NC Budget Cuts Threatens Rehabilitative Program For Disabled Children
By the end of June 2010, NC Officials will no longer use Medicaid a Federal government Health Care Insurance program to help poor residents, to pay for a major service for Disabled Infants and Toddlers in North Carolina who have fallen behind in walking, talking or speaking.
State officials must figure out a way to replace the service despite the elimination of federal money, because federal education laws require states to help disabled children. So any future program would likely be trimmed to narrow the kinds of help provided and serve fewer families.
Parents and therapists are pushing back in an effort to preserve the service.
The program provides therapists who go to homes and day care centers to show parents or teachers the best way to interact with young children to improve their physical and emotional development. It is aimed at children younger than 3.
The program, along with other early intervention services, is considered essential to help disabled children prepare for school.
"Our service is there to teach the caregiver," said Briana Kelly, a therapist from Pender County. She started an online petition that had 399 signatures as of Wednesday afternoon.
The program is meant to help disabled children catch up in skills with those of most children their age, Kelly said. If the severity of the disabilities won't allow that, the goal is to "get them to the best they can be," she said.
"If they saw those kids and those families, they won't cut the service," Kelly said of state officials.
In recent years, the federal government has told states to stop using Medicaid money to pay for services that are not considered rehabilitative, said Brad Deen, a spokesman for the state Department of Health and Human Services. The services cost Medicaid an average of $1 million a month over the 12-month budget cycle that ended last June, Deen said.
As the state looks to narrow the kinds of service offered, it will consider how to limit use and keep out some children who state officials don't believe need the help, he said.
"Medicaid would like there to be a little more selectiveness," Deen said.
In August, 4,766 children were eligible for the service, and about 65 percent of them were thought to be on Medicaid, according to Deborah Carroll, head of the early intervention office in the DHHS.
As the state struggles financially, the department is trying to figure out what comes next for the services and the children who get them.
How other states cope
In a Dec. 11 memo, Carroll listed some states that had devised ways to have Medicaid pay for community-based infant and toddler services similar to what North Carolina offers, but she said in an interview this week that she did not know whether the DHHS would pursue that course.
Private insurance, state money and federal grants are also used to pay for the service.
Jennifer Pfaltzgraff of Raleigh, whose 6-year-old son, Ethan, received community-based services when he was younger, said the program is essential for all disabled children and their families.
"It's a great tool in that it's not only the professional working with the child, but the family's involved," she said. "It's the best way to pull the services together and make it understandable for the parent."
Potential impact
Private insurance paid for the services for Ethan, who has cerebral palsy. But Pfaltzgraff said Medicaid cuts can hurt middle-class families, too.
Some private providers could go out of business without the Medicaid income, which would mean fewer therapists available to work with children, said Pfaltzgraff, who is president of the ARC of Wake County, an advocacy group.
"Everyone will be affected by it," she said.
Federal Judge Halts Mental Health Cuts
A Federal District Court Judge today stopped a Government Mental Health Management Agency from enacting cuts that would lead to two disabled people losing their apartments.
The Beacon Center, the local mental health agency that covers Wilson, Greene, Edgecombe, and Nash counties planned to cut the state money that helps two mentally ill and developmentally disabled residents live in their own apartments.
The two Wilson-area residents, Marlo M., 39, and Durwood W., 49, sued with the help of Disability Rights North Carolina, which argued that the move violated the federal Americans with Disabilities Act and a U.S. Supreme Court decision that gives disabled people the right to live in the least restrictive settings possible.
The U.S. Department of Justice supported their argument. The federal government has participated in cases in several other states where the civil rights law for the disabled was at issue, said Justice Department trial attorney David W. Knight. In other cases, the Justice Department was trying to help residents move to community living, he said. This is the first case the federal government was arguing for people already living in the community fighting imminent institutionalization, Knight said.
U.S District Judge Terrence W. Boyle stopped The Beacon Center's cut, at least until a ruling on the merits of the suit, saying Marlo M. and Durwood W. would suffer irreparable harm, and that it was in the public interest to have state programs and funding adhere to the Americans with Disabilities Act.
The Beacon Center's lawyer, Christopher P. Brewer, said he did not know whether they would appeal.
Vicki Smith, executive director for Disability Rights North Carolina, called Boyle's decision "a victory for people with disabilities in North Carolina."
North Carolina Must Repay Feds $300 Mil For Medicaid "Billing Errors" (Fraud)
-It took the state months to notice that one of its Medicaid funds was flush with money, but employees couldn't figure out why.
Now, because of a huge accounting error, North Carolina must repay the federal government about $300 million for taking too much for public hospital services.
The state will pay back $200 million by the end of this month, and will repay the rest during the next 11 months, according to the state Department of Health and Human Services.
Medicaid is the federal government's health insurance program for the poor and disabled. The state received about $7.5 billion in federal Medicaid money last year. Though the federal government pays most of the costs, the state picks up about one-third of the expenses.
The mistake was triggered in November, when a state worker sent the department's controller's office incorrect information on how much money hospitals should take from the federal government and how much they should take from the state account, said Lanier Cansler, DHHS secretary.
State workers noticed the Medicaid account was out of whack about March, but couldn't find the source of the problem, Cansler said. The state discovered the mistake at the end of June as it prepared to make more changes to Medicaid billing formulas, and told the federal government about it.
The $200 million can be repaid almost immediately because the state has unspent money in the account hospitals were supposed to be tapping, Cansler said.
The $300 million mistake comes at a sensitive time for Gov. Beverly Perdue, as she pushes for tax increases to cover a budget that is nearly a month overdue. Earlier this week, the governor upended budget negotiations, saying she could not support a budget with an income tax surcharge and a drop in per pupil education spending.
In a statement, Perdue said she told Cansler and the state's new Medicaid director, Craigan L. Gray, to make correcting the problem a top priority. She said she wants a report on disciplinary actions.
"While this problem may have originated prior to my term as Governor, the circumstances under which it was made and perpetuated are simply unacceptable," she said.
Perdue said Friday she ordered DHHS to tell the state budget office if its Medicaid accounts are more than 2 percent off projections and submit a report explaining the cause.
This isn't the first time the state has lost the handle on Medicaid payments. DHHS was criticized in a recent legislative report for losing track of how much Medicaid money it was spending on a community mental health program that peaked at more than $100 million a month soon after it started.
New computers coming
A key to better monitoring Medicaid money, Cansler said, is a computer system that will be installed in four months that will let users know quickly how much money is being withdrawn from accounts and where it's going. It will replace a system that Cansler called "old and outdated."
The computer system will cost about $500,000, and the federal government will pay about 90 percent, he said.
After discovering the mistake, DHHS and the state budget office checked all of the department's federal accounts and will examine them each month for problems, Cansler said.
"It raises confidence issues in my mind about everything," he said. "We didn't find anything else. We will continue to look at everything like that and how we can strengthen controls."
Not being run very well
Senate Minority Leader Phil Berger, an Eden Republican, said the state should have been taking such care with its accounts all along.
"You would think there would be internal audit procedures and internal review procedures," he said. "This is just one more indication that our state is not being run very well."
In the past, the state has been asked to repay Medicaid because of incorrect payments to hospitals.
In 2006, the state and 51 hospitals had to repay the federal government $151.5 million in excess Medicaid payments made over six years. The hospitals paid $91.5 million and the state was responsible for the rest.
A two-year investigation found that the state mistakenly claimed too much money through a federal program designed to subsidize hospitals for their care of poor patients.
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Sources: McClatchy Newspapers, News & Observer, Allbusiness.com, Autism Society of North Carolina, Voices of America, Youtube, Google Maps
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