will impact our children's access to healtcare in this State!  Here is the actual news segment and you can even view the video at the following address:   http://www.walb.com/Global/story.asp?s=5414040   Please take a moment and thank the reporter, Alicia Eakin   aeakin@walb.com for taking interest in the story and also send an email to  news@walb.com?subject=Medicaid/AE .   It takes a lot of energy and time in order to have these segments aired.  I also want to thank Stephanie H. for being willing to go on camera and state what a lot of parents are experiencing and continue to educate the community on the issues our providers are experiencing with Medicaid right now as well! Thanks to Missy for letting me know about the coverage as well!   Only through building awareness of the situation (and in this case: working with the media), are we going to impact change in the State of Georgia!    I hope you can see that we are continuing to get attention on this matter!  This is exactly why having a Healthcare for Kids Rally on November 4th 9:30am at the GA State Capitol is so important (before the election on November 7th).  It's going to be a major event! More information will be sent out soon including the flyer for the event.    Thanks in advance for writing your thank you's.  If you see media attention in your area, please let me know so we can make sure everyone knows what's going on throughout the State and be able to express our thanks as well.....   Keep up the great work.  UNITED... WE WILL MAKE A DIFFERENCE!   Heidi   --Heidi J. Moore (Proud Mother to Jacob - 6 years old with Down syndrome & Jared - 4 years old) "Help The Children Now, So They Can Help Themselves Later!" The material contained in this e-mail is for general information only. It is not intended in any way to provide or offer legal advice. To obtain legal advice, please consult with your attorney or a qualified legal representative. Heidi J. Moore Fri, 22 Sep 2006 00:00:00 EDT http://www.lgtinc.org/articles/172/1/CBS-46-Coverage-of-Medicaid-Situation-and-Rally-Update September 18, 2006   Dearest Advocates:   As many of you may be aware, there has been alot of work going on with Atlanta CBS 46 and providers and parents regarding this Medicaid situation in the State.  I truly appreciate CBS wanting to show the true impact on our children and providers due to bad decisions made right now by Dept. of Community Health.    I talked to the reporter today and she said the story is still scheduled to air on Thursday September 28th at 11pm. She said these dates are always subject to change because they are still trying to get some of the final elements for the story.  Last Friday, she was finally able to sit down with Mark Trail to get an interview.  CBS 46 News is planning to run promotions to preview the September 28th story. That means hopefully a lot of people will watch!  They may also do follow-up stories during November ratings period.  So stay turned!   I'll send another e-mail out when the time gets closer to airing but wanted you all to be aware that we are continuing to get TV coverage of the issues our families and providers face due to bad decisions. Ultimately, our children are not getting the services they deserve and need.   I do think having the Healthcare for Kids rally at the Capitol is going to get everyone's attention to this matter. We have a team of over 40 volunteers working on this Rally.  I am convinced the time is now to unite our voices as one and express our concerns with the entire Medicaid system (including CMO's, BCW, Disability Waivers, etc)   The bottom line is..... children are not getting the services they need and can't find providers to provide those services due to the bureaucracy of paperwork Medicaid has developed in order to cut costs!   The system is in a crisis and we are not going to take it anymore.  Hope to see you at the Rally- November 4th 9:30am at GA State Capitol.  I will be sending out the flyer later this week for everyone to distribute. Hope to see you there.   It is going to be an event YOU will not want to miss!   United... WE WILL MAKE A DIFFERENCE!   Sincerely, Heidi --Heidi J. Moore (Proud Mother to Jacob - 6 years old with Down syndrome & Jared - 4 years old) "Help The Children Now, So They Can Help Themselves Later!" The material contained in this e-mail is for general information only. It is not intended in any way to provide or offer legal advice. To obtain legal advice, please consult with your attorney or a qualified legal representative. Heidi J. Moore Fri, 22 Sep 2006 00:00:00 EDT http://www.lgtinc.org/articles/170/1/Healthcare-for-Kids-Rally-Flyer-and-Other-Information--Please-Distribute%21 September 19, 2006   Dearest Advocates:   Please find attached the "official" flyer for our upcoming Healthcare for Kids Rally to be held on November 4th at 9:30am at Georgia State Capitol.    