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

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