Tuesday, November 30, 2010

Hawaii Medicaid office takes responsibility for coordinating interdepartmental services, including DOE, for children covered by Medicaid

On November 23, Dr. Kenneth Fink, State Medicaid Director for Hawaii, sent me a letter.  The letter began:

The Department of Human Services/Med-QUEST Division (MQD) is committed to assuring that your daughter, Hannah, has coordination of medically necessary Medicaid services that are being provided through multiple State agencies......To facilitate this, we are requesting your consent to allow the Department of Education (DOE) to release to us a copy of Hannah's most recent Individualized Education Plan (IEP).

I haven't heard whether any of the other hundred-thousand children receiving Medicaid, or even the twenty-thousand some kids in Special Education, have received the same letter.

This letter, while addressed only to my daughter, opens up a tremendous opportunity for all Hawaii's children with special health needs.  The DOE no longer has the final say in the services provided to your child enrolled in Medicaid.  The state Medicaid office is essentially assuming responsibility for ensuring your child's medically necessary services are provided, if not through the school, then through either Evercare or Ohana.

For instance, if your child's doctor prescribes five hours a week of occupational therapy and the school is only willing to provide two, you can count on Medicaid to handle providing the other three.

It inadvertently brings up the related question of why Hawaii DOE doesn't appear to be actively enrolling kids in special ed into Medicaid.  Once they do, the federal Medicaid budget (administered out of Dr. Fink's division) picks up 75% of the cost of all that kids' services that are provided by the school.  The budget savings that could be realized by transferring that 75% from state coffers to federal ones are enormous, and why it's being ignored by our local school district is beyond my comprehension.

Whether that issue is related to the fact that Evercare and Ohana are becoming aware of  requirements that EPSDT funds be paid out of the capitation fees they receive, I can't say.  Paying for school therapy services could dig into the $15 million profit they make off the monthly $100 million or so in capitation fees Hawaii pays them.

For parents and advocates, MQD admitting this responsibility for service coordination opens an alternative for receiving services DOE either can't or won't provide.  Federal Medicaid EPSDT regulations and laws provide more protection and additional means for winning disputes than can happen with IDEA alone.

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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.