So who would be hurt if this happens, and everybody in state . . . → Read More: Who will be hurt and who makes out from the Administration’s new Medicaid policy?]]> The chair of the health policy department at George Washington University has warned of the potential “spill-over” effect into other state programs run with federal funds if the Supreme Court interprets too widely the Administration-backed policy paper on Medicaid submitted May 26.

So who would be hurt if this happens, and everybody in state “safety net” programs loses their federal rights?

* Around 25 million children will be affected. While non-disabled children account for 49% of Medicaid enrollment, spending accounts for only about 20% of the total Medicaid budget.

* Disabled children and adults, blind adults and senior citizens total about 9 million recipients, or 18% of the total. Budget-wise, however, they account for two-thirds of all Medicaid spending.

How will we ever be able to keep our loved ones at home with us if state bureaucrats and Medicaid insurance companies can cut their services with impunity? These are our children, our siblings and our parents that we are trying so hard to keep home with us and not locked up in institutions.

Who will protect, let alone enforce, the federal rights of this population of 35 million Americans?

It can’t be CMS – the Centers for Medicare & Medicaid Services – and they are the arm of HHS responsible for oversight of state adherence to federal Medicaid regulations. A parent in Hawaii, whose daughter’s life has been endangered by cuts in her home nursing services, was told the following:

While filing a complaint directly with CMS, the Federal agency responsible for programmatic and fiscal oversight of the Hawaii Medicaid program, provides CMS information regarding the Hawaii program, it does not protect your rights. The only process that federal law recognizes as protecting your rights is filing the an appeal with the managed care organization, in this case Evercare [Unitedhealth].

A corporation that makes its profit by denying medical services has as much interest in protecting our rights as Big Business has in paying higher taxes.

CMS themselves are projecting out to 2019 almost an 11% per year growth in state and federal Medicaid dollars paid to private insurers. Big insurance companies like Unitedhealth and Aetna are getting into Medicaid and Medicare “managed care”, and new corporations focusing just on Medicaid/Medicare are experiencing twenty percent annual growth rates. Between September 30, 2010 and March 31, 2011, Unitedhealth increased its Medicaid membership by only five percent, while quarterly Medicaid revenue (i.e., how much they were paid in capitated payments for managed care services) went up 23%.

This projected trend reflects the assumption that many of the newly eligible Medicaid enrollees in 2014 will be enrolled in Medicaid managed care plans, as has been true of currently enrolled children and adults. Capitation payments are projected to remain as the fastest-growing category of services in Medicaid over the next 10 years.

The companies winning all these new contracts are responsible to shareholders, not policyholders, even if the premium is paid by the federal government. Profit is measured by how much out of each premium is not spent, and it’s called the Medical Loss Ratio (MLR – percentage of the capitation payment actually spent on medical expenses for the individual).

Companies strive to keep these MLRs as low as possible, and they have trended below 80%. However, the reliability of these reported MLRs has been called into question. Recent criminal Medicaid fraud investigations that resulted in refunds demanded from Wellcare, Unitedhealth, Humana and Amerigroup suggest these figures could be severely inflated. Actual MLRs on a children’s Medicaid program were discovered as low as 49%.

Even with the protections we have under federal Supremacy (federal law is the law of the land) now, companies that have been caught stealing money from newborn babies and children with disabilities are being handed additional contracts, for Medicare as well as Medicaid.

According to the National Senior Citizen Law Center, the brief, which was submitted against the wishes of HHS Secretary Kathleen Sebelius and with President Obama’s support, “contradicts the law as applied for decades, in scores of cases, by the Supreme Court and the lower federal courts.” Simon Lazarus, Public Policy Counsel to NSCLC, concludes in his legal analysis of the brief:

The brief charts a path for the Supreme Court to permit federal courts to continue routinely to apply federal supremacy to strike down state laws protecting consumers, workers, retirees, bank depositors and others, alleged by business litigants to conflict with federal laws, while arbitrarily withholding identical protection from the vulnerable populations served by Medicaid and other safety net laws.

If we allow this brief to become policy, we could lose any effective means to challenge the medical decisions these for-profit Medicaid companies will be making about our loved ones.

Please sign our petition here to have the Administration withdraw this dangerous brief from the Supreme Court.