The time has come for us to unite our voices to be heard....HEALTHCARE must be a priority for our children! This rally is being put together for everyone that has been impacted or has a vested interest in the Medicaid system (which includes the following: parents, providers, and concerned tax paying, voting citizens of Georgia....Therefore, everyone is impacted by this issue in the State of GA!)   At the rally, we will be discussing the following issues: + Eligibility + Access to care and provider networks. + Early Periodic Screening Diagnosis & Treatment Federal Requirements. + Burdensome Application, Appeal and Claims Process.   We encourage children to attend and plan on having some entertainment for them as well. It is going to be a family friendly event! We need to put a face to the children being impacted by poor decisions.   The color theme is RED.  Please try to wear red the day of the event.    We recommend that you either car pool with other families or take Marta. There is parking available but it might be easier to come together as a group!    We currently have a wonderful volunteer group of over 40 concerned citizens wanting to make a difference and change in the direction of Medicaid!  I am amazed at how many people are actively wanting to get involved.  If you would like to volunteer (still looking for people the day of the event to help with set-up/clean-up): please send Leanne Manning (leanne_d@bellsouth.net ), my administrative assistant for the Rally, an e-mail with the following information: Name, e-mail, phone numbers, where you live, and if you are a parent, provider,etc.   Also- if you know of a organization and/or person that would like to donate to the Rally, please let us know.  North Metro Miracle League (NMML) has graciously offered to be an administrator of funds for the Rally! Please see the attached flyer for further information. Thanks in advance for your help in this matter.    This is going to be the event of the year for Healthcare in this State....... Let's show our support!   Feel free to distribute this flyer to anyone you think would like to attend and post at therapy clinic's doctor offices,etc. WE need to get the word out about this event. The more people that show up the better........   We are voting citizens and need answers to the healthcare crisis in Georgia!   UNITED... WE WILL MAKE A DIFFERENCE!   Additional information can be found on our website: www.kidshealthcarega.org  Hope to see you there!   Sincerely, Heidi J. Moore Healthcare for Kid's Rally Coordinator   --Heidi J. Moore (Proud Mother to Jacob - 6 years old with Down syndrome & Jared - 4 years old) "Help The Children Now, So They Can Help Themselves Later!" The material contained in this e-mail is for general information only. It is not intended in any way to provide or offer legal advice. To obtain legal advice, please consult with your attorney or a qualified legal representative. Heidi J. Moore Tue, 19 Sep 2006 00:00:00 EDT http://www.lgtinc.org/articles/166/1/URGENT%3ASave-That-Date%3A-Children%26%2339%3Bs-Healthcare-Rally%21-11%7B47%7D4%7B47%7D06-at-9%3A30am September 1, 2006   Dearest Advocates:   The time has come for EVERYONE to get involved.......    We are planning a Children's Healthcare Rally at the State Capitol on Saturday, November 4th at 9:30am.  More information will be following but I wanted to make sure you SAVE THAT DATE!   We all need to speak up and have our voices heard for our children and the providers that service them.  This is an election year and we need to make sure the State understands OUR priorities must include healthcare for our children.   The Children's Healthcare Rally will involve some of the following issues:   1. Eligibility Issues for disability waivers (including the Katie Beckett Waiver). 2. Access to a viable provider network (including therapy!) 3. CMO concerns. 4. BCW Concerns. 5. Overall, administrative paperwork problems in the system!   As you can see, we will be advocating for all children with and without disabilities that require healthcare from the State.   The issue is...... all children need healthcare (which includes having service providers to perform those services!).   If you are interesting in getting involved, donating time, or money in helping make this be the most effective rally to get the lawmakers attention....please send me a BRIEF e-mail stating the following:   1. What you think you do to help the cause? 2. Contact information including: name, phone numbers, e-mail address. 3. Where you live? 4. Are you a parent, provider, friend, concerned citizen, etc?   A rally committee is being put together to help make this a successful event.  Thanks in advance for wanting to participate!   Let's show our strength in numbers....OUR VOTE COUNTS!    UNITED... WE WILL MAKE A DIFFERENCE!   Hope to see you there! More detailed information will be following shortly.    