RE: RE: Medicaid Waiver.......An inaccurate experience/ HUGH mistake....

[Guest guest]

Yes, and there is no recourse....

That I know of - other than maybe contacting your legislator.

That is why it is SO IMPORTANT to call them yearly to MAKE SURE your child is

on that list!

There are different numbers for different lists. Some have combined - but you

need to call each number for each waiver program. Keep them in a file -

document when you call and who you talk to, etc. Do this yearly.

They should call you yearly - but if they don't - YOU CALL THEM.

EACH LIST - EACH YEAR....

So sorry that has happened! I know a couple parents who had that happen.

denise roberts wrote:

, nna, anyone....

Inaccurately, I considered my younger son's name to have been placed on the

CLASS Waiting List.

QUESTION: Has anyone experienced the regrettable mistake of thinking their

child's name was on a medicaid waiver list? If so, was there any recourse to

take?

2002, an In-take Specialist accepted my application request for Mental

Retardation Service Options for my son. My son's name is listed on the

HCS/MDCP/In-home. Mistakenly, I misunderstood for his name to have also been

placed on the CLASS List. HUGH mistake!!

This is particularly distressful, in view of the fact, my older child’s name has

been placed on the CLASS/HCS/In-Home Waiting List for over 6 years..

Many times over the past 4 years, I requested/inquired to my children’s

numerous/different TCMHMR Service Coordinators to confirm the listing of both my

son’s name placement on the MRLA/CLASS List. This inquiry was verified and

validated several times over!

This responsibility was/is mine and unfortunately, I misunderstood that all

waiver services and supports were achieved through MRLA Program. In addition,

many laypersons and professionals had stated for the CLASS Listing to be

included with the MRLA registration….or at least, this is what I understood.

“MRLA/CLASS List…are one and the same.” “MRLA is the CLASS List.” NOT!!!!

In view of the ambiguous information; as related to the CLASS program/MRLA; it

was my misunderstanding for TCMHMR department to offer/provide all the waiver

services and supports through the MRLA/Medicaid Program waiver program services

throughout the state. NOT!!

It was my oversight to have considered and trusted MRLA to be all-inclusive for

HCS/CLASS…..comprehensive for HCS/CLASS! An acronymous mistake….confusion!

Related to this and similar misunderstandings, I have been informed that the

acronym MRLA for Mental Retardation Local Authority has been changed and

eliminated for this reason. Apparently, I am not the only one to have made this

HUGH mistake.

Singleton wrote:

Ok Medicaid waiver 101.

Medicaid is a health insurance program provided by the federal and state

government to those

who meet FAMILY income requirements (i.e. those who have a very low

income--exactly what

that income is changes with inflation but it's pretty low.) The federal

government matches the

dollars that the state is willing to put into its own Medicaid-eligible

population.

Medicaid will ONLY reimburse services provided by " LICENSED practioners of

the healing arts. "

This is a small but important detail. This means IF there is a health

service offered by someone like

a dental assistant (who generally aren't licensed) they won't pay, but they

will for a dentist, who is

licensed.

The states quickly realized that some services were needed, but weren't

appropriate to be licensed--

like respite, etc. So a while back they appealed to the federal government

to create a waiver program.

The waiver program allows each state to design a program, a waiver, to serve

whatever special population they

saw a need to serve. Each waiver program can be designed any way the state

wants to. Usually

BUT NOT ALWAYS the two requirements that are waived for persons with

specific needs due

to a disability of one sort or another are 1) family income requirement and

2) the license requirement

for service providers. Often the waiver will use the INDIVIDUAL'S income,

which in the case of children

is nothing--unless a general grandparent or other relative has given them

money under the uniform

gift to minor act. A child with a disability should have no assets in their

name--it should be in a

special needs trust for this reason. By waiving the licensing requirement,

the waiver could pay

for services like day habilitation or respite, or other therapies not

covered by " traditional " Medicaid if

those services are specified in the waiver.

That is why the waivers are so confusing. Entering each one is like walking

into it's own little universe.

Each one serves a different population: HCS, only serves those with IQ <70

or with autism IQ<75.

CLASS serves those with developmental disabities, no IQ specification. MDCP

serves those with medical

needs (i.e. dependent on medical equipment or medication). There is a

wavier for adults with dev. disabilities

CBS I believe.

There is a waiver for person with deaf/blind designations. Texas Home

Living is for persons already

receiving services funded by general revenue dollars through MHMRA--and this

waiver does NOT waive

the family income requirement, only the licensing requirement.

