Katie Beckett Waiver: Advocacy Update: Media, Level of Care Changes, Etc.
http://www.lgtinc.org/articles/104/1/Katie-Beckett-Waiver:-Advocacy-Update:-Media,-Level-of-Care-Changes,-Etc.
Heidi J. Moore
Heidi has a BS in Civil Engineering from Purdue. After the birth of her son Jacob, she elected to stay home to ensure his needs were met. Heidi is very involved in many organizations;last year she was appointed by the Governorâs office to be on 3 Medicaid Reform committees, looking at overhauling the entire Medicaid system.Heidi currently has an advocacy distribution list of over 2,500 members to promote awareness of the advocacy issues that affect children and adults w/ disabilities & empower parents. By Heidi J. Moore
Published on 04/10/2006
April 10, 2006
Dearest Advocates:
Hope everyone had a great spring break. I have a couple of advocacy updates for everyone. You may want to print this e-mail out to read due to the length................
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1. I have been informed the Skilled Nursing Level of Care has been changed for the Katie Beckett Waiver. The Dept. of Community health has added under Column B #3 the following language: "The beneficiary must require skilled nursing or skilled rehabiliation services or both on a daily basis". To see entire Level of Care, please go to the following website:
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2. Due to all your wonderful Letters to the Editor of the John's Creek Herald and Revue and News Newspapers regarding the recent Katie Beckett Waiver article, they dedicated an entire section to our families comments. The editor stated the following: "We received a huge response from readers regarding our 3/29 story on disabled children who've lost their Katie Beckett Medicaid benefits. Above is just a sampling from some of the parents of these children".
Many thanks to: Christy Butch, Paige Couper, Amy Adams, Sherry Brooks and Loretta Mitchell for your comments to Rosemary Taylor (Editor). Let's keep up the great work at continuing to educate the community of the concerns we face of families with children with special needs. If you would like to write Rosemary, her e-mail address is: rosemary.taylor@northfulton.com. I know last time I spoke to her, she is interested in possibly doing a follow-up article later this year.
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3. I have had a couple of families contact me over the last two weeks expressing some concerns with the "process" of renewal even after they appealed last years denial and were reinstated. Just a reminder: If you know that your renewal date is coming up and have NOT received a Medicaid renew application in the mail, PLEASE contact your DFACS worker and let them know. Don't assume, just because you did not receive any paperwork you don't have to submit this year. A few families were denied AGAIN due to this procedure problem.
We as parents need to be proactive with our child's Medicaid and make sure we have the necessary paperwork in on time with the DFACS office.
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4. I will be posting a parents "Letter of Medical Necessity" that their child's Pediatrician submitted on behalf of their appeal. Happy to say they were reinstated the Katie Beckett Waiver. Many thanks to Judy D. for submitting this information to help other families. If you would like to see this example, please go to the following website for more information:
If you have a successful letter that may help other parents or tips of how to help families, please submit to my e-mail address: heidijmoore@comcast.net. We can all learn from each other.........
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5. Another article was written by reporter, Lee Shearer of the Athens Banner Herald on Sunday regarding the Katie Beckett Waiver situation. Please take a minute to thank Lee for his on-going coverage of the issues! Lee can be reached at lee.shearer@onlineathens.com. Communication and education are the key for us continuing our advocacy efforts. Keep up the great work. Many thanks to Jodi C. for letting me know about the article!
Here is the article just in case you missed it:
Parents unload on Medicaid programs For disabled children
By Lee Shearer | lee.shearer@onlineathens.com | Story updated at 8:57 PM
on Sunday, April 9, 2006
ROYSTON - Parents of children with severe and costly disabilities vented their
frustrations with state Medicaid programs designed to help them pay big medical
bills at a meeting at the Royston Baptist Church on Saturday.
Decisions on whether a child is eligible for Medicaid help are sometimes
arbitrary, parents said.
Jodi Cronic, assistant principal at Madison County's Comer Elementary School,
said Medicaid has helped her family pay for overwhelming medical costs over the
past three years for her 12-year-old son, who has complex learning and behavior
problems.
But now, state officials say the family is no longer eligible, she told about 50
people at a meeting of a group called "Connections for Special Parents." The
reason for the denial: Part of her son's problem is considered psychological,
and help for primarily psychological problems is not allowed under the Katie
Beckett waiver, a Medicaid program which has provided financial help to cover
her son's medical bills for three years.
"How fair is that?" she asked. "I think it's discriminatory."
Most Medicaid programs are designed to help low-income people, but the Katie
Beckett waiver helps families with children with unusually severe disabilities,
regardless of family income. It's called a waiver because federal officials have
waived normal rules that limit Medicaid spending to people confined to
institutions, such as nursing homes. Waiver programs like Katie Beckett allow
them to receive treatment in their home or community instead.
Cronic, crying as she spoke to the group, said her family will face medical
costs they can't pay for if a final appeal fails. Her state health insurance has
denied coverage for her son's treatments, and the cost for just part of it, a
one-week stay in a psychiatric hospital last year, was $14,000, she said.
Hundreds of families have been cut off the Katie Beckett waiver since last year,
after the state Department of Community Health, which administers Medicaid,
tightened up eligibility requirements.
Nancy Durden, a state Department of Community Health administrator, reminded the
group that federal regulators, not state ones, make the eligibility rules.
Before tightening the eligibility rules, Georgia had gotten "pretty far outside
the guidelines," she said.
The eligibility rules were not the only target of complaint Saturday.