According to a legal analysis published today, the brief asserts “that beneficiaries of Medicaid and other safety net laws should no longer be permitted . . . → Read More: Could the Administration’s war on Medicaid be the death knell for EPSDT?]]> Our children could lose the right to challenge the medical decisions made by their Medicaid providers if an Administration-backed brief submitted to the Supreme Court is allowed to become policy.

According to a legal analysis published today, the brief asserts “that beneficiaries of Medicaid and other safety net laws should no longer be permitted to request federal courts to “preempt” – i.e., invalidate – state laws that violate conflicting federal legal requirements.” The analysis by Simon Lazarus, Public Policy Counsel to the National Senior Citizens Law Center, concludes:

The brief charts a path for the Supreme Court to permit federal courts to continue routinely to apply federal supremacy to strike down state laws protecting consumers, workers, retirees, bank depositors and others, alleged by business litigants to conflict with federal laws, while arbitrarily withholding identical protection from the vulnerable populations served by Medicaid and other safety net laws.

The DOJ brief’s position is difficult to reconcile with the administration’s proclaimed goals and priorities.

What does all this have to do with EPSDT?

The medical protections our children have under the Early Periodic Screening, Diagnosis and Treatment (EPSDT) program, are entirely federal, and already routinely violated. EPSDT mandates that every child on Medicaid receive all the services their doctor says are medically necessary. If our children lose the ability the enforce EPSDT regulations, then their lives, not just their medical decisions, will be in the hands of state Medicaid bureaucrats, or worse yet, the private big business health insurers that are buying up Medicaid.

I am not a lawyer, but I have been reading about EPSDT, and using it to advocate for my daughter Hannah’s services for about ten years now. All the federal court cases that have supported our children’s rights to medically necessary care depend on what is called the federal “Supremacy Clause” – states cannot restrict legal rights defined in federal law and regulations. The end result of every case, and of every document I’ve seen coming out of CMS in the past two years, has been to broaden the federal definition of the “full EPSDT benefit”.

Every case has also represented the attempt by a state, or its Medicaid contractors, to deprive our children unreasonably of medically necessary services. I say “unreasonably”, however with the double-digit growth in for-profit Medicaid contractors, the reason is increasingly corporate profit.

These are companies that routinely report to the SEC spending only eighty cents out of every Medicaid and Medicare dollar, achieved by denying twenty percent worth of actual medical expenses from the get-go. If the number of criminal Medicaid fraud charges brought already against companies like Amerigroup, Humana, Wellcare and Unitedhealth are any indication, the denials of actual Medicaid services can actually range easily into the thirty to fifty percent range.

Sara Rosenbaum, head of the George Washington University health policy department, warned in Politico that “there’s “no stopping point … in terms of its spillover effects” if the Supreme Court broadly restricts individuals’ access to the courts over state implementation of such a federal program [Medicaid].”

We cannot allow our children to be the victims of this kind of “spill-over.” We have created a petition to Attorney General Eric Holder, and the Acting Inspector General of the Department of Justice, asking for this brief to be withdrawn from the Supreme Court. Please sign it, and help us get the word out.

Filed by Acting Solicitor General Neal K. Katyal on May 26, the amicus brief effectively exempts everyone receiving . . . → Read More: Parent Action Alert: Don’t let the Administration turn our kids into second class citizens]]> Our children stand to lose all the federal civil and legal rights gained over the past fifty years if an official Obama Administration “friend of the court” brief to the Supreme Court is not withdrawn.

Filed by Acting Solicitor General Neal K. Katyal on May 26, the amicus brief effectively exempts everyone receiving Medicaid – including children, the elderly and people with disabilities – from the protection of federal law.

As parents and family caregivers, we already know that fighting for the services our children are entitled to under federal law is difficult. It is the reason why more and more studies are showing that parents of kids with special needs are suffering from PTSD. Access to federal courts to enforce EPSDT, the ADA and the Olmstead Decision is the only thing keeping many people with disabilities out of institutions and at home with their families. If this document stands on the public record, not to mention if it is allowed to influence the pending Supreme Court decision, our children lose this access.

We need to unite and let the Administration know how we feel. Please sign our petition!

The New York Times reported on May 28 that Representative Henry A. Waxman of California called the brief “wrong on the law and bad policy.”

I am bitterly disappointed that President Obama would accept the position of the acting solicitor general to file a brief that is contrary to the decades-long practice of giving Medicaid beneficiaries and providers the ability to turn to the courts to enforce their rights under federal law,” Mr. Waxman said. He said that he and other Democratic lawmakers planned to file a brief opposing the administration’s view.