Sincerely, Heidi   --Heidi J. Moore (Proud Mother to Jacob - 6 years old with Down syndrome & Jared - 4 years old) "Help The Children Now, So They Can Help Themselves Later!" The material contained in this e-mail is for general information only. It is not intended in any way to provide or offer legal advice. To obtain legal advice, please consult with your attorney or a qualified legal representative. Heidi J. Moore Fri, 01 Sep 2006 00:00:00 EDT http://www.lgtinc.org/articles/139/1/Disabled-man-wins-the-right-to-bear-arms Disabled man wins the right to bear arms Judge reverses police denial of permit for aspiring hunter to buy shotgun Wednesday, April 05, 2006 BY JIM O'NEILLStar-Ledger Staff After suffering a severe head in jury in a car crash and awakening from a coma, Charles Breitweiser developed a greater joy for life. He started spending time outdoors and, over many years, realized activities such as camping and fishing helped him build strength to compensate for the debilitating paralysis to the left side of his body. Eventually, friends introduced him to target shooting and, he says, he became so proficient that he began to believe he could actually learn to be a licensed hunter. But when the 44-year-old East Brunswick man applied for a firearms identification card and a permit to purchase a shotgun about a year ago, township police turned him down, concerned that his limited motor skills posed a safety threat to himself and others. Now a judge in Middlesex County has disagreed, ruling police violated the state's anti-discrimina tion laws when they rejected Breit weiser's application. "I kind of knew he was going to rule in my favor," Breitweiser said. "I convinced the judge that I am safe with a gun." Breitweiser, who works in the billing department of a health insurance company, won't be going hunting anytime soon. The judge stayed the decision after prosecutors said they will appeal. Prosecutors, who denied any discrimination, said they still fear Breitweiser could lose his balance, fall and hurt somebody -- or him self. He has difficulty walking, limited peripheral vision and cannot use both hands to hold a shot gun, police say. "We have concern for his safety, and we are concerned for the safety of anybody around him," Assistant Middlesex County Prosecutor Cindy Glaser said yesterday. "There are a number of people throughout the state who have handicaps and are safe with firearms, but we believe that his particular combination of handicaps made him unsafe to handle firearms." In an eight-page written opinion handed down March 22, Superior Court Judge Edward Ryan disagreed, asserting that as long as Breitweiser is with other experienced shooters when he goes hunting, uses proper safety equipment, and completes the gun safety and licensing process for hunters, there's no reason he can't have a permit to buy rifles or shotguns. During a two-day hearing before the judge in January, "the police officers made much of the possibility that Breitweiser might fall and ac cidentally discharge his shotgun," Ryan wrote. "However ... Breit weiser testified that as a safety precaution and as a condition placed on his firearms license, he would al ways go hunting with a companion and never walk with a loaded gun." An Edison group that teaches the disabled how to live independently hailed the judge's decision. "People with disabilities have a right to the same kind of hobbies as everyone else, so long as they're good at it," said Ethan Ellis, head of the Alliance for Disabled in Action Inc. "Very often, when they master a skill, it confounds people who haven't gone through that experience, particularly people in authority, like policemen, who substitute their own experience for the disabled person and then come to the wrong conclusion," Ellis said. Statistics were not available yesterday on how many people with disabilities use guns, but the National Rifle Association says there is enough of a demand that the sportsmen's group initiated a special safety program for the disabled. "The National Rifle Association believes that with education, training and appropriate devices, the shooting sports are perfectly safe for individuals with physical disabilities," Autumn Fogg, an NRA spokeswoman, said. Glaser, the prosecuting attor ney, defended the decision by East Brunswick officers to deny the ap plication. All are experienced with weapons and "made a very detailed and well-reasoned decision," she said. During the hearing, the officers testified Breitweiser has limited vision, walks with a limp and displayed "jerky motions," that bring safety into question, according to court records. Breitweiser said he was thrilled by the judge's decision and promises that when he gets licensed, he will let his friends carry his shotgun and will use a bipod to hold the weapon before firing with his right hand. He also will use a special sighting lens to help spot his tar get, he said. Battling to overcome his disabilities has been practically a lifetime struggle for the sportsman. He was 17 years old when he lost control of his car because of a mechanical problem and slammed into a tree in Sayreville, he said. After awakening from the coma six months later, he faced years of rehabilitation and has never re gained full use of his left arm and left leg. His left hand is tightly balled, according to police, and his speech is still slurred. It was