/Children with disabilities losing Medicaid coverage

Children with disabilities losing Medicaid coverage

They aren’t scammers, however. These are children with disabilities whose parents used the public insurance loophole to pay for expensive medical treatment. Many families that had been eligible for the Disabled Child living at Home waiver were denied benefits after a recent crackdown on Medicaid eligibility. After parents’ outcry, lawmakers are currently working to reinstate coverage for the affected families. Clay Taylor, father of a child who has cystic fibrosis and uses a feeding tube, said that disabled children are being stripped en masse of insurance they have relied on for many years. Tobias, six years old, had been covered by Medicaid most of his life. However, the agency declared him ineligible for Medicaid in November. Federal law provides coverage for children with special needs whose families are unable to receive other Medicaid programs. The waiver is only available to children who are disabled according to federal disability rules. They also need the same level of care as those receiving other Medicaid programs. This insurance covers services that allow the child to live at home, which is often more convenient and less expensive. eQHealth Solutions was the contractor that determined eligibility for Mississippi’s Medicaid program. However, for many years, some families had been approved for children with disabilities. These children may be disabled and/or have other limitations, but they do not require intensive nursing care. Taylor stated that if this was the original intent of the law, it has not been followed. Medicaid pays for thousands of dollars in monthly prescriptions, medical supplies and breathing treatments to Taylor. His family is prepared for a significant hit to their budget. This includes thousands of dollars in annual premium increases and out-of-pocket costs for medication and hospital visits. Kelli Bridwell was a single mother and teacher. She was denied the Medicaid waiver for Aiden, her 14-year old son with central core disease. Aiden cannot stand or walk and is unable to walk. Bridwell stated that Aiden had a spinal fusion and spent time in intensive care. The bill was nearly $1 million. She said that if Medicaid does not continue to cover the supplies and services needed to keep Aiden’s medical condition stable over the past 14 year, it could cause us to go bankrupt. Pooley stated that the waiver provided Sylvia Pooley and her son Zane much more speech and physical therapy than they would have under private insurance. These services have helped Zane make tremendous progress. Pooley stated that Zane has an opportunity that he wouldn’t have otherwise because of the error in eligibility. However, Zane, who suffers from a rare genetic disorder was denied renewal. Matt Westerfield, a Medicaid spokesperson, told Mississippi Today that 79 waiver applications were denied by Alliant Health Solutions from September 2019 to January 2019. This was because the child didn’t meet the requirements for medical necessity. Parents fear that this is just the beginning of these denials. Alliant denied another 126 families due to technicalities, meaning they need to provide more information. Families can appeal denials. Westerfield stated in a written statement that they are currently reviewing the matter and are ensuring our policies are appropriate. He also said that the denials are not placing an undue administrative burden upon the parents or providers of care for these children. Concerns over the growth of Medicaid rolls and the belief that some people were receiving fraudulent benefits prompted legislators to pass the Act to Restores Hope Opportunity and Prosperity for Everyone (the “HOPE Act”) in 2017. This law gives state agencies a new computer system to verify and track information submitted by applicants for public assistance programs. The Legislature has pushed Medicaid to tighten eligibility. However, Westerfield said that the Alliant contract and subsequent denials were not a result the HOPE Act. Instead, the company submitted the best offer during the most recent round of procurement. Sen. Chad McMahan (R-Guntown) said that Alliant had “interpreted the law with a much narrower scope than the previous vendor.” McMahan said to Mississippi Today that he will file a bill to restore Medicaid waiver for families who are denied or earn less than 300% of the poverty line. That would be $78,600 per family of four. McMahan stated that it was important for him to ensure that disabled children are provided with the necessary services. Parents have created a Facebook group to help people who are denied waivers or concerned about denials. It has over 280 members. “We have not yet found anyone who has been approved. Taylor stated that Taylor considered this a red flag. As of December, the waiver covered 2,013 children. Families that appeal are still considered enrolled. “Me and mine are not seeking handouts. Taylor stated that Taylor and his wife are not people who have manipulated the system in any manner. “We are just trying to find the best care for our son.”_x000D