The amicus brief was apparently the opposite of that requested in a letter submitted to Katyal on March 21 by twelve national organizations. Signatories included groups such as the American Hospital Association, the American Academy of Pediatrics and the Catholic Health Association. The letter stated that “the federal government has an interest in assuring that … federal laws are not undermined by conflicting state laws.” The letter went on to say that the right of Medicaid beneficiaries and providers “to vindicate federal Medicaid requirements further[s] the federal government’s interest in ensuring that the Medicaid program provides meaningful benefits to Medicaid recipients.”

On June 3, the National Senior Citizens Law Center released an evaluation of the brief, saying it “will eliminate what is often the only practical corrective mechanism for ensuring that federal Medicaid funds actually provide the treatments and services prescribed by Congress.”

The Acting Solicitor General’s argument arbitrarily carves safety net laws out from the protections of the Constitution’s supremacy clause. The brief charts a path for the Supreme Court to permit federal courts to continue routinely apply federal supremacy to strike down state laws protecting consumers, workers, retirees, bank depositors and others, alleged by business litigants to conflict with federal laws. This result hardly fits the administration’s often-proclaimed goal of promoting courts responsive to the needs of ordinary people rather than powerful interests.

I’ve written more about the possible link between the effects of this brief and those same “powerful interests” elsewhere. While the battle to end Medicare is being fought in an extremely public arena, the end of Medicaid as we know it is progressing swiftly and silently. Wall Street-driven private insurance companies (like Unitedhealth, Wellpoint, Amerigroup, Aetna) are already benefiting from the Affordable Care Act, buying up new Medicaid (and Medicare) contracts around the country. The problem is these companies routinely spend only about eighty percent of every federal dollar received. The twenty percent operating profit for the corporation, while generating great glee among shareholders, means a human price has been paid. Somebody’s medical services have been cut by twenty percent.

Many of us have been told that we should use our “natural supports” to provide services to ourselves and . . . → Read More: Parents are caregivers, not professionals]]> The National Organization to End Waiting Lists (NOEWAIT) has released a survey to gauge how often parents are told to rely on “natural supports” in caring for their children and loved ones with disabilities.

Many of us have been told that we should use our “natural supports” to provide services to ourselves and our kids – even in place of paid services. Do you have natural supports? Tell us if you do or not, and a bit about them.

This is an 8 question survey, anonymous and should take about 5 minutes or less.

This is for parents/guardians, caregivers and individuals with disabilities ONLY.

http://www.surveymonkey.com/s/JWWTXBF

Results, when completed, will be posted on the PAD-CO website. We will leave the poll open about 30 days.

http://www.ourwebs.info/indexpad.htm

Please copy and paste this post into your listservs and emails. Lets get as many responses as possible. Thank you

This poll was developed by Denver Fox, Ed.D. dnvrfox@aol.com

I encourage you to take NOEWAIT’s survey.

My concern is when a family is told to rely on natural supports as a justification either for cutting home Medicaid services, or refusing entrance into a Medicaid-funded program that delivers these home care services.

In the “new Medicaid math”, everyone with a disability is assigned a “risk code” which is used to determine how much the provider will be paid every month for that person. The state or federal government signs a contract with a for-profit HMO with guaranteed monthly checks written based on the sum of all these individual per-person-per-month rates. Most of these contracts do not stipulate any minimum percentage of these fees that the HMO needs to spend, and corporate profits are determined by how much is NOT spent.

One way that Medicaid providers keep costs down is to refuse to enroll high risk individuals. This has happened in my local community. The provider knows up front they will have a high Medical Loss Ratio (MLR) for that individual and for them, it’s not financially sound to accept the enrollment. I know of families where the child’s entrance into Medicaid was delayed for months, and other examples where it’s been denied for years.

The second way Medicaid providers keep the MLR low is by cutting existing services.

I don’t know about most of my readers, but my “natural supports” evaporated soon after discovering my daughter’s disabilities. Anyone trying to tell me to rely on “natural supports” is merely saying “thanks for saving me time and my employer money”.

What is more disturbing, however, are the skilled nursing evaluations that parents are being forced to take by these for-profit HMOs. The companies are trying to prove that parents and caregivers are sufficiently trained to replace professional care, which then justifies cutting service levels.

