Thursday, April 16, 2009

How EPSDT is supposed to guarantee services from your school

In 2004, a brochure was published by the US Department of Health and Human Services explaining to the parents of children with disabilities how EPSDT would help them. EPSDT - Supporting Children with Disabilities was published in September of 2004. Flip to page 17 and you'll find the following rather extended quote:
A special case of how EPSDT covers medically necessary services occurs in the education system – where many children receive their services. Many children with special needs receive a wide variety of services through the public school system. They range from academic services, such as reading and math instruction, to more health-related services, such as physical therapy and personal care. Trying to figure out who is responsible for paying for which services can be very confusing. However, schools can (and many do) bill Medicaid for reimbursable services under EPSDT. Medical necessity is just as important here as it is outside the school system. According to the federal government, “Medicaid is the payer of first resort for medical services provided to children with disabilities pursuant to the Individuals with Disabilities Education Act (IDEA).”5 In other words, Medicaid eligible children with disabilities are entitled to receive medical services in the school setting, paid for by Medicaid, if two important requirements are satisfied. First, the school/school district must be a participating Medicaid provider. Second, the services must be written into the child’s IEP/IFSP, which automatically makes them considered medically necessary.
My child's school district is a Medicaid provider. Assuming this is true, then how on earth can they justify denying services requested by her doctors over and over again? If you're the parent of a child within the special education system, you may or may not be having difficulties with your school system. Many of us have experienced the feeling of walking into a room with 15 or so teachers, and the only chair left is one that's kid-sized. It usually doesn't bode well for the rest of the meeting. Be that as it may, the point is that the Federal government appears to be saying that our children are entitled to everything that one of their service providers says is medically necessary. The list is extensive, and it's on page 14 of the brochure. Take this brochure and give it to every caregiver and parent of a child with special health care needs. Please.

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About Me

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I'm the mom of a child with disabilities. Hannah's first neurologist said she might never develop beyond the level of a 2 month old infant, and there wasn't anything I could do about it. The brain damage was just too severe. Nine years later, she walks, uses a touchscreen computer and I've just been shown she can learn to construct sentences and do simple math with the right piece of technology. Along the way, I discovered I needed to teach myself what Hannah's rights to services really were. Learning about early intervention services led to reading about IDEA and then to EPSDT. I've been waiting for the Obama administration to realize the power and potential of EPSDT for the medical rights - including the right to stay at home with their families - of children with disabilities. The health reform people talk about long term care, and the disability people talk about education and employment, but nobody is talking about EPSDT. So I am.