Tag Archives: medicaid

A Letter to Health and Human Services and Texas Legislators

Dear Health and Human Services Commission (HHSC) Director and Texas Legislators:

I am writing to you today as a parent, therapy provider, and concerned citizen regarding the significant delays Texas Medicaid is currently experiencing with authorizations which are drastically affecting continuity of care and quality of life for my son and thousands of Texas children. These delays seem to be a direct result of recent legislation passed to decrease funding to the Texas Medicaid program by approximately $350 million (Rider 50). While the proposed budget cut is currently on hold due to a court injunction, it would appear HHSC has implemented these cuts in the form of delaying authorizations in effort to save the program money.

As a provider, here is just one such example. I received an authorization September 15, 2016 at 7:15 pm via fax. Our office submitted this authorization request on August 1, 2016 – 46 days ago. This letter is dated September 1, 2016 and the authorization period begins on August 15, 2016. The Texas Medicaid Provider manual states that services will not be compensated for without an authorization and authorizations will not be backdated, so therefore, we as providers, must tell our therapists that they cannot see their patients until authorization is received or we risk not receiving payment for services rendered. In this case, our therapist has not seen their patient since the evaluation was performed on August 1st. Now, here we are 46 days later and we find out that 15 days ago our authorization was approved and backdated an additional 15 days, so our patient has missed a month of therapy because we were not notified in a timely manner. Furthermore, our request was for two visits per week and the reviewer denied our request suggesting our patient only required one visit a week due to “slow progress toward therapy goals. “ This is only one example of many we have personally experienced and the countless more we know other patients and providers to be currently experiencing across the state. On average, our authorization requests are taking 4-6 weeks to be approved, if no additional information is requested. If Texas Medicaid & Healthcare Partnership (TMHP)  requests additional information, the delay is an additional 2-3 weeks, at minimum. Per the TMHP manual, we cannot submit authorization requests more than 30-days prior to the expiration of a current authorization rendering us unable to be proactive and submit requests 4-6 weeks in advance. As a result, with the current timeline of approval our patients are experiencing 2-3 week lapses in therapy service, and sometimes greater.

These delays are detrimental to the health and well being of our patients. One month without therapy can cause significant regression for chronically ill and long-term disabled children. To add insult to injury, our patients are experiencing regression and loss of skills due to authorization delays and when our request is reduced to once a week visits instead of twice a week, our patients do not have adequate service to reach their prior level of skill nor continue to make significant progress toward goals. Progress is slow because our therapists have to take several steps backward to get our patients back to where they were before there was a lapse in treatment. And then attempt to make progress toward the goals previously set.

The authorization delays directly coincide with the time period in which the court issued an injunction to delay implementation of Rider 50, which would reduce payment for therapy providers. Thousands of children across the state are experiencing lapses of 3 weeks or greater, which, in turn, is undoubtedly saving the state a great deal of money. This seemingly underhanded attempt to implement the budget cut despite court rulings is gross negligence and directly impacting the lives of our children. For many children, therapy is required to maintain current level of function, to decrease the chance of contractures or serious injury, to ensure safety in the environment, to improve and strengthen fine and gross motor skills, to teach speech, to correct speech deficits, to ensure safe feeding, to improve quality of life by teaching skills that will allow children to interact with their peers, and for so many other reasons. Therapy is a cornerstone of ensuring proper development in children.

Additionally, providers have tried to address these concerns with TMHP reviewers and we are told that authorizations are going to nurse review and there is no time period for which they must be approved. Meanwhile, parents are calling TMHP and the Medicaid Ombudsman’s office and being told that authorizations should be approved within 3 business days. As a result, our patients assume it is the providers delaying the authorization and we are losing the trust and rapport we have worked hard to earn from our patients.

The lives of our state’s most vulnerable citizens seem to constantly hang in the balance while legislators and state departments toy with policies looking to save money all while harming the lives of children. It is clear that the powers that be do not understand the needs of special needs community nor do they know how to meet those needs. As a result, children across the state are currently without the necessary services that would improve their quality of life. This issue needs to be rectified immediately. As it stands, the state is currently profiting off of the steady decline in health and absence of service for our children, which is simply abhorrent, to say the least.