There is nothing in federal Medicaid regulations, the ADA, the Olmstead Decision or the Social Security Act that exempts people with disabilities living with their parents from the civil and legal rights enjoyed by every other person with a disability. When a for-profit insurer like UnitedHealth Group, whose profits rose 21% in 2010, orders a nursing skills test done on a parent, the only explanation possible is they are looking to reduce costs by cutting services.

I have added questions to our parent and caregiver survey to see how prevalent these practices are. Results so far are showing alarming rates of reductions, denials and failures to inform parents of home nursing and attendant support for their children.

The . . . → Read More: Survey shows the human toll of for-profit Medicaid cuts]]> The sample is small, but the results are unanimous: All respondents (41) reported being the victim of at least one illegal act by their state Medicaid providers. All nineteen states represented have violated US law, the provisions of The Social Security Act, the Americans with Disabilities Act and the Supreme Court’s Olmstead Decision.

The survey was designed to track state adherence to federal Medicaid rights and regulations. These initial indications paint a dark picture of institutionalized abuse and brutality of children with disabilities and their caregiving families by insurance companies and state Medicaid bureaucracies.

It is NOT happening because of budget cuts. It is happening because more and more state Medicaid provider contracts are being bought by companies that brag to stockholders about saving twenty cents out of every federal or state Medicaid dollar received.

For instance, every disabled child or adult in the state of Hawaii is receiving their Medicaid through a for-profit provider. The annual $1.3 billion budget is split between just two companies, UnitedHealth Group and Wellcare. UnitedHealth’s 2010 operating profit from premiums was 19.4%, up to 20.4% in the fourth quarter. Wellcare makes 15.6%, up from only 13.5% in 2009. The company commented in an SEC filing that the new higher premiums they were being paid in Hawaii were helping raise that profit margin.

Just for Hawaii, that profit margin translates into about $18 million every month that UnitedHealth and Wellcare do not spend of the federal and state Medicaid dollars they received. Eighteen million dollars a month that was intended to be spent on prescription medications, durable medical equipment, home nursing supplies and home care services has instead gone towards corporate profits.

A young man has had to begin dialysis three times a week because one of those two companies denied payments for twenty-two different medications he was already taking. A 14-year-old boy died in July 2009 when one of those companies refused to pay for a life-saving prescription. A ten-year-old boy has just died after the same cost-saving act.

Money destined to keep our children healthy and home should not be used to make Wall Street fatter. Please sign our petition to put a stop to putting our children’s medical decisions in the hands of for-profit insurance companies.

THE FULL EPSDT BENEFIT
EPSDT stands for Early Periodic Screening, Detection and Treatment. It is defined in the Social Security Act, and is a set of regulations that cover every child under the age of 21 enrolled in Medicaid. For children with intensive medical needs, EPSDT mandates they receive every medication, treatment and/or service that their doctors say are medically necessary.

George Washington University’s National Health Policy Forum outlined in 2006 what is now becoming officially known as “the full EPSDT benefit”:

EPSDT’s unique medical necessity standard is broad in scope to ensure access to care at a level consistent with each child’s medical needs. States are to provide all medically necessary services covered by Medicaid regardless of whether those services are part of the individual state’s Medicaid program. In other words, states must provide all federally defined Medicaid mandatory and optional benefits to children (see Appendix 1). While individual states may place limits on coverage for adults (for example, limits on mandatory benefits, no coverage for optional benefits) they do not have this discretion with respect to services for children. This federal treatment requirement and EPSDT’s definition of medical necessity results in uniform and comprehensive Medicaid coverage for children across the states, an aspect of Medicaid that is unique to coverage for children.

The comprehensive benefits and broad medical necessity standard of EPSDT allow Medicaid to meet the extensive needs of children facing serious, often life-long disease and disability. The presence of EPSDT guarantees access to specialized services frequently needed by children with chronic and high-cost medical needs … This extensive coverage protects children with disabilities and special health care needs from limits on services.

If Federal EPSDT funds are received by a for-profit insurance company, then high operating profits derive from lowering the Medical Loss Ratio by eliminating costs by denying, reducing or limiting medical services to the individual.

THE HUMAN COSTS OF LOWERING THE MEDICAL BENEFITS RATIO

For someone who does not live in a medical home environment, it can be hard to understand the human cost when daily medical supplies are denied or reduced.

