If your state is an official Medicaid provider (in other words, your state has the ability to bill your state Medicaid department), and your child is receiving physical therapy, occupational therapy, speech therapy, para-professionals, autism services, behavioral or mental health services from the school, then you need to make sure your child is signed up for Medicaid.
It does not matter what your family income and assets are. Your child can be qualified for Medicaid based on his or her disability, and own income and assets.
It may be possible that the schools themselves can do this. It is to their financial advantage, since they can bill the Federal government through their state Medicaid office for 75% of the cost of all these services. The state can only do this if the child is enrolled in Medicaid.
If your child is already receiving any of those Medicaid-billable services from the school, then there is a good chance that your child is “Medicaid eligible.” Clinics, private companies, and our pediatricians can set up systems to evaluate our kids and write the reports necessary to get our children signed up for Medicaid. The idea isn’t far-fetched; a company in Pennsylvania does just that and has a website.
If your kids are “Medicaid eligible”, they are now entitled, as of January 2010, to the treatments and services necessary to reach their “best possible functional level.”
The schools and IDEA have never offered our kids the “best” of anything. Now federal Medicaid regulations, codified in Title 42, give our kids that are signed on for Medicaid the right to the services they really need.
I am not a lawyer. I cannot give legal advice and I’m not. But as parents we need to know that the wording in federal regulations gives our children broad legal, and perhaps even civil, rights.
And while we’re doing it we’re saving our state school system 75% of the cost of services already being provided to our children, along with 75% of the time the school spends administering those services.
Isn’t it time our kids get the services and treatments individually tailored to help them attain the “best possible” life? As parents, we have the power now to give our children this gift. And we as parents have the power, armed with this law, to make sure our kids get what we know, and have always known, is best for them.
Some state, and even federal regulators, might try to argue with you that Medicaid “has options which states may elect to participate in and not all states will choose every option. So there will be differences in services provided between states.”
But Title 42 of the Code of Federal Regulations, Section 1396d(r)(5) states clearly that the state Medicaid EPSDT program (which covers all children on Medicaid under the age of 21) will include “such other necessary health care, diagnostic services, treatment, and other measures described in subsection (a) of this section to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan (my emphasis).
A letter sent by the Federal Department of Health and Human Services in January 2001 to all State Medicaid Directors on implementing the Surpeme Court’s Olmstead Decision reads that “under EPSDT requirements, a State must cover any medically necessary services that could be part of the basic Medicaid benefit if the State elected the broadest benefits permitted under federal law (not including HCBS services, which are not a basic Medicaid benefit). Therefore, EPSDT must include access to case management, home health, and personal care services to the extent coverable under federal law.”
That same letter goes on to say that children on Medicaid cannot be put on any waiting list for a medicaid coverable service. Some states try to put children with disabilities on waiting lists for home services, but once your child has a Medicaid ID number, “State Medicaid programs must make EPSDT services promptly available [for any individual who is under age 21 and who is eligible for Medicaid]“.
Once our kids are signed up for Medicaid, we have access to an entirely different appeals process than offered through IDEA. You can skip the due process hearings and go straight to federal Medicaid and civil rights regulators. As long as your school is an official Medicaid provider, they have to obey Federal Medicaid regulations, and since the federal funding is made available through the EPSDT program, the schools need to follow federal EPSDT law. If the dispute is over services that “can allow children with special health care, as well as developmental and behavioral needs, to remain in their own homes and communities and receive the supports and services they need”, then access to the service becomes a civil rights issue enforced by the Office for Civil Rights of the US Department of Health and Human Services. It becomes an issue related to the civil rights granted to children with disabilities under the Supreme Court’s Olmstead Decision.
You even have the ability to bypass the school entirely and go straight to your child’s Medicaid provider for the services. The percentage of federal funding received isn’t as high as what the schools get, but the medicaid provider still has the legal obligation to provide the treatment or service.
Let’s get our children the services they need, rather than what some bureaucrat has determined is “adequate.”