during his years of recovery, he said, that he learned about camping and fishing, and now boasts that he can stand deep in the Delaware River and cast a line with ease. "Everyone recommended me not to do these things. They were too dangerous for me," Breitweiser recalled. "That made me say, 'Oh yeah? I'll show you.' And I'll do it anyway. I'm the kind of person that can't be told 'no.'" Jim O'Neill covers the Middlesex County Courthouse. He may be reached at joneill@starledger.com or (732) 249-5670. © 2006  The Star Ledger © 2006 NJ.com All Rights Reserved. Alan Weinrib Sun, 25 Jun 2006 00:00:00 EDT http://www.lgtinc.org/articles/137/1/K-Mart-Class-Action-Settlement Entry for May 27, 2006 - Kmart Class Action Settlement                                         866-562-7848                                      www.kmart.com Legal Notice If You Use A Wheelchair or Scooter and Shopped At Kmart, You Could Get A Payment From A Class Action Settlement. Who? You are included in this lawsuit if you use a wheelchair or scooter and shopped at Kmart, will shop at Kmart, or would have shopped at Kmart but for access problems, between May 6, 2003 and the end of the settlement term (approximately 2014) ("Class Members"). If you shopped at Kmart in California, Colorado, Hawaii, Massachusetts, New York, Oregon or Texas ("Damages States") between May 6, 2003 and now, you may be eligible for monetary recovery. What? The lawsuit sought to make Kmart alter its stores with respect to access for people who use wheelchairs or scooters and damages in an amount specified by statute ("statutory minimum damages") for people who shopped or shop at Kmart in Damages States ("Damages Sub-Class Members"). Kmart denied liability. The Court did not decide which side was right. Under the settlement, Kmart will make alterations to its stores and pay $13 million ($8 million in cash and $5 million in gift cards). Qualifying Damages Sub-Class Members can obtain monetary recovery. How? The detailed notice package contains everything you need to make a claim. Call the number below or visit the website below to get one. To qualify for a payment, you must submit a claim by August 16, 2006. Effect? If you are a Damages Sub-Class Member and don't want to be bound by the settlement's monetary provisions, you must exclude yourself by July 7, 2006. If you exclude yourself, you can't get money from this settlement. If you don't exclude yourself, you will release all claims for statutory minimum damages relating to accessibility of Kmart stores in Damages States for people who use wheelchairs or scooters for the period from May 6, 2003 through the end of the settlement term (approximately 2014). Class Members can't exclude themselves from the non- monetary parts of the settlement and will release non-monetary claims against Kmart relating to store access through the end of the settlement term. If you wish to object to the settlement, you must do so by July 7, 2006. The detailed notice explains how to exclude yourself or object. The U.S. District Court in Denver, Colorado will hold a hearing before Judge John L. Kane on July 27, 2006 at 10 a.m. to consider whether to approve the settlement and a request for attorneys' fees by lawyers representing the class. The detailed notice explains how you or your attorney can participate in that hearing. THIS IS AN INCOMPLETE SUMMARY OF THE SETTLEMENT. Please Call The Number Below or Visit The Website Below For The Full Summary. 888-366-5352 or 888-252-4449 (TTY)   www.KmartAccessSettlement.com Alan Weinrib Sun, 25 Jun 2006 00:00:00 EDT http://www.lgtinc.org/articles/136/1/EEOC-filed-suit-against-Wal-Mart-Stores The U.S. Equal Employment Opportunity Commission ('EEOC') has filed suit against Wal-Mart Stores Inc., charging the retail giant with discriminating against a job applicant who uses a wheelchair. The lawsuit filed in federal court in Kansas City alleges that Wal-Mart refused to hire or even accept an application from James Bernard at its Clinton, Mo., store because of his disability. Bill Wertz, a spokesman for Wal-Mart, declined to comment specifically on the lawsuit but said 'we employ a large number of handicapped people, and we do not have policies that would discriminate against them in any way.' ---- Since 1994, the EEOC has filed 17 lawsuits against Wal-Mart, the nation's largest retailer, for violations of the Americans with Disabilities Act. Twelve of these suits are pending and five have been resolved--three were jury verdicts in favor of the plaintiffs and two cases settled out of court, according to the EEOC. In June 2001, a federal judge issued a $750,000 sanction against Wal- Mart for failing to comply with terms of a discrimination settlement involving two deaf job applicants in Arizona. 8/01 Alan Weinrib Sun, 25 Jun 2006 00:00:00 EDT http://www.lgtinc.org/articles/27/1/The-Hell-of-Medicare-part-D The Hell of Medicaid part D By Mike Reynolds.   