Mentally disabled lose services

Medicaid cuts have hurt clients, providers alike By CLAUDIA PINTO • Staff Writer (Tennessean) • March 2, 2008 Barbara Eastep’s son is 26 years old, but he only recently learned to walk up stairs by himself and speak clearly enough to order a meal at a restaurant. Eastep said her son’s progress is being stymied because he has lost physical therapy services and is about to lose speech therapy services he receives through the statewide Medicaid Waiver program. The waiver provides a variety of services to roughly 6,000 Tennesseans who have an IQ lower than 70. “I am very angry,” said Eastep, whose son is blind, epileptic and mentally disabled. “This is a safety issue. How is he going to learn how to communicate in an emergency without speech therapy? How will he gain enough balance to keep from falling on his face when he has seizures without physical therapy?” Ricky Eastep — who has suffered a fractured eye socket and multiple stitches from seizure falls, despite wearing a helmet — is one of many Tennesseans being affected by the cuts. The state’s Division of Mental Retardation Services is in the process of eliminating services to an undetermined number of people on the waiver. In addition, a 6.1 percent rate reduction in payment to the 400 providers that deliver services has been in place since Jan. 1. Building Strength and Muscle without Illegal Substances Scholarships for Working Moms Going Back to College Get an Internet Filter for Peace of Mind Families and providers are reporting the following consequences: Providers have cut workers’ pay, laid workers off and stopped offering services altogether. Clients are losing needed services or not getting as much treatment. Steve Norris, deputy commissioner with the state’s Division of Mental Retardation Services, said anyone who loses services could appeal the decision. He said those affected would receive a letter explaining how to do so. Norris said the division was in the beginning stages of reviewing every care plan to make sure people are getting appropriate services. He said the process would take a few months to complete, and that it was unclear how many people would lose services. “We are trying to be very careful,” Norris said. “The last thing we want to do is deny someone needed services.” He said he hoped the individual cuts would end the rate reductions to providers by July 1, and that rate reductions could decline in the months ahead as expenditures for clients go down. “This is a temporary problem,” Norris said. Housing worries some Max Tice, a behavior analyst for people on the waiver, says he has a client who beats himself up and is covered in bruises. Tice used to be able to work with him for 10 hours a month, but since the cuts has only five hours a month to try to stop the dangerous behavior. “Here’s a guy that we need plenty of time to work with,” Tice said. “He will take a fist and beat himself in the head as hard as he can. It’s damaging to the brain.” In addition to clients’ losing treatment services, Tice said he was concerned about a money-saving housing measure. Tice said two of his clients had been told that they would be getting housemates — one is physically violent and has bitten off a person’s finger; the other is a sexually aggressive, convicted pedophile. “Based on what I’m seeing, I’m frightened,” Tice said. “I am frightened for these people who can’t take care of themselves.” Norris said cutting services and implementing rate reductions was not something he wanted to do. However, he said it was the only way to avoid a $15 million budget shortfall for the year. “I’m obligated to stay within my budget,” he said. While the federal government pays for the bulk of the statewide waiver services, the state still pays out $170 million per year for the roughly 6,000 people enrolled. State officials say the average cost per client needs to be $209 a day to stay within budget. In October, the cost was $233 a day. “We are dealing with 6,000 individuals who deserve everything we can provide for them, but it can’t be open-ended,” Norris said. “There have to be limits.” Norris said that because health-care costs for things such as nursing and therapy services are going up, it’s important to trim any unneeded services. He said single-person placements could be one of those things. “There are some people who must live alone,” he said. “My feeling is that there are not a whole lot of them.” Norris said any provider concerned about the safety of a client should contact the regional director or him. “We are not going to force anyone to live in an environment that’s unsafe,” he said. Providers aren’t paid The disabled aren’t the only ones affected when services are cut. Providers such as Lori Wigginton no longer get paid. Wigginton, who is also a behavior analyst, said she used to spend about nine hours a month per client and now spends an average of four and a half hours a month with them. “My pay is being cut in half,” she said. “If I’ve already used up my hours for the month, then I don’t get paid if there is a crisis.” She said she had found herself working for free. “It’s unethical for me not to.” Norris said he had heard that a lot of providers had experienced pay cuts and that “several” agencies had laid off employees, but he could not provide exact numbers. He said he was aware of only one agency in East Tennessee that has stopped providing services because of the reduced reimbursement rates. However, Wigginton said she knew of seven providers that had stopped offering services. Carol Westlake, executive director of the Tennessee Disability Coalition, fears there will be more provider closures and layoffs if the rate reductions continue much longer. “They can’t business-wise continue this way,” she said. “They’ll go out of business, and there won’t be enough providers to serve people in the community.”