The answer should be yes. Not "how can I get my loved one help?"

Category Archives: medicaid

filing an appeal with medicaid.

While the state is actively reviewing David’s case, we are going to file an appeal.

Not sure what will happen, but this way, no one can say we didn’t exhaust all measures.   It seems strange to me to have to appeal something that he was ordered by the court to have until he is 18.  Usually, one files an appeal to get out of whatever court order is in place.

At any rate, that is all to report today.

Cheers.

Carl

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Medicaid, still no resolution

Well, it has been a week since we learned that David’s Medicaid would be closed and that we would have to reapply in the state where the PRTF level facility he resides is located.   Still no resolution.  But we have a variety of people from the state working on it, and I am creating a case history with our state Protection and Advocacy agency in regards to this.

Why?

It isn’t just because he has Medicaid and they should have to cover the expenses.  He was court ordered to have Medicaid provided on his behalf until he turns 18.  The key here is Court Ordered.  That means that  a judge says he has to have it.   It isn’t an entitlement in the sense that most people are thinking.  I didn’t apply for him to have medicaid.  It came with him as part of his adoption.

Where I am struggling is:

  1. The state where he is in PRTF level care is Montana.
    1. In Montana, PRTF level of care is an “optional MA service”.  Meaning that even if we apply for Medicaid there, and he is accepted, they can say no.
  2. I was asked who placed David in the facility.
    1. This is a rather gray area.  When we left his last placement, no other facility in our state would accept him.  His current facility in Montana even questioned why he was there, as he was leaving one facility for another facility just like it.  Which we agree with, but what can we do?  I can’t force him into the care of a facility that doesn’t want him.
    2. Does it really matter who placed him?  He has court ordered Medicaid until he turns 18.  We went through all of the Interstate Compacts and Approvals prior to driving him 550 miles from home to place him in that facility.  All of the necessary paperwork was completed.  If this is really an issue, shouldn’t it have been an issue before placement?
    3. If someone decides he isn’t supposed to be there, then where is he supposed to be?  I honestly don’t think that he is ready to be at home.  So where does he go?  If no facilities in our state will accept him, what other options are available?
  3. His current placement was not our first choice.  I would much rather him be within our state so that we could see him quite a bit more than we do.  We used to see him every week, sometimes I would see him twice a week.  Since January, I have seen him twice.  Mom has seen him once, and he hasn’t seen his siblings since Christmas.

Is this an ideal situation?  Of course not.  I wouldn’t wish this on anyone.  But this really isn’t about me.  This is about what is best for David.

David doesn’t deserve this limbo that he is in.  For that matter neither do his mother or I.  We just want the care that he needs, we want what the state agreed to when his adoption was finalized.

I guess above all, what I remember each day is this.  He is my son.  That will never change.

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Medicaid, Medicaid, Medicaid, you frustrate me so….

David is adopted.  He was a special needs adoption.  Not because of all of the mental health concerns, but because of his race.

As part of the adoption, he was court ordered to have access to Medicaid.

It seems like every time we turn around, we are fighting for David.  For things that David needs.  Today I received a telephone call regarding his Medicaid.

Evidently because his treatment center is in another state, and because he is a subsidized adoption, we have to apply for Medicaid in the state where the treatment center is.

Why does it seem like every week there is a new road block to surmount?

Today, I was informed that our county will be closing David’s Medicaid, effective the end of the month and that I need to apply for Medicaid in the other state.  Even though we don’t live there.  Even though this isn’t a permanent placement.

Why?  Because he is a subsidized adoption.

I asked, if he wasn’t a subsidized adoption, would it make a difference?

The social worker didn’t know.