Nov 8, 2011 8:07 PM by Matt Stafford
Several Colorado patients -- whose disabilities require in-home nursing aides -- are finding out that the number of hours of help from the State they get is being reduced. Medicaid seems to be tightening its belt, but some of the patients and care givers are saying not so fast.
"This is a letter I got in the mail for my son," says Heather Wilson, a parent of a child with severe mental disabilities. She also serves as her son's certified nursing aide. The letter is from Medicaid, telling her about the hours of services her son will get.
"They have reduced the requested units here from 5,260 (hours), and only approved 3,750," explains Wilson. That's for the whole year.
As her son's CNA, she's been getting reimbursed through Medicaid -- so it's her job, and she says one that is definitely full-time.
Wilson found out about the drop in hours just a couple of weeks ago, and with no notice the hours were cut instantly. Wilson wasn't alone; several parents and CNAs were asking about the same thing at their home health care provider in Colorado Springs -- Nursing and Therapy Services of Colorado, Inc. They work with about 300 families in the Pikes Peak region.
"Panic, I mean just panic; they're panicked as to what's going to happen," says Victoria Stewart, who handles community relations for Nursing and Therapy Services.
"Many of these kids have been on this program for years, so it's hard to fathom how they qualified for so many years and now today they don't," says Stewart. She says they never got any notification from the state that their CNAs hours would be reduced; they just started noticing several accounts getting cut back beginning in September.
Rebekah Stevens was at the meeting on Monday; her hours haven't been reduced, yet. She's been her son's CNA for about 3 years.
"I kind of though it was one of those too good to be true issues," says Stevens. She had to quit her job to care for her son with Downs Syndrome; the CNA program was a blessing for her, but now she's planning for changes.
"For me, I'm going to have to get a night job; that's the only way around it," says Stevens.
"It's hard when you can't give them any firm information or give them any firm guidance because we're not sure either," says Stewart. "We would really like firm guidance, ourselves, from the state; that way we can pass down what needs to happen." That's what they say they aren't getting from any State or Federal offices.
News 5 contacted the Colorado Department of Health Care Policy and Financing; they say Federal Medicaid offices directed the State to add more overview to what's being paid out.
"To ensure we are monitoring our programs and services on behalf of taxpayers, we review program rules and conduct audits periodically to verify that rules are being followed," Joanne Zahora, a spokesperson for Health Care Policy and Financing.
"Upon the review of the home health rules, we found that the annual prior authorization review process needed to be more strongly enforced for medical necessity and appropriateness of care," said Zahora. "The number of approved hours for a care giver to be paid is based on this assessment."
State officials say the patients utilizing waivers for additional care are the ones most likely to see reductions.
Many of the parents plan to appeal what the state says; there's a process set up through the State to dispute any reduction in hours. Some of the parents are also looking into legal issues as well, like if the patients were given enough notification of the reduction in assistance. However, in the meantime, they're concerned.
"It also makes me worried about what other areas will be reduced in his (her son's) life," says Wilson.
"Everybody's worried for their children," says Stevens.
Each patient's reviews from the State comes at different times of the year, so Stewart at Nursing and Therapy Services says they plan on getting a new wave of families with reductions in services every month.