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Federal laws state, in no uncertain terms, that your state Medicaid provider cannot deny, limit or reduce what your physician says is “medically necessary.” I’m going to start by saying I am not a lawyer. I’m a mom, of an eleven year old girl who has severe brain damage and non-stop seizures. In 2002, . . . → Read More: Letters of Medical Necessity: When your doctor becomes a partner in advocating for your child A discussion recently came up on a mailing list I belong to about how many mic-key buttons the kids were getting through Medicaid. It ranged from twelve a year down to two per year. For those who don’t know, a mic-key button is a two inch long piece of plastic with an inflatable balloon . . . → Read More: What federal law entitles our children to By Summer Harrison, on December 17th, 2009 Two court decisions handed down by a US Federal District Judge in Georgia have essentially made a civil crime out of denying our children their medical legal rights. The bottom line effect of these decisions is to give parents and caregivers a level of control over deciding . . . → Read More: Major court victories for our kids’ legal medical rights By Summer Harrison, on December 31st, 2009 Medical necessity is the defining factor for all Medicaid services accessed through EPSDT (for children on Medicaid under 21) or any participants in a state’s 1115 or 1915 Medicaid waiver programs. The tendency over the past years has for states to try to exert control over determination . . . → Read More: EPSDT and “Medical Necessity” By Summer Harrison, on February 22nd, 2010 The primary function of the Early Periodic Screening, Detection and Treatment program (EPSDT) is to ensure all kids on Medicaid get appropriate medical care, including all the normal baby exams, vaccines and the like. But for children with disabilities, EPSDT also includes a wide, sweeping civil right . . . → Read More: Understanding EPSDT and the rights it gives your child By Summer Harrison, on January 31st, 2010 A federal court decision in Florida last week has highlighted the fact that some states are still refusing to provide diapers to children covered under EPSDT. Diapers are a medically necessary service under EPSDT. All you need is a prescription from your doctor and letter of medical . . . → Read More: Diapers are a covered service under EPSDT BY SUMMER HARRISON, ON NOVEMBER 15TH, 2009 In December of 2008, Hawaii’s Developmental Disability Division of the Department of Health sent a letter out to participants in the state’s DD waiver program, announcing an across the board cut of 15% in home and community based services. The written decision issued by the Department of . . . → Read More: Hawaii DOH appeal decision opens the door for restoration of Medicaid waiver cuts By Summer Harrison, on January 6th, 2011 We have released two surveys that will help us see how well the states are following federal Medicaid statutes with regard to children and adults with disabilities. The first survey collects information based on the experiences of children and adults with disabilities currently enrolled in Medicaid. The . . . → Read More: Surveys will document compliance with Medicaid regulations protecting children and adults with disabilities By Summer Harrison, on January 5th, 2011 A discussion recently came up on a mailing list I belong to about how many mic-key buttons the kids were getting through Medicaid. It ranged from twelve a year down to two per year. For those who don’t know, a mic-key button is a two inch long . . . → Read More: Are our kids getting all the help they are entitled to under the law? By Summer Harrison, on September 26th, 2009 A report by the Government Accounting Office released Wednesday raises concerns about states’ use of stimulus funds, citing “internal control deficiencies”. The report notes the “possible risk for the quality and reliability of these data” received from the states. The three recommendations made in the report all . . . → Read More: GAO report cites state lack of accountability for stimulus funds |
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