I hope your respective offices will look in to the matter and ensure corrective action will be taken. My son has a life-long disability and depends on therapy services to provide him his best chance at success in life. The issues I continue to see with Texas Medicaid provide me with little hope for his future. I know that one day soon, his service will be denied, as it has been for several of our chronic patients, because what we see as leaps of progress, you deem to be “too little” progress. While Texas is historically a pro-life state, the state places little value on the lives of the disabled, which is evident when legislation passes that can directly harm their lives. It is unfortunate when families like ours rely on the Texas Medicaid program, even as a secondary insurance (as we do), because without it we simply could not afford the staggering costs associated with caring for a disabled family member, only to have that crucial support ripped away due to systemic downfalls and budget cuts.

As you prepare for the next legislative session, it is my hope you will have greater consideration for the lives of your most vulnerable citizens. They are your sons, daughters, nieces, nephews, grandchildren, and they desperately need you to speak up for them in these matters because they deserve the right to a full life. They deserve access to quality healthcare, to programs that enrich their lives, to services that will enable them to become successful tax-paying citizens. We, the families, the providers, the taxpayers, hope for a resolution – sooner rather than later.

Sincerely and with hope,

A Texas Mother looking out for her son and the lives of all Texas children

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Filed under Kids and Family, Special Needs Child

The Face of Welfare

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And what if the family you saw was mine?

Here lately, I’ve seen a lot of e-cards and posts flying around about how welfare recipients are basically the scum of the Earth and just looking for a handout.  What if I told you that wasn’t true? I’m not trying to be political here, just trying to offer a different view; a reality that I know all too well.  In fact, I don’t feel like I side with one party over another…I listen to the issues, do my own research, and find the candidate who most closely aligns with that be they red, blue, purple, green, whatever.  I don’t blindly follow a party based on ideals that aren’t fully in practice anymore.  That being said, I have a serious issue with the flagrant ignorance running rampant throughout our society.  By no means am I an expert, and I’m not claiming to be, I simply want to offer our story for you to think about the next time someone tells you that everyone on welfare is worthless.

When I was growing up, I didn’t have many luxuries.  Almost everything we had was second hand, off brand, and never enough. BOTH of my parents worked hard trying to support us.  I don’t think there was ever a time that my parents didn’t work to try and provide for our family.  My dad was a truck driver and also played in a band, and my mom has had so many jobs trying to help make ends meet while my dad chased his dreams.  Despite the struggles, we never went without our basic necessities because our parents worked hard to provide at least that for myself and my 5 siblings.  We had food stamps and medicaid for as long as I could remember.  We often had “Blue Santa” or the Salvation Army bring us Christmas gifts because my parents simply could not afford everything we wanted.  Even then, welfare acceptance was stigmatized and I was embarrassed to have it, but I’m thankful that we did.  My parents worked as hard as they could and it wasn’t enough.  I’m thankful everyday to them for doing all they could for us.  That’s the story for most people who are on welfare.  This sensationalized idea that EVERYONE on welfare has gold teeth, tattoos, an iPhone, and brand name purse sitting at home collecting your hard earned taxes is completely ridiculous! Yes, there are some people out there who abuse the system, but it’s not as many as you think.  Several families are struggling to make ends meet and need that extra assistance to better themselves.  Not everyone wants a handout for the rest of their life.

Fast forward just a few years ago, I was a single mom raising my child and trying to finish college so I could get a better job and afford things for my daughter that I didn’t have when I was a kid.  I had to suck up my pride and walk in to that medicaid office. She was on medicaid and we received food stamps because there just wasn’t enough money to eat sometimes.  I can’t tell you how many times I went without food so my child could eat.  I had 2-3 jobs trying to finish school and trying to afford childcare because I didn’t want to simply sit at home collecting a check.  I worked my butt off and paid taxes just like everyone else, why should I feel ashamed to ask for some of that money back in the form of welfare assistance? Yes, perhaps I should have thought about that before I had a child, maybe I was irresponsible, I should have had a savings in place, but whatever, you can’t send a kid back once they’re here, you have to step up and be a parent.  You do whatever it takes to provide, and that’s what I did.  I’ve never touched a drug in my life. I don’t smoke.  I rarely drink.  I don’t spend my money on all the things people claim.  Every cent I had went to rent, bills, and my kid.  I probably, no definitely, had the same clothes for several years before I bought myself anything.  My child was always clothed before me.  I tried. I’m still trying.