Workers with a private company the state hired to make eligibility decisions for
Katie Beckett help often are not qualified to make those decisions, said Joshua
Norris, director of legal advocacy for the Georgia Advocacy Office, a nonprofit
corporation that helps disabled and mentally ill people in the state.
And case managers with the state Department of Family and Children Services, who
are supposed to help families negotiate the Medicaid bureaucracy, often don't
know the Medicaid programs well enough to help, some parents said.
"Why can't you tell parents what services are available?" asked one parent,
speaking to DFCS representatives at the meeting.
The director of state Medicaid programs promised more than a year ago to see
that DFCS case managers were trained in Medicaid programs, said Pam Moore, who
works with the parents of disabled children in the Madison County School System.
"They haven't been," she said.
Others said it's hard for people who work with Medicaid full-time to keep up
with frequently changing rules and programs, much less DFCS workers, for whom
Katie Beckett families are a small part of a caseload of hundreds of families.
"The one thing you need to realize is even if you think you understand it
(Medicaid), it will change," said Dottie Adams of the Governor's Council on
Developmental Disabilities.
Georgia could stretch its Medicaid dollars more, Adams said.
The federal government provides generous matching money when states put money
into Medicaid waiver programs, but Georgia doesn't get as much federal Medicaid
money as some other states, she said.
"One of our problems is that it has not been a priority for our legislature,"
she said. "It's a good deal for our state."
But good news came out of this year's legislative session, she said.
Legislators added enough money to the Medicaid budget to take 1,500 people off
waiting lists to receive various kinds of Medicaid services such as in-home
nursing care. There are about 6,000 people on these waiting lists, but there
ought to be more than 14,000, Adams said. Many people who are eligible for state
help don't even bother to sign up because the waits are so long, she said.
Parents unload on Medicaid programs For disabled children
By Lee Shearer | lee.shearer@onlineathens.com | Story updated at 8:57 PM
on Sunday, April 9, 2006
ROYSTON - Parents of children with severe and costly disabilities vented their
frustrations with state Medicaid programs designed to help them pay big medical
bills at a meeting at the Royston Baptist Church on Saturday.
Decisions on whether a child is eligible for Medicaid help are sometimes
arbitrary, parents said.
Jodi Cronic, assistant principal at Madison County's Comer Elementary School,
said Medicaid has helped her family pay for overwhelming medical costs over the
past three years for her 12-year-old son, who has complex learning and behavior
problems.
But now, state officials say the family is no longer eligible, she told about 50
people at a meeting of a group called "Connections for Special Parents." The
reason for the denial: Part of her son's problem is considered psychological,
and help for primarily psychological problems is not allowed under the Katie
Beckett waiver, a Medicaid program which has provided financial help to cover
her son's medical bills for three years.
"How fair is that?" she asked. "I think it's discriminatory."
Most Medicaid programs are designed to help low-income people, but the Katie
Beckett waiver helps families with children with unusually severe disabilities,
regardless of family income. It's called a waiver because federal officials have
waived normal rules that limit Medicaid spending to people confined to
institutions, such as nursing homes. Waiver programs like Katie Beckett allow
them to receive treatment in their home or community instead.
Cronic, crying as she spoke to the group, said her family will face medical
costs they can't pay for if a final appeal fails. Her state health insurance has
denied coverage for her son's treatments, and the cost for just part of it, a
one-week stay in a psychiatric hospital last year, was $14,000, she said.
Hundreds of families have been cut off the Katie Beckett waiver since last year,
after the state Department of Community Health, which administers Medicaid,
tightened up eligibility requirements.
Nancy Durden, a state Department of Community Health administrator, reminded the
group that federal regulators, not state ones, make the eligibility rules.
Before tightening the eligibility rules, Georgia had gotten "pretty far outside
the guidelines," she said.
The eligibility rules were not the only target of complaint Saturday.
Workers with a private company the state hired to make eligibility decisions for
Katie Beckett help often are not qualified to make those decisions, said Joshua
Norris, director of legal advocacy for the Georgia Advocacy Office, a nonprofit
corporation that helps disabled and mentally ill people in the state.
And case managers with the state Department of Family and Children Services, who
are supposed to help families negotiate the Medicaid bureaucracy, often don't
know the Medicaid programs well enough to help, some parents said.
"Why can't you tell parents what services are available?" asked one parent,
speaking to DFCS representatives at the meeting.
The director of state Medicaid programs promised more than a year ago to see
that DFCS case managers were trained in Medicaid programs, said Pam Moore, who
works with the parents of disabled children in the Madison County School System.
"They haven't been," she said.
Others said it's hard for people who work with Medicaid full-time to keep up
with frequently changing rules and programs, much less DFCS workers, for whom
Katie Beckett families are a small part of a caseload of hundreds of families.
"The one thing you need to realize is even if you think you understand it
(Medicaid), it will change," said Dottie Adams of the Governor's Council on
Developmental Disabilities.
Georgia could stretch its Medicaid dollars more, Adams said.
The federal government provides generous matching money when states put money
into Medicaid waiver programs, but Georgia doesn't get as much federal Medicaid
money as some other states, she said.
"One of our problems is that it has not been a priority for our legislature,"
she said. "It's a good deal for our state."
But good news came out of this year's legislative session, she said.
Legislators added enough money to the Medicaid budget to take 1,500 people off
waiting lists to receive various kinds of Medicaid services such as in-home
nursing care. There are about 6,000 people on these waiting lists, but there
ought to be more than 14,000, Adams said. Many people who are eligible for state
help don't even bother to sign up because the waits are so long, she said.
====================================================
Hope this information helps. Have a great evening.
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
(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.