State & Local Medicaid News

Transition Update: When You’re 18 – A Health Care Transition Guide for Young Adults

Information to help young adults understand what it means to be legally in charge of their health care and how to stay healthy as they grow into adulthood. Includes quizzes on being an adult with special needs, life as an adult, talking with doctors, plus additional Web resources on college and work.

For more information visit https://www.disability.gov/education/student_resources/self-advocacy.

ALERT – ALERT – MEDICAID – ALERT – ALERT

No Rest For The Weary! We received a very disturbing call today and are trying to sort out details and gather information. It seems Mississippi Medicaid has a new policy: REGARDING OUTPATIENT SPEECH-LANGUAGE PATHOLOGY (SPEECH THERAPY). Please read the new policy that is below and go to the full text. Medicaid, as we know, submits these children to HSM for additional therapy and those they deem without medical necessity will be denied further services. But, m>Don’t Panic Yet – we are trying to sort this out and get to the truth.

PROVIDER POLICY MANUAL SECTION 49.03,49.04,49.05.49.07 AP2009-35 THIS ADMINISTRATIVE POLICY ADMENDMENT UPDATES THE SECTIONS OF THE PROVIDER POLICY MANUAL LISTED ABOVE REGARDING OUTPATIENT SPEECH-LANGUAGE PATHOLOGY (SPEECH THERAPY). UPDATES ARE MADE THROUGHOUT SECTION 49.03(EXCLUSIONS), ADDITIONAL EXCLUSIONS ARE LISTED ALONG WITH A LIST OF CONDITIONS/SERVICES THAT THE DIVISION OF MEDICAID CONSIDERS NOT MEDICALLY NECESSARY. THIS AMENDMENT ALSO INCLUDES UPDATES TO THE GENERAL COVERAGE CRITERIA AND DEFINITIONS SECTION OF THE MEDICAID PROVIDER POLICY MANUAL. CHANGES TO MEDICAID’S POLICY ON GROUP THERAPY INCLUDE “GROUP THERAPY IS DEFINED AS THE SIMULTANEOUS TREATMENT OF TWO (2) BENEFICIARIES. GROUP THERAPY IS NOT COVERED UNDER THE OUTPATIENT SPEECH-LANGUAGE PATHOLOGY PROGRAM.

16295 Status: Final Proposed: 5/19/2009 Final: 6/15/2009 Notice Full Texthttp://www.sos.state.ms.us/busserv/AdminProcs//PDF/00016185b.pdf

I have been in contact with my DC and Baltimore contacts today and this is their opinion:

“Such a broad exclusion seems to violate EPSDT requirements for children in Medicaid which include services children need to reach optimal development not just medical services.” I will be having more conversations with them Monday. I also sent this opinion to key State Senate and House Leaders as well as state and federal legal contact.

At This Point: We need to know if any of you have received a letter from Medicaid stating that your child will no longer qualify for speech therapy effective July 1, 2009.

If you are a provider, I need the same information from you. You may email the information to us at info@msccd.org, fax to my attention (601) 709-0250 or deliver to 2 Old River Place, Suite A – Jackson, MS 39202 If the information we received is correct, Medicaid is trying to no longer be covering speech therapy for children with developmental or intellectual disabilities. Next Plan of Action will be a call, email and fax campaign.

So, please stay alert and be ready to move! I promise you, we are NOT going to let this go without a fight!

NOTE TO ADVOCATES: During extraordinary economic time as we are now experiencing, the first thing we hear from policy makers is, “We will have to cut services to save money.” What they must understand and YOU must help them to understand is that during extraordinary economic times more people will be qualified for Medicaid services and cutting services to healthcare is the first domino to fall in quality of life issues such as education and health employees. Please take the time to read A Guide for State Advocates below and help be a part of the answer to save Medicaid services in Mississippi for over 700,000 recipients.

Building a case against Medicaid Cuts

Four arguments demonstrate that Medicaid cuts are harmful and counterproductive:

  • Medicaid cuts hurt people
  • Medicaid cuts are unpopular
  • Medicaid cuts hurt the economy
  • Medicaid cuts are inefficient and ineffective

Resources: Community Catalyst Fact Sheet: Reasons to Protect Medicaid