Journalists are supposed to be objective, yet it is impossible for me to have any objectivity over the new prescription drug plan offered as part of the new Medicaid part D coverage. As an individual with a disability, I knew this was going to be a bit of an adjustment.  The difficulty I experienced, however was totally unpredictable.  I feel I did have some benefits; my best friend is a technician at the pharmacy where I get my medications.  I have worked in the insurance industry, and I would like to think I advocate for myself effectively. All of these assumptions would be tried in my mind in the month of dealing with part D. I should preface this with the fact that I did go through a medicine change that was unexpected and unrelated to Medicaid. I am disabled due to Cerebral Palsy (CP) and also have a diagnosis of Panic Disorder. The CP is due to a difficult birth, my Panic Disorder was diagnosed when I was 15, though I know I have had it from a very young age, I think my first panic attack was at 7, which wasn't considered plausible when I was growing up. I need various durable medical items to get through the day, but since this law did not affect DME, there is no need to really discuss the entirety of those needs. I tried to get a drug I was out of on December 30th. But there were some complex issues with my doctor's office, the drug was never refilled, and I found myself without it for a week. This drug was a form of neurontin, which I was taking for post surgical pain and spasms, which had been treated with physical therapy. I had some of my Lexapro, which I had used for years to help with my anxiety issues, in conjunction with a script for klonoprin, a drug I have been on since I was 17. On January 3, I went to go get my klonoprin refilled. I had my part D card from a company, which, I guess was better than some folks, who did not even receive any information in the mail. I also have since learned that this was the program the government threw me into, without looking at my medicines at all. My friend informed me that no drugs in the same class as my klonoprin were covered by any plan. My neurontin drug was to be picked up at my doctors office as it was also, not covered without some lengthy paper trail. This had already taken a couple of hours, and as I was going home, my friend called my cell phone and let me know that my Medicaid was also somehow cut off. This was more than 2.5 hours after "just trying to get a script refilled." It took an hour to go to the Human Services office and get my Medicaid re-instated. It was discontinued due to a computer error.  I received a letter and was told by the pharmacy I could get my drug refilled in 3 days, luckily I had enough to last those 3 days. I went home exhausted, physically, spiritually and mentally. I am usually a pretty resilient person, but this had left me wiped out. I was left wondering why part D didn't pay for meds I needed to stay sane. Was I some sort of horrible person for needing the medication? Was it a frivolous drug expense? I went to sleep early, my partner looking in on me, as I seemed a bit distressed. The same week my body went into crash mode, or just basically deciding it would not cooperate with what a 32-year-old body should do.  I had lost bowel control, something that has happened before but after the third day of "oops," my partner decided that maybe an ER visit would be advisable. I had no idea why my lower half of my body just stopped and said to my brain "He, you thought you had control of us, eh, well, we're rebelling, and you can't stop us."  The ER visit sucked, most do, but this even more so. Instead of my neurological impairment being the main focus, my sexual preference was somehow more important. The ER attending ruled it a bout of diarrhea, a dubious diagnosis because I know my body, it wasn't that, but after four hours in the ER, I could care less, I just wanted to go home. I decided to see my general doctor. He was on vacation, but I got a script and the need to try and get on a bowel program seemed to iron things out. My doctor came back and decided to change my anxiety meds to see if a different combo worked.  It did, but a bit too well; I was constantly tired and stopped after a couple weeks. My disability does have some effects on my body that are less than desirable, but after the runaround I have dealt with part D of Medicare, I cannot see how this drug benefit really helps anyone except insurance and drug companies. I mean I am glad I have coverage, and I am glad Maine is one of the states that made sure that there was some stopgap protections. Certainly I cant be the only one with these problems, but after the amount of bureaucracy, I can only imagine how other people who may not have the education or background, or a good friend who knows the benefits from working in a pharmacy and was helpful enough to tell me that my Medicaid was cut off, which probably saved me time by getting it all done in one day. So I guess I'm frustrated, but overall, not hurt by Medicare part D.  I just hope they don't plan on doing this to DME supplies or it will be an enormous headache.   Mike Reynolds Tue, 07 Feb 2006 00:00:00 EST