Not all waivers are available in all counties in Texas. Not all waivers

provide identical services or pay the

same annual amount (they have different spending caps).

NOW that said, getting on a Medicaid waiver is no cake walk. There is a

maze of approved contractors,

hiring staff who are approved Medicaid providers (and THAT's a trick often

to become one of those) etc.

because Medicaid billing is very, very complicated. However, there are

people who have been able

to make it work to get extra services for their children.

Right now, ALL waviers have a significant waiting list in Texas (i.e. >4

years.) I would suggest that

anyone with a child with autism sign up for HCS, CLASS, and MDCP waiting

lists. I believe

instructions on how to sign up are posted on the www.texasautismadvocacy.org

home page.

Is that more information than you wanted???

S.

Medicaid Waiver

Hello there:

Although I have tried to read up on-line and figure this out for

myself, I just can't seem to get a straight (read: Easy) explanation

for what a Medicaid Waiver is. Could someone please " dumb it down " for

me?

What is it? Who qualifies? And how do they qualify?

Thank you!

A. Weber

Dallas, TX

Texas Autism Advocacy

www.TexasAutismAdvocacy.org

Texas Disability Network

Calendar of Events

www.TexasAutismAdvocacy.org

[Guest guest]

I heard a parent say, not too long ago, that the State of Texas is

really into recovery of funds used by persons on Medicaid/Medicaid

waiver programs/SSI, such that, if you put a foot wrong with your

accounting, or provide your child something you're not supposed to,

you might find yourself suddently with a bill for $40,000, or the

amount of services provided so far. That parent said she'd received a

bill in that amount.

Does anyone know about this? It seems illogical that they'd bill you

if all your past accounting had been okay.

[Guest guest]

--- " J. Ruede " wrote:

> the State of Texas is

> really into recovery of funds used by persons on Medicaid/Medicaid

> waiver programs/SSI, such that, if you put a foot wrong with your

> accounting, or provide your child something you're not supposed to,

> you might find yourself suddently with a bill

Hi ~

I can't speak to the Medicaid (it's supplementary to CIGNA and we only see

" approved "

Medicaid providers) but I know the social security administration keeps close

tabs on

Evan's SSI. We usually have an annual financial review (we weren't subjected to

that

this year, but not much has changed!) and last year they claimed they overpaid

us some

$400...but his case worker just wrote it off for us. HTH.

Love,

Diane.

http://babiesonline.com/babies/e/evankyle

__________________________________________________

[Guest guest]

Sounds like that parent needs to talk to someone at adovcacy inc or at least

their legislator.

RE: Re: Medicaid Waiver.......An

inaccurate experience/ HUGH mistake....

I heard a parent say, not too long ago, that the State of Texas is

really into recovery of funds used by persons on Medicaid/Medicaid

waiver programs/SSI, such that, if you put a foot wrong with your

accounting, or provide your child something you're not supposed to,

you might find yourself suddently with a bill for $40,000, or the

amount of services provided so far. That parent said she'd received a

bill in that amount.

Does anyone know about this? It seems illogical that they'd bill you

if all your past accounting had been okay.

Texas Autism Advocacy

www.TexasAutismAdvocacy.org

Texas Disability Network

Calendar of Events

www.TexasAutismAdvocacy.org

[Guest guest]

Well, Sorry to say sorry. About the only thing that you can do is sue the

state. Hmmmmmmm.

Perhaps you should contact Advocacy to see about joining the current waiting

list lawsuit.

Anyway the programs send you a letter to confirm that your child's name has

been placed on the

waiting list. KEEP that letter. If you don't have a letter, then chances

are very good that your child

was never on the list despite was you were promised or told or thought.

Also, should the state begin

using a different computer system to keep track of everyone (and PLEASE make

sure the programs

are on the list to notify of new addresses!!) and they lose your child's

name from the list, that letter

is the only proof you have that your child's name was on the list. Yuck.

S.

I would call your legislator and give them an ear-ful and write them a

letter AND contact Sen. Zaffirini's office.

If the legislator's would take care of eliminating the stupid lists, then

there wouldn't be problems like

this anyway.

Medicaid Waiver

Hello there:

Although I have tried to read up on-line and figure this out for

myself, I just can't seem to get a straight (read: Easy) explanation

for what a Medicaid Waiver is. Could someone please " dumb it down " for

me?

What is it? Who qualifies? And how do they qualify?

Thank you!

A. Weber

Dallas, TX

Texas Autism Advocacy

www.TexasAutismAdvocacy.org

Texas Disability Network

Calendar of Events

www.TexasAutismAdvocacy.org