Letters show Hawaii out of compliance with ARRA and CHIPRA since April 2009

On April 8, 2009, Lillian Koller sent a letter to Governor Lingle asking approval for 41 positions needed for Hawaii Medicaid to "effectively implement" new federal Recovery Act and Children's Health Insurance Act regulations.  A virtually identical letter, asking for the same positions, was sent today by Hawaii Medquest Administrator Kenneth Fink to Lillian Koller.

The implication appears to be that Hawaii has knowingly been out of compliance with the new Medicaid regulations for the past fifteen months.

Both letters state that "these programs can generate in excess of $327 million in new Federal funds for the State if we meet all the requirements".

In our current economic situation, it is difficult to understand why the State would knowingly forego $327 million in funds to benefit children and adults with disabilities as well as the elderly and blind.

Both letters cite the immediate need "to expedite State Plan Amendments and Hawaii Administrative Rules....Both of these bills generate millions of Federal dollars for Hawaii, but we need to be able to do the work in order to be able to access thyese funds.  Due to two vacancies, staff will not be able to execute the provisions of the ARRA and CHIPRA."

Both letters cite possible violation of federal regulations for Medicaid agency personnel training. "Federal financial participation (FFP) is being claimed for training costs at 50%. This office currently has a 43% vacancy rate...If the funding for this position is not approved, the State will not be able to provide the required level of training for existing andnew employees and will not be able to claim the federal funds for its training costs."

Both letters cite a 56% vacancy rate in the Customer Service Branch.  "The average number of monthly calls has dramatically increased due to QUEST Expanded Access (QExA) [QExA is omitted in June 2010 version], and is expected to only further increase as a result of the ARRA."

A recent article noted that DHS had received only 62 phone calls in April 2010 with complaints from UnitedHealth and Wellcare members.  I recently discovered, however, that DHS had no record of my complaints regarding my daughter's services, nor that anything for her had been denied, which casts some doubt on the figure quoted in the Advertiser.

The article also noted that UnitedHealth and Wellcare receive about 15,000 phone calls a month, not all of which are about "problems".  Enrollment in the two companies is only about 40,000.  These numbers may be more representative of the dramatic increase in calls to Medquest's Customer Service about the program run by UnitedHealth and Wellcare that is referred to in both letters.

The letters do not state what the cumulative cost to the state will be for the 41 positions.  I would assume, however, that it is significantly less than either the $327 million to be gained, or even the $15 million a month that UnitedHealth and Wellcare are making in net profit from premiums.

National disability fellowship awarded to Hawaii doctor linked to federal investigations into Olmstead violations

The Honolulu pediatrician who has received a prestigious Kennedy Foundation Fellowship has links to two on-going Federal inquiries into whether cuts in home services provided to people with disabilities violate the Americans with Disabilities Act.

Dr. Jeffrey Okamoto has been the Medical Director of Hawaii's Developmental Disability Division of the Department of Health.  In December 2008, the Division announced an across-the board fifteen percent cut in home services for people with developmental disabilities.

Federal Medicaid regulators from CMS have been flying into Honolulu regularly since last fall, meeting with state officials to discuss the appropriateness of these cuts.  Discussions and personal meetings have expanded in scope.  I was asked by CMS to provide additional evidence as recently as last month.

In February, the Office for Civil Rights of DHHS opened their own formal investigation into whether the Developmental Disability Division's across-the-board service cuts violate the Americans with Disabilities Act.

Dr. Okamoto intervened directly in my daughter's formal Department of Health appeal against the 15% cut in her nursing services, testifying unexpectedly at the hearing.  Because of that involvement, I have written testimony from Dr. Okamoto that I am willing to share with the public, even though it contains private medical information about my daughter.

He disputed Hannah's neurologist's evaluation and prescription for 24/7 skilled nursing in the home.  In written testimony presented to the Hearing Officer, Okamoto wrote: 

24/7 nursing as being requested by Dr. Griffiths should indicate that Hannah is not safe at home.  This even exceeds the hospital level of nursing provided.  If Hannah is safe at home, then 24/7 nursing should not be necessary.

The written decision of the Department of Health Hearing Officer rejected explicitly all of Dr. Okamoto's arguments.  This included Dr. Okamoto's attempt to link parental training to whether or not a child is safe living at home.

In spite of that written decision, Dr. Okamoto's concept that the safety of a disabled person in their home can be linked to the level of parental training has been expanded upon.  Honolulu civil rights attorney Rafael Del Castillo says he has seen the issue brought up in at least one other case, but by the Department of Human Services.

Earlier today I reported that these threats are being made to families even now, but by representatives from the two for-profit insurance companies that operate Hawaii Medicaid's special programs for people with disabilities.

These issues and complaints remain outstanding. 

