CDREA posts DOH and DHS decisions that benefit Hawaii's disability community

The Children's Disability Rights Education Association (CDREA) yesterday posted information from two Hawaii  appeals hearings that hold out potential benefits for thousands of the state's QExA 1115 Experimental Project participants.

Both decisions were in response to an appeal made on behalf of a Kauai child against a unilateral 15% cut in her home nursing decisions that was to have gone into effect on February 1.  The cut was instituted against all participants in Hawaii's Developmental Disability 1915(c) Medicaid waiver program, regardless of need.

The written decision by the Hawaii Department of Health hearings officer may open the door for all services that were cut to be reinstated immediately.  The "informational note" by the state Department of Human Services" acknowledges the responsibility of the 1115 Experimental Program (QExA) to pay for assistive and augmentative communications devices.

UnitedHealth Group and WellCare Health, owners of the two for-profit health insurance companies providing all the Medicaid QExA services, have begun a new round of drastic cuts.

The cuts are severe enough to appear to violate Hawaii's contract with the federal Medicaid regulatory agency.  Yet the feds are doing nothing to stop this.

CDREA publishes new CMS definitions of case management for kids with disabilities

The Children's Disability Rights Education Association (CDREA) has published an article on the latest definition of case management services issued by the federal Medicaid regulatory agency.

The broad scope of required activities that must be included in "case management", coupled with the role that the individual or their designated health care decision maker play in determining these activities, gives families more control over the services they need than ever before.

While the document in question related specifically to children covered by EPSDT (i.e., under the age of 21 and receiving Medicaid), similarly written documents have been issued that cover individuals of any age who receive Medicaid because of their enrollment in what's called a "Medicaid waiver" program. 

In the state of Hawaii, for instance, anyone currently enrolled in the state's QExA program, and therefore receiving their Medicaid services through either Evercare or Ohana, plus anyone currently enrolled in the states Developmentally Disabled waiver program, are entitled to case management services.

Hawaii's decimation of its aged, blind and disabled population worsens

Hawaii's two gold-digging for-profit insurance companies handling Medicaid have sunk to new lows. A Mom on Oahu got a call from her medically fragile son's Medicaid for-profit company. With no written notice, the company was downgrading her son from 54 hours a week of RN level nursing to 14 hours a week of a CNA. A little boy's life will be in danger beginning November 15, while no one knows what Hawaii Governor Lingle has done with the $154 million in stimulus funds she's received that can only be spent on Medicaid. The boy's services are provided as part of a deal Governor Lingle's administration negotiated with UnitedHealth Group and WellCare Health Plans for the two out-of-state, for-profit companies to take over medical care for the state's "aged, blind and disabled" populations. More than 37,000 people on February 1 were dumped from their pay-for-service Medicaid care into the merciless grip of UnitedHealth and WellCare, with no information from the state about this essential distinction in their care. As part of the negotiations, UnitedHealth and WellCare had to agree to make no cuts in home and community services for their 37,000 new clients for 90 days. After a Kauai mom filed complaints with the federal DHHS Office for Civil Rights and Center for Medicare and Medicaid Services (CMS, the division that regulates Medicaid), a wave of new cuts in August was halted. A little boy's life will be in danger as of November 15, when the final slash of 88% of his home care services takes effect. Where are our Medicaid stimulus funds? Background information on these two for-profit Medicaid managed care companies continues to be updated. Unitedhealth has paid out over $1.3 billion in fines, penalties and settlements to 9 states and their own shareholders since January 1, 2008. Their subsidiary Evercare was fired by the state of Texas in May, 2009. Fines and settlement just in 2009 include $536,000 to Missouri in August, $750,000 to Georgia in November, $457,000 to Colorado in October, $3 million to Texas in October, $630,000 to Texas in January, $350 million and a separate settlement for $50 million to New York in February. Yet on October 20, Unitedhealth posted a 13% increase in their profit from the same quarter a year earlier. The company's private plan membership dropped by 6%, but enrollment in its Medicaid and Medicare programs had increased by 14%. I'm not an economist but it seems that the aged, disabled and blind community is not unprofitable. We already reported Wellcare has paid out over $90 million in restitution and fines since May 2009. We recently learned that in February 2009, WellCare was ordered by the CMS to stop taking enrollment in certain of their Medicare plans. A letter from CMS to WellCare noted "WellCare was one of the overall worst performers among all plans,” and “WellCare’s complaints are three times the national average.” CMS kindly released WellCare from the suspension on November 4, 2009, in time for the company to participate in the federal open enrollment period. Also on November 4, "WellCare reported higher-than-expected third-quarter earnings Wednesday, swinging to a profit of $28.7 million, or 68 cents per share, from a year-earlier loss of $18.2 million, or 44 cents a share." Hawaii desperately needs an audit done of where the state's stimulus funds for Medicaid have gone if the companies running our Medicaid can make these kind of profits, while paying the sort of fines and settlements we've described, while at the same time cutting a toddler's home nursing services by 88%.