The Lane's

Medicaid

Megan Launis created an overview of state and federal funding options.

Appendix F of the HB296 report contains a summary of eligibility guidelines and services.

The Kentucky Autism Training Center has posted a few documents on their site. These include a flow chart of services for children under five and a resource manual.

Budget cuts in 2003 made it more difficult to obtain Medicaid services.


Marcia Morgan presented her FY '03 & FY '04 Budget Reductions to the House Budget Review Subcommittee on Human Resources on January 22, 2003. She described an unpleasant future. Politics and posturing are involved, but recent policy changes in HCB waiver eligibilty guidelines have resulted in many autistic individuals loosing their waiver and associated Medicaid services.

Marcia Morgan and Kathy Kustra later presented a Medicaid Update for the Interim Joint Appropriations and Revenue Committee on January 28, 2003. This contained more bad news. Item 7 on page 27 was particularly unpleasant. Please call your legislators and consider attending the relevant Comittee Meetings in Frankfort.

The ASD Consortium met with Mike Robinson (Medicaid Commissioner), Marilyn Duke (Deputy Commissioner), and Dave Hannah (Autism Waiver) on Febuary 4, 2003. The meeting went better than expected. Everyone was polite and honest, but there wasn't any good news. Dave Hannah repiled to numerous questions from the ASD Consortium in a well organized handout.

In my opinion, the HCB waiver eligibility guidelines ( Nursing Facility Level of Care) haven't changed and our kids haven't changed, but the state budget has changed. As a result, Medicaid asked HRC to reinterpret the eligibility guidelines.

I contacted Pam Smith, a supervisor at HRC (800-292-2392x6446), after receiving a denial letter for our son's HCB waiver. She stated this denial only restricted his respite services. This was double-speak because all his services and therapies depend on the HCB waiver. Pam Smith did like to look at the issue from this perspective. She claimed she was simply following guidelines from the department of Long Term Care and encouraged me to call Vira Frazier (Associate Director 502-564-7540) and Mike Cornwall (HCB Policy 502-564-5560). I will do this and also attempt to reach Marcia Morgan to discuss my son's options.

Autistic children are (or were) eligible for Medicaid in Kentucky. You will probably be told that families must qualify financially to receive services. This is not true. All that matters is the child's income and assets because the child has a disability.

Qualifying for Medicaid is the easy part. Obtaining services is where things can get difficult. Many families have used the following process to obtain services. This process may change when the autism waiver is defined.

The parents should contact a home health provider in their area and ask them to evaluate their child for respite services. It may take several weeks to get this appointment or they may be able to come out the next day. After a nurse evaluates the child for respite they will receive a letter confirming that he is eligible for services through the home health agency and they will direct parents to the Social Security Office. Parents will be asked to present documentation about their income, assets, etc. This info is used to determine if the child qualifies for Medicaid services for financial reasons or the Home and Community Based Waiver. Confirmation will be sent to parents within a few weeks and a medical card should be received within 30 days. The entire process takes anywhere from 4 weeks to 4 months. Once a medical card is received, that child is eligible to apply for IMPACT Plus services. To qualify that child must have an Axis I diagnosis (mental health related disorder) and have documentation of ongoing and persistent maladaptive behaviors occur across all domains for the past 6 months. The parents should contact a provider for IMPACT Plus or the main office to find out how to get started. IMPACT Plus number is (502)564-4797.

If you suspect that your child may have difficulty with independent living as a adult, you should consider applying for the Supports for Community Living (SCL) waiver. I have been told this is an excellent program and the only program that serves autistic adults. The problem is that it has a long waiting list. Law suits in other states have determined that these waiting lists are a volation of federal law. These rulings are nice, but they also run the risk of terminating these programs. The federal government provides 70% of Medicaid funding, but Medicaid is managed at the state level and is an optional program.

 
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