Likely,
most parents whose children have Medicaid for insurance have
seen examples of illogical, wasteful spending related to their
childrens' care. Nancy is convinced, from her own experience, that
there is a tremendous amount of needlessly spent monies. But at the
same time, there are children who are denied essential needs, and whose
families spend enormous amounts of time and emotional energy fighting
those denials. This information, based on real life examples and good
ol' common sense, often doesn't filter up to the people who can make
policy changes.Nancy intends to make legislators and VT State officials aware of what parents and families are experiencing, and their suggestions for effective, money-saving changes. She hopes it will eventually force VT Medicaid to address inefficiencies in the system and learn how to better use the available dollars.
The questions asked in her article were: Do you feel that Medicaid dollars are being spent on care or equipment that isn't helpful for your family? Are there better ways to apply those dollars in your case? Here are a few responses:
$1000 Lift Story: As Chris grew, caregivers hurt their backs lifting him; his mom, Nancy, had to lift him- having no choice. After much research, the family requested a one-point ceiling track lift with compatible sling. Chris successfully used this system at school. His mom and support professionals knew the lift and sling that Medicaid wanted to purchase was not adequate to transfer him safely. But Medicaid would only purchase the totally inadequate lift and sling; a minimum of two adults were needed to stabilize him. During a consultation with an experienced nurse, the lift actually got stuck, causing Chris to fall through the sling; taking the nurse, the physical therapist, the mom, the aide and Chris' RN to extricate him from the sling and free the lift. After nine months of appeals, countless hours of advocating and also professionals' time writing justification reports, letters of necessity, and the involvement of the Agency of Human Services, Medicaid finally purchased the proper system for Chris. The $1000 original lift and sling sit unused in the garage.
$700 Brace story: Another parent needed to have her son's braces repaired. She initially went to a large Orthotic and Prosthetic laboratory in VT. She inadvertently found out that the lab would bill Medicaid $700 for the repair. Concerned about this high cost, the parent decided to take the braces to a local shoemaker. The shoemaker charged her $12 for the repair!
Stock Pile Story: Due to a tracheotomy, Jason (a ficticious name) required suctioning and needed saline bullets. Jason's need for saline fluctuated from one month to another. At the end of some months when less saline had been used, Jason's parents would only request what was needed to bring their saline supply up to an average month's level. The rationale (and reasonably so) was that they could just get more if needed. It was learned, however, that if they didn't take a full month's supply, Jason was in danger of losing his monthly supply for good!
Jason's parents started what they had never intended to do - stock pile the saline. It resulted in a waste of supplies and money! Why couldn't there be a system in place to only get what the child needed each month - without a huge hassle? Wouldn't this save money? It would also save time for the parents having to fight for supplies.
$100 Diaper Story: Lisa qualifies under Katie Beckett for prescription and therapy benefits. Both are central to the family's financial stability.
Lisa's family receives a diaper benefit; her mother reports that she would regularly select diapers from the store shelf, bring the box (valued at $23.90) to the pharmacy counter, and watch them bill Medicaid $98 for the same box! Although the pharmacy was billing high, it was probably not being reimbursed at that level as Medicaid reimburses only 60 cents on the dollar. Who benefits from the excessively high billing rate? Higher billing means escalating costs all around, ultimately affecting services and benefits.
Vermont families and parents care deeply about the wise use of Medicaid dollars. They can impart logical and practical suggestions. Nancy's idea is that all of those wastes, combined, could add up to significant savings. She says: "We are all in this together, it seems only right that by working directly together we can make better choices and outcomes for Vermont's families and Vermont Medicaid." Y
