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Kids, families await Medicaid changes

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Many Colorado families with a disabled child rely on Medicaid payments that reimburse them for "medically necessary" care. Often a trained parent or family member is the one administering the care, and the payments are what allow that caregiver to stay home with the child.

Thus, it was disastrous for families when this spring, the state changed the way it determined the reimbursements families would receive, leading to sudden cutbacks ("The parent trap," News, March 27).

Patricia Yeager, CEO of the nonprofit Independence Center, which serves clients with disabilities, says she heard from families who no longer knew how they could pay their bills. Some even considered giving their children up to the state, because their financial situation was so dire.

In the past, a doctor had decided what type of reimbursement a family needed. But in an effort to reduce fraud and better meet federal requirements, the state had switched to a "Pediatric Home Assessment Tool," a sort of quiz that assigned points based on aspects of a child's disability. Yeager says the tool didn't consider all the aspects; notably, it did not ask if a child was missing any limbs.

The Colorado Department of Health Care Policy and Financing, which created the tool with the help of consultants, initially defended it. But a few months into the program, state Medicaid director Suzanne Brennan ordered the tool to be reviewed.

A team made up of local stakeholders, representatives from families and developmental pediatric staff is currently conducting the review. A new tool could be in place as early as September.

In the meantime, the state estimates that 100 to 130 of the 300-plus families who saw their payments cut have seen the payments reinstated, either because a review found the cuts inappropriate or due to a legal error on the part of the state connected to the appeal process. Another 20 cases are under review.

The state is also considering adding a Medicaid program that would reimburse parents (likely at a lower rate) for care that isn't deemed medically necessary but is nevertheless required, such as 24-hour supervision. "We need a category for that," Yeager says.

— J. Adrian Stanley

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