Tag Archives: ACA

Happy One Year Placement Anniversary David

honesty doesnt make us bad parentsIronically, the day after we receive notice of denial of coverage of services for our son, is the anniversary of his placement at the current facility.  It has been one year since we placed David in a facility 500 miles from home.

Today, I am struggling with the stress of not knowing where we are at with my youngest son’s mental health treatment.  The denial of continued care is weighing heavily on my mind, and it will be Tuesday before I can file any appeals.

He deserves better than this from the system that is responsible in part for his care.  When we adopted him, he was ordered by the court to have complete state sponsored medical coverage until he turns 18.  This is Medicaid.

It isn’t safe for anyone for him to come home.  Even the staff that works with him day to day has said that.  A month ago, he was self-harming.  Cutting, and after they took the sharps away from him, he inserted his fingers into the wound on his knee and started pulling on it to make the wound larger.  Initially, he wouldn’t have needed stitches. The manic behaviours that he displays, the ceaseless energy – coupled with what changing facilities would do to his treatment plan… now is not the time for change.

As a father, I want to fix it and make it better.  I can’t do that, and while it isn’t my fault that the system is broken, I feel like a failure for not providing direct care for him.

Yesterday marks one year since he began his placement in the current facility.  The next closest facility that could take him if necessary is 700 miles away from our home, in Denver.  Like I said in a previous post, how does moving him further from family help him?

I am not looking for a debate about the ACA. I know what it is and isn’t doing for the people I know. It works for some, and doesn’t work for others.

About a month ago, I wrote a post “It’s not our fault.”  I guess I should go and read that one again.

I have this book that I am working through.  “Getting Your Joy Back” – I am going to read through parts of it again.  Need to find my joy.  And know in my heart that we are doing everything that we can for him.

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 policy change?

Adoption

When we adopted David, a part of the adoption decree was court ordered Medical Assistance until he is 18.  This is because he was a special needs adoption and would have ongoing health care needs. We didn’t request special consideration for medical assistance, it was granted automatically as part of the adoption process for special needs children.

Today I was notified by the PRTF where he resides, that medicaid rejected the invoice stating that David’s case was closed.

So I called our county social services office and asked about it.  Seems we have to reapply every year for his benefit even though it is court ordered.  This is a first for us.  We have never had to apply for it before, even before the adoption was finalized.

I don’t understand this.  It is a simple thing to complete the paperwork.  It is 23 pages.  That isn’t my point.  How can they arbitrarily deny him a coverage that was court ordered?

I just don’t understand.  Lucky enough, the social worker works for the state and not the federal government.

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