Reversal of Medicaid policy is ‘good news,’ advocates say
"I do see it as good news, absolutely," said
"Slowly but surely, at least we're being listened to, and there's more people at the table talking about this," said her co-worker,
In mid-May, the
Patients had to be evaluated based on criteria in the Early and Periodic Screening, Diagnosis and Treatment benefit. It relied heavily on "medical necessity," meaning that a separate doctor looked over the reams of paperwork and decided how many hours Medicaid would pay personal-care attendants to help those individuals with eating, dressing and other life skills.
"Nine times out of 10, those plans were cut" in an effort to reduce costs, Gratz said.
And, as
Family members and disability advocates railed against the changes, and some filed grievances with the state or appealed the cut in hours. Officials at dRC, which held an informational session in March encouraging families to let their voices be heard, believe the state reacted to the formal complaints, as well as the pleas made to political representatives.
"Having the politicians hear it from the consumer, then it becomes real, it becomes a person and not a number," Ryan said, adding how unusual it is for a policy to be repealed after only nine months.
In wake of the reversal, decisions about personal- care hours will once again be based on services the patients need to stay in their homes and communities, according to a letter from DMAS. The change applies only to services provided through the CCC Plus Waiver for members under age 21 and for plans put in place after
But the change in policy doesn't mean that Medicaid recipients immediately had their hours restored for personal-care attendants. Fields, whose 7-year-old daughter,
"DMAS doesn't talk to us or help us understand what we need to do on our part," Fields added.
Ryan said some of her clients have had their hours restored and others have filed new plans of care, again requesting the hours they once had before. While the policy change is supposed to affect children only, she knows disabled adults whose hours have been cut as well.
"The money is absolutely a big part of it," she said.
In 2017,
There are eight different types of Medicaid waivers, meant to keep residents out of institutions and in their communities. There are 37,671 Virginians who receive the waivers, according to DMAS.
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