Jackson Free Press

The Mississippi Coalition for Citizens with Disabilities says the state Division of Medicaid is illegally cutting off children from the state's Disabled Children Living at Home program.

Mary Troupe, director of the Coalition will speak to legislators about disabled children who are no longer eligible for state and federally financed child-therapy service during a Medicaid hearing at the state Capitol this afternoon.

"The right hand doesn't know what the left hand is doing, while the governor continues to say on public television that no one is being taken off Medicaid. But today, we will show him and the Division of Medicaid that not only are these families and individuals being hurt. but it is costing the state more money in the long run to have to pay for institutionalized health care," Troupe told the Jackson Free Press.

Former President Ronald Reagan created the Katie Beckett Medicaid program in 1981 to provide home services for disabled children in response to a lawsuit filed by Katie Beckett's parents in Iowa. The parents sought government services to pay for home therapy rather than more expensive institutionalized health care. Prior to the 1980s, many handicapped children or children with Down syndrome could not get government aid to finance therapy unless they were institutionalized.

The Katie Beckett Medicaid program allows states to waive parents' traditional Medicaid income requirements to qualify their children for government-assisted therapy. Most families must be at poverty level to qualify for government health care for their children, but the waivers extend to middle-income parents specifically for health-care costs related to a child's disability. The program does not qualify the parents for Supplemental Security Income.

But Troupe says the Mississippi Division of Medicaid is refusing service for many parents who should rightfully qualify for aid, under the federal government, and abruptly cancelling service for people who have been in the program for years,

"They don't give them any 30-or 60-day warning," Troupe said. "They just call them and tell them services will no longer be provided. To re-qualify you need to take your child to a certain specialist. These parents are working parents; these children are ill, and (parents) can't run them all over the state trying to find someone to evaluate them. The state is setting up all kinds of barriers to keep these children from receiving services according to federal standards on early diagnosing and screening that children with disabilities should receive so they can become productive citizens."

State Department of Medicaid spokesman Francis Rullan said the state department publishes eligibility requirements on its website, and added that the state is only following government guidelines.

"The Mississippi Department of Medicaid is limited by the guidelines set forth by the federal government and the state government," Rullan said. "Any questions concerning those guidelines can be referred to the division through its website or its toll free number: 1-800-421-2408."

While the division's website outlines eligibility requirements for the Children's Health Insurance Program and general Medicaid and other services, it does not appear to feature the eligibility requirements for the Disabled Children Living at Home Program, which uses a different set of eligibility standards.

Deborah Edmonson, whose daughter Taylor Edmonson suffers from Down syndrome, said her daughter qualifies for aid according to the U.S. Department of Disability Services, but has been rejected for aid since her birth about a year ago.

"She was born with her intestines twisted, her pancreas in two pieces. Down Syndrome children like her have muscles with very low tone" Edmonson said. "She needs physical therapy. She has physical, occupational and speech therapy once a week. She sees an endocrinologist, a surgeon, a cardiologist, eye doctor, an audiologist. Even with our insurance co-pays, we've got $10,000 worth of bills, but (Mississippi Medicaid says) she is no more work that a typical baby," Edmonson said. "And they won't tell anybody what the criteria is that you need to meet."

Edmonson appealed the state's rejection in Hinds County Chancery Court in August. The case is still pending.

The Medicaid hearing begins at 1:30 p.m. today at the state Capitol in room 201A.

Previous Commentsshow

Ben: Can you expand (without being ugly about it) what "reputation" it is that's being "killed" by Troupe? We're talking about Medicaid, disability and children -- indeed, a program that appears to have been created by the Reagan Administration... so just not sure what your argument is.

Todd Stauffer

Nov 4 2010

My son is 6,and has been on the Disabled Child Living at Home program his entire life. He has Down Syndrome, and a number of physical and developmental problems associated with his diagnosis. Last year Medicaid terminated his services, after sending me to numerous appointments and making countless requests for information--we (I and my son's doctor) sent the information again and again but Medicaid has repeatedly said they do not have it or did not receive it or it wasn't the right information. My son's services were terminated, even though his condition is unchanged from previous years. We requested a hearing to appeal this decision. During our inquiries about his case, my son's case worker told me specifically that his supervisor, Pam Commander, had told him and others in his position that it was their job to get these people off the medicaid rolls. I was horrified. We have spent 100s of dollars going to specialists to get the information they have requested, many many hours trying to get that information, and we are still awaiting our hearing...this IS happening. We are not alone. This program is important--our private health insurance is expensive, has an appallingly high deductible, and doesn't cover many many of the services our son needs. And this is typical for so many of these children. And the better we provide for him and others like him, the better their lives will be, and the more they will give back to society. Thanks for this article.

