Reversal of Medicaid policy is ‘good news,’ advocates say

June 02-- Jun. 2--Officials with the disAbility Resource Center say the state's recent reversal of a policy that cut benefits for some of the most severely disabled hasn't fixed every problem, but it is a step in the right direction.

"I do see it as good news, absolutely," said Jennifer Ryan, service facilitator with the dRC in Fredericksburg.

"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, Tennie Gratz, a long-term Medicaid specialist.

In mid-May, the Virginia Department of Medical Assistance Services, or DMAS, sent out letters to families, telling them it had reversed a policy put in place in September. That policy had required the state agency, which oversees Medicaid, to use a different evaluation to determine how much assistance the most severely disabled need with daily living activities or nursing services.

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 Louisa County parent Amy Fields stated in a March story in The Free Lance -- Star, "a physician who has never laid eyes on my child" made the decision to reduce the waiver, or services her daughter received, from 80 hours to 49 hours a week.

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then it becomes real, it becomes a person and not a number," Ryan said, adding how unusual it is for a policy to be repealed after only nine months.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 May 1.

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, Cary Lynn, has such severe issues she qualifies for placement in a nursing home, said she's "gotten no reassurance that the hours will be restored" or any type of time frame.

"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, Virginia joined other states nationwide in having its Medicaid waiver programs operated by private health-insurance companies. Virginia uses six managed-care organizations, or MCOs, and the differing regulations in each company contribute to the ongoing confusion, according to advocates of the disabled.

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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