Now, here we are in 2013, and I’m surely better off than I ever have been, but still receive some form of assistance.  I have a good job and so does Joseph. In a perfect world, we wouldn’t need assistance, but in 2011 our lives were forever changed.  We didn’t ask to have a medically complex child, hell, we didn’t even have the slightest clue that we would, but here he is. He didn’t ask to be born into these circumstances, but for whatever reason, he was.  As his parents, we will do everything in our power to care for him and get him the treatment that he needs.   We work, we’re drug tested, we’re paying taxes, and we’re getting medicaid for our kids. I have an iPhone (guess what? it was free), occasionally I get my hair and nails done ($60 every 2-3 months is hardly anything to for you to huff at), occasionally we have a night out (usually it’s for a show that Joseph is doing that he is being PAID for so we can have extra money and for the really rare occasion that we go out for fun, why aren’t we allowed that privilege? Spend one day in my life and tell me a night out every 3 months isn’t justified).  If these things annoy you because we are receiving medicaid YOUR taxes paid for, guess what? Our taxes did too.

Joseph has insurance for Braxton through his work and had a savings before Braxton was born.  Braxton had a 3 week NICU stay. Do you know how expensive that is? Last year, in 2012, we had over $200,000 in medical bills.  I don’t care how good your job is, co-pays and deductibles for $200,000 worth of bills adds up, and it adds up quick! The savings that was in place was used much faster than we thought. So much for staying ahead and being prepared. And now? Pffft, there is no savings.  The money is used before it is even received.  Braxton’s formula was $8 per bottle.  He was using 4 bottles per day.  $32/day x 30 days in a month…that’s almost $1,000 a month just so our kid could eat.  Guess what? Private insurance does NOT cover that cost.  Sure, get health insurance, have a good job and you won’t have so many problems is easy to say, but in practice, that’s just not how it works.  If we didn’t have medicaid, I don’t know how I’d feed my kid.   We have 13 different specialists and 6 different therapists that Braxton sees regularly.  Private health insurance doesn’t fully cover the cost for all of those visits.  Medicaid has to pick up that balance.  Braxton requires several medical supplies on a monthly basis that we simply couldn’t afford without medicaid.  We aren’t the only ones with this story.  I know several families who have children who vary in disability and some are far worse than Braxton.  In some, one parent is FORCED to quit working simply because they HAVE to care for their child.  Try living in a one income household in today’s world…it doesn’t work.  Unless you are born from money, an athlete, or Hollywood star, there is no way you could afford it.  There are countless people on assistance because they NEED it, but they are stigmatized because you all refuse to see that reality.  All you see is the few who abuse the system and then make gross generalizations and spread them as truth, when they couldn’t be further from it.  Why should we be stigmatized? Why should I be ashamed to admit that I have medicaid? I’m not proud of it, but I sure am thankful.  I work just as hard as everyone complaining about paying taxes and I even pay taxes so why not take advantage of the service I’m paying for anyway.  Joseph paid over $24,000 in taxes last year.  That’s more than some people make.  Don’t tell me we should be shamed for having medicaid…us and so many others are NOT sitting at home collecting a check, selling/doing drugs, living a ghetto fabulous life…we are merely trying to help our family survive and we are contributing citizens who deserve access to the assistance that probably prevents us from living on the street.

This crass stereotype has to stop somewhere, hopefully with you.  I’m sure there are some dishonest people that are ruining it for everyone else, but think about our family the next time you trash talk EVERYONE who receives assistance.   It hurts to see so many of my own friends perpetuating this hatred and public shaming. Adamantly insinuating that anyone on welfare is the scum of the Earth.  I’m sure we’ll receive some “OH, I wasn’t talking about you” “But you guys are different” responses, but know that you are talking about us and we aren’t different than many of the people you trash, and try not to be so cynical, and understand that public assistance is going to people who truly deserve it. And just because people might have *some* nice things and still receive assistance, understand that they may have earned those things before their circumstances were different.  An iPhone is no longer a status symbol for being wealthy….they’re free now.  Having your hair and nails done is not irresponsible…maybe I want to appear that I’m not falling apart on the inside and looking nice makes me feel better about myself, is there really some unwritten rule that you HAVE to look like trash if you’re receiving assistance?   Name brand clothes even aren’t good indicators of abusing the system…Ross sells Polo for $20, may be last season, but all you see is the brand and automatically assume the worst.  Check your own perspective and think about what you are spreading before you click that ‘Like’ button or share that “hilarious” e-card demanding a photo of the “ghetto family” you are supporting with your taxes…probably not so funny if you opened that envelope and saw our picture on the inside, huh?

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Filed under Family, Kids and Family, Life, Special Needs Child