peytonfrances

Nov 4 2010

No, you are not alone. My cousin's child also has a genetic disorder. She is also 6 years old. BCBS won't cover a dime because its a "pre-existing" condition. Of course its "pre-existing"-It happened at BIRTH (or BEFORE, technically). Anyway, they have Medicaid coverage under these eligibilities for costs that BCBS won't cover. This year, Medicaid attempted to kick them off. They made my cousin jump through hoops to get her recertified. And, to top it all off, Medicaid won't pay certain claims that it says BCBS is "responsible" for because they are alledgedly the "primary".Then BCBS won't pay for it because its "pre-existing". They have to fight to get a damn thing paid for and they technically have TWO DIFFERENT KINDS OF INSURANCE-both private and public. I actually think my cousin has screamed about BCBS and been printed in the JFP before. There are TONS of these stories out there. And no one is paying attention to them! (I mean, minus you guys). But, not only did they kick off disabled children (and try to act like they aren't) they are systematically shutting down every day treatment program provided to Medicaid kids in the state. They are finding loopholes. Haley has lawyers combing federal Medicaid regs and closing every single loophole they can find. THAT is why their statement includes the "we have to follow federal government guidelines". Yes, in some sense, they do. In others, they do not. Its a federal match block grant. They aren't highly "restricted" funds. The state can interpret Medicaid laws as tightly or as "relaxed" as they would like. Right now, they are systematically trying to find as many people as they can to which they can deny and/or revoke coverage in "anticipation" of.....hell, I don't even know what. And I'm pretty sure if you called that "tollfree" number they wouldn't be able to tell you either.

Lori G

Nov 4 2010

This is Medicaid (Roberson) basically admitting (as much as the DEVIL will) that they are tightening the federal statutes as I stated above. Roberson is a lawyer. He's the lawyer that Haley's charged with "getting Medicaid under control". I hope he sleeps well at night. Roberson said the institutionalization criterion has been the most frustrating point for parents and physicians. "This is a complex thing. I understand why families and physicians may be frustrated but we can't change the criteria. It's outlined in federal law," Roberson said. "What we can try to do is assimilate the documentation to make it easier on providers and families to get the documentation to Medicaid to demonstrate the child's needs and hopefully facilitate a smoother process." (EMPHASIS MINE) As of July, there were 1,176 children who belonged to the disabled child Medicaid program. House Health and Human Services Committee Chairman Steve Holland said Medicaid's most recent actions don't make sense. "The fact of the matter is we just decided, as we say in the country, to screw the lid down tighter just because we could," said Holland, D-Plantersville The part in bold is how they are REALLY screwing the people that are clearly eligible. They say they don't have the required "documentation" and then deny them coverage hoping they get at least a few more months where they do not have to pay for care.

Lori G

Nov 5 2010

This makes me so mad. It is an unforunate truth, but a child with Down's Syndrome is not going to suddenly wake up one day and not have Down's. It's just not going away. Much like a lot of other disabilities. So why does Medicaid make parents jump through these hoops when it's already been established that the child has a irreversible disability? It's just as Lori said, they're hoping to frustrate people enough that they'll just go away. It happens to adults with disabilities too, people who have PAID into the system and still have to jump through so many hoops in order to get SSDI and Medicaid. There are other ways to trim the budget. Cutting out much needed services for people with disabilities (I'm also thinking about how the Guv wants to close the mental health crisis centers - BIG mistake) is not helping anyone. The state will still end up paying, and paying even more, to put people in nursing homes, institutions, and in the case of the crisis centers, jails. It won't be pretty at all.

andi

Nov 5 2010

The Medicaid law for children--EPSDT--is designed to accelerate the discovery of new interventions for disabled children via the most educated and motivated demographic within the Medicaid system, i.e., parents of Katie Beckett children. The government can in turn apply these discoveries to the adult population, but only if the decision-makers at the top of the food chain bureaucracy embrace the potential. For example, the 2000+ parents at MedicaidforHBOT.com have forced Medicaid coverage of Hyperbaric Oxygen Therapy (HBOT) in 23 states. HBOT reverses the effects of brain-injury in adult and pediatric groups. See the video at hyperbaria.org HBOT could be used to reverse stroke, cerebral palsy, autism, Parkinson's, Alzheimer's, multiple sclerosis, etc. Utilizing HBOT for these neurological problems can immediately save billions of dollars and millions of heartaches. David Freels MedicaidforHBOT.com

davidfreels

Nov 5 2010