The survey is showing that families are routinely denied necessary sterile medical supplies, prescriptions, and skilled home health care for their children. States are brazenly consistent in violating federal regulations mandating complete disclosure to the parents of “EPSDT-eligible” children of all the services they can access on their child’s behalf.

Forty of forty-one respondents are parents and family caregivers for children with disabilities, coming from 19 states.

Only two families reported they had been informed of all the major elements of EPSDT, four reported they had never been told anything.

Eighteen of twenty-five families reported Medicaid had denied or reduced requests for durable medical equipment like wheelchairs, commodes, bath lifts, etc.

Twelve of twenty-four families had had home nursing services denied or reduced, while another four had never been told their children were entitled to this.

Sixteen of twenty-five families had had prescribed occupational, physical and/or comunications therapies denied or reduced by Medicaid.

Sixteen of twenty-four families had had prescribed medictations denied or reduced by Medicaid.

Nine of twenty-three families had never been told Medicaid would pay for their child’s travel to out-of-state specialists, while three had had such requests outright denied.

“Case management” is mandated under federal law for everyone with disabilities receiving Medicaid. Thirteen respondents didn’t know who their child’s case manager is, two families reported never having a case manager and two reported not hearing from the case manager in months (also a federal violation).

“Uniform and comprehensive coverage” should mean, for instance, that every child, regardless of where they live, is entitled to the supplies needed for their feeding tubes. This include things like the mic-key button, which costs about $150, and extension tubes, which cost about $10. The mic-key button itself is inserted into the child’s stomach. If it is there longer than a month, the skin begin to attach to it. The longer it is there, the worse the wound that is created when it is changed. As for the extension tubes, when the kids are hospitalized there is a new one every day. No one would dream of trying to completely sterilize these things.

Instead, here is what parents are reporting receiving:

“We were told 3 or 4 buttons per year. 2 extension tubes per month (we need at least 3)”

“2 extension set for g tube need 3-4 per month”

“g tube button 4 per year”

“I was told 2 mickey’s per year and 2 extention tubes per month.”

“1000ml bottles of sterile water and sterile saline cut in 3/10 from 46 1000ml bottles a month to 18 per month.only allowed 4 extentions a month could use a couple more because tubing not so easy to keep clean.Pulse oxcimiter became a paid up item 5/10 so no longer allowed to get the cable that attaches the probes use to get 3-4 a year.”

“We have two children on MA have to fight to get extentions even when our state says we can have 6 per month or supplier has been told they can only bill for 2 at a time. One of our boys has a trach and we have trouble getting some of those.”

“I don’t know if this counts as medical supplies, but right now Medical won’t pay enough for my daughter’s seizure medication. This month the pharmacy said they’d take a loss and give it to us, but that they couldn’t keep doing that, and that Medical needed to cover at least the pharmacy’s cost of the medication.”

“extensions only 4 per month”

“Was told 1 Mic-Key button every 3 months”

“We have been given limits on quantity, quality, and brand of diapers. We have successfully fought the brand issue but not the absorption level. We have been denied items such as diaper liners despite a neurogenic bladder. We have been denied seating options despite being medically prescribed and justified. Bath chairs and commode chairs are not deemed medically necessary and are not covered. These are just a few examples.”

“Everything. Mickey buttons only 4 per year ( needs at least 1 every other month), Feeding bags 30 per month (needs 31 on months there are 31 days), syringes 10 per month (Needs 20), trachs 4 per month, trach ties 4 per month, oxygen tubing 4 per month, nebulizer masks and nebulizer kits 1 every 3 months, Mickey extensions 4 per month, Suction supplies 1 every other month and many other things. Oxygen Saturation Sensors that hook up to the Pulse Ox machine are impossible to get medicaid to cover.”

“Only 1 mic-key button every 3mos. either diapers or underpads but not both, because you know the diapers they provide hold so well! Only one suction swab per day, but his medication has to be applied twice daily. Only 15 days supply of medication at a time because it’s too expensive?!?! no oral swabs (unless they are suction). only 20 syringes/mo. ”

“mic-key, extension tubing, pulse oximeter, formula, in home nursing, pharmacy- prevacid for gerd now 11+ yrs old and diagosed since then. bathing chairs with transfer base. We live in 2 story home with daughter 12 yrs. now totally non mobile and it takes 2 adults to help carry and bathe. stroller to take her out on outings into community.”

“Extension tubes limit to 10 per month. She needs at least 15. Mic-key limit is 7 per year, she needs 12 at least.”

