PCA hrs denied by AHCA

[Guest guest]

Just to bring some of you up to speed. As of 7/1/10, APD (MEDWAIVER) will no longer cover PCA hrs for individuals under 21. The responsibility will then be in Medicaid's (AHCA) hands. Unfortunately, for those of us who have already been converted over to this new plan, we are getting denials from AHCA leaving us with no hrs even for those of us who have very involved children. My son has received a denial of services and I am going to a hearing next week.

My support coordinator issued this question to APD:

Question:

Kepro* is starting to deny our autistic children Medicaid PCA based on the

fact that they feel autism is behavioral and not medical. Therefore, they

are stating that PCA for autistic children is NOT MEDICALLY NECESSARY.

Unfortunately, we know differently, especially when some of these children

are unable to toilet, feed or dress themselves. If we have a KEPRO denial,

will MW (MedWaiver) pick up these services?

(*Keypro is the authorizing agency for Medicaid)

RESPONSE:

APD Central Office had a preliminary meeting with AHCA to discuss this

issue. As you all may already know, effective 7/1/10, the DD WAIVER will

not cover PCA at all for children under 21. The WSC might want to continue

to request the waiver cover pca for this child until 6/30/10 or provide

needed documentation about the need for pca based on the child's need for

assistance, and not because of his/her autism, but as to the WHY of he/she

needs PCA to complete his/her self-care and can not do for himself/herself.

Our APD Cental Office continues to work through this issue with AHCA . If

you area aware of any other situation, please let me know ASAP.

If we all do not band together on this issue, all of our kids will lose their PCA hrs by 7/1/10. Please call the Governor's office at to file your complaint. Also, please contact your state representatives about this issue. This may need to be one of the issues at the forefront in Tally this April.

Herskowitz