The Joseph P. Kennedy Jr. Foundation, which has awarded Okamoto a Public Policy Fellowship, is devoted to furthering the rights of people with disabilities.  One has to wonder if anybody bothered to tell them that Hawaii's entire program of home and community services for the disabled is under a combination of formal, informal and criminal investigations by CMS, OCR and DOJ?

Should UnitedHealth and Wellcare have the right to call for investigations by CPS or APS?

According to an employee of the Hawaii Department of Human Services, the two for-profit insurance companies running the state's Medicaid program are now able to call in complaints directly to Child Protective Services (CPS) and Adult Protective Services (APS).

Calls are coming in to DHS, according to the employee, with complaints that UnitedHealth and Wellcare are using the threat of calling CPS or APS to intimidate families into decreasing their requests for home services.

According to my source, the general threat is that if the person receiving care needs as many hours as the family is requesting, then it is not safe for them to be in their homes.

It's now no longer a threat to institutionalize their child, but a threat to take them away forever.

CDREA publishes 11th Anniversary webzine on the failure of the Olmstead Decision

A year ago, both the President and DHHS made a big public hoopla about the June 22, 2009 tenth anniversary of the Olmstead Decision.  That was the Supreme Court ruling that gave people with disabilities a civil right to not be institutionalized.

This year there is a small article on the government's Disability Blog.  Considering that at least twenty-two states have come under some sort of regulatory attack for violating the civil rights protected by Olmstead, it may not be too surprising.

The Children's Disability Rights Education Association has published a three page webzine on the failure of the Olmstead Decision.  We have had some success advocating here in Hawaii and legal documents are linked.

The point was also to put a face on the people who are actually being targeted for state Medicaid budget cuts across the state.

There are three sections:
The Failure of Olmstead
The Victims when Olmstead Fails
Successful Advocacy in Hawaii

Hawaii's Medicaid Death List Weighted Towards Native Hawaiians

Sources tell me that the infamous "death list" of Medicaid-care related fatalities is "more than fifty percent Native Hawaiian."

There are approximately 25 names on the list.  These are individuals with disabilities and special health care needs that require home health care from Medicaid to keep from being institutionalized. 

Reportedly the list is under investigation by the FBI and several of the families have confirmed they were interviewed. 

The death rate among this group rose 36% in the first year after Medicaid care was turned over to two for-profit health insurance companies, UnitedHealth and Wellcare.

Washington Post reports increased activity by DOJ Civil Rights Division

An article in the June 4, 2010 Washington Post reported on the vast change that has occurred in the Department of Justice's Civil Rights Division.

While mention is made of several different avenues that DOJ is currently investigating, the story omitted mention of the five states where DOJ has actively intervened on behalf of people with disabilities since December.

The following is the comment I posted in response to The Post's article:

disabilitymom wrote:
The disability community has seen a significant increase in the Division's attention to ADA issues. DOJ has intervened directly in five states since December on behalf of people with disabilities whose Medicaid home services are being cut below the level of medical necessity.

OCR at DHHS has opened two investigations in Hawaii into whether cuts in Medicaid home services violated the civil rights of two little girls (one of them mine).

The Division's Criminal Investigation unit has been looking into deaths from lack of care by Hawaii Medicaid providers UnitedHealth and Wellcare. Hawaii has seen a 36% increase in deaths among the elderly and disabled tied to lack of care issues in the first year since they entered this market.

This story links to the attention being paid to the fact that states are cutting Medicaid budgets to the disabled community because that's where they get the biggest bang for their buck.

One of the holdovers from the Bush era has been the privatization of Medicaid. Social and medical services that enable disabled children, adults and elderly to live with their families instead of in institutions are being put in the corporate hands of insurance companies like UnitedHealth, WellPoint, and Wellcare.

UnitedHealth and Wellcare together are taking home about $15 million a month from the Hawaii Medicaid program. Sixty-seven percent of that is federal money.

Nobody would ever propose putting Wall Street bankers in charge of our schools; why would anybody put disability services into the hands of companies that treat billions of dollars in fines as a cost of doing business?
6/5/2010 3:35:05 PM

Taped State Senate testimony reveals 36% increase in Medicaid-care related deaths

On March 16, sworn testimony presented at a Hawaii legislative informational hearing stated the death rate among the state's disability community had risen 36% in the year following privatization of the state's Medicaid services to the disabled and elderly. 

Larry Geller of Disappeared News attended the hearing and posted a videotape on his blog two days later.  There was never any response from the state regarding the startling news.

The sworn testimony is being given by Dr. Tina McLaughlin, Chief Executive Officer of CARE Hawaii.  The hearing is being held by State Senators Suzanne Chun Oakland, chair of the senate DHS committee, and David Ige, chair of the senate health committee.  The comments about the increased death rate come at about 5:40 on the video.