“Trach straps – 4 per month, mic-key – 2 per year, custom trach – 2 per year, electrodes – 30 per month (dropped from 60 per month)”

If you have not yet taken our survey, please do so. There are actually two different ones: This one is for the caregivers of individuals currently receiving Medicaid, and this one is for people who are on a waiting list for Medicaid home services.

Fourteen year old Mycal Johnston drowned from the . . . → Read More: Death by Medicaid: the victims of Olmstead’s failure]]> Politicians, bureaucrats and insurance company executives make decisions about life-saving medical care for people with disabilities every day. When those decisions are based on financial considerations, such as the size of profit made by the company providing the care, Olmstead fails and people may die.

Fourteen year old Mycal Johnston drowned from the fluid in his lungs on July 12, 2009. He had been discharged on June 24 from Oahu’s Kapiolani Children’s Hospital, with a prescription to fill at home for the one drug specialists had found that could control this life-threatening symptom of Mycal’s cystic fibrosis. Wellcare was receiving more than $15,000 dollars a month from the state of Hawaii to provide Mycal with his Medicaid services, but by refusing to provide him with a primary care physician the company was able to deny filling the prescription until Mycal died.

More of Mycal’s story is told on Disability Mom’s blog.

In May 2010, a Honolulu man may have attempted suicide when he was shot by an off-duty FBI agent. Research showed that he had been off his medications since January, not purposefully, but because Wellcare refused to provide him with a primary care physician who could authorize the prescriptions.

Erik Sorensen died because he turned 21. The monthly payment Wellcare was receiving from the state of Hawaii went from almost $12,000 a month to less than $6,000, while his scheduled nursing and personal care assistants were costing Wellcare over $10,000. They slashed his services to fit his budget, and Erik later stated in a deposition filed in Hawaii District Court that he felt strongly that Wellcare was threatening to institutionalize him if he did not accept the reduction in services.

If Erik had been institutionalized, Wellcare would have gone back to receiving more than $10,000 a month for his care.

More about his story is written here.

Worse yet is the plight of hundreds of thousands of people with disabilities who are on waiting lists for Medicaid services. Federal law prohibits Medicaid-eligible children under the age of 21 from being placed on any kind of waiting list for servces, but there is anecdotal evidence that many states disregard this right.

Individuals who did not make it into Medicaid before they turned 21 can then sit on waiting lists for services for up to thirty years.

Olmstead has failed them as well.

The Georgia Advocacy Office sent the following email back, with direct contact information for anyone else in Georgia needing similar help.

Your email was forwarded to me for . . . → Read More: Help for parents who can’t get Medicaid to pay for diapers]]> After receiving three separate complaints from Georgia moms unable to get diapers from Medicaid, I went to find somebody in Georgia would could provide direct help.

The Georgia Advocacy Office sent the following email back, with direct contact information for anyone else in Georgia needing similar help.

Your email was forwarded to me for reply. I have read the comments on your website from the Georgia mom’s and the advice posted about getting a prescription for the diapers and other supplies. We would certainly like to speak to these mom’s directly to find out if they need further assistance to get the supplies / services that their children need from Georgia Medicaid.

Please ask the Georgia parents to contact Resource Advocacy at the Georgia Advocacy Office. They can speak to either myself or to my supervisor, Denise Quigley.

For people who live in metro-Atlanta the phone number is 404-885-1234. Outside of metro-Atlanta the phone number is 800-537-2329. Both numbers are voice and TTY.

Thanks.

Donna Champion
Resource Advocate
dchampion@thegao.org

For those of you in other states who are having problems getting diapers, there are similar disability law centers in every state. They are called Protection and Advocacy Centers (P&As for short). They are federally funded, but each state’s P&A can have different priorities. Contacting your state P&A is the best way to start, though, because if they aren’t working directly on the issue, they should be able to tell you who is.

Here is a list of all the state P&As. I also found a great description of the P&As on Disaboom’s website.

You are still going to need to have a prescription for the diapers from your child’s doctor. The doctor will submit that along with your particular state’s version of its Medicaid “request for authorization form”. There’s a time limit for Medicaid to respond, and if they deny it or don’t respond within the legal time limit (in my state it’s two weeks), then you call your P&A.

I would like to start keeping a list of local state contacts, including private attorneys, who can help parents obtain Medicaid services for our kids. Please email me with any information and I’ll start an online resource center.