A Bad Medicaid DME Ruling Reversed in Missouri

[Guest guest]

Anyone from Missouri on this list?

From National Council on Independent Living

On March 2, 2007, a federal district court ordered Missouri to cease

enforcement of a 2005 emergency Medicaid regulation that reduces the

availability of durable medical equipment (DME) for most of the

state's categorically needy Medicaid beneficiaries (Lankford v.

Sherman, W.D. Mo., No. 05-4285, 3/2/07). Acting on remand from the

U.S. Court of Appeals for the Eighth Circuit, Judge Dean Whipple of

the U.S. District Court for the Western District of Missouri issued a

permanent injunction requiring the state to " amend its current DME

program to comply with Medicaid's reasonable-standards requirement "

that state Medicaid programs use reasonable, nondiscriminatory

standards in treating recipients. Seven disabled Medicaid recipients

and 10 public advocacy groups filed the lawsuit in August 2005,

claiming the emergency regulation precluded them from Medicaid

coverage for items such as orthotics, catheters, hospital beds, bed

rails, lifts, and repair items. The regulation did maintain full DME

coverage for categorically needy blind recipients.

Full text of the decision is available at http://op.bna.com/hl.nsf/r?

Open=thyd-6z4u7h.

[Guest guest]

Are you working with advocates to sway it? Any legislative staffers

proving to helpful?

>

> Yeah... unfortunately the legislature now has 3 choices:

>

> 1) keep the coverage restoration

> 2) figure some other way to exclude people from coverage

> 3) drop coverage of DME entirely

>

> Given the present legislature makeup and attitude, I'm really worried

> that they'll take option #3.

>

>

[Guest guest]

I am worried about what the present legislature will do, also. The

sad part is they don't get it. They cut these DME services thinking

they are saving 'the almighty dollar' but in the end it really

doesn't. I've lived in MO my whole life and am really fearful of what

our Governor will cut next.

>

> Yeah... unfortunately the legislature now has 3 choices:

>

> 1) keep the coverage restoration

> 2) figure some other way to exclude people from coverage

> 3) drop coverage of DME entirely

>

> Given the present legislature makeup and attitude, I'm really worried

> that they'll take option #3.

>

> Alana wrote on 03/12/07 15:47:

>

> > Anyone from Missouri on this list?

> >

> >>From National Council on Independent Living

> >

> > On March 2, 2007, a federal district court ordered Missouri to cease

> > enforcement of a 2005 emergency Medicaid regulation that reduces the

> > availability of durable medical equipment (DME) for most of the

> > state's categorically needy Medicaid beneficiaries (Lankford v.

> > Sherman, W.D. Mo., No. 05-4285, 3/2/07). Acting on remand from the

> > U.S. Court of Appeals for the Eighth Circuit, Judge Dean Whipple of

> > the U.S. District Court for the Western District of Missouri issued a

> > permanent injunction requiring the state to " amend its current DME

> > program to comply with Medicaid's reasonable-standards requirement "

> > that state Medicaid programs use reasonable, nondiscriminatory

> > standards in treating recipients. Seven disabled Medicaid recipients

> > and 10 public advocacy groups filed the lawsuit in August 2005,

> > claiming the emergency regulation precluded them from Medicaid

> > coverage for items such as orthotics, catheters, hospital beds, bed

> > rails, lifts, and repair items. The regulation did maintain full DME

> > coverage for categorically needy blind recipients.

> >

> > Full text of the decision is available at http://op.bna.com/hl.nsf/r?

> > Open=thyd-6z4u7h.

> >

> >

> >

> >

> >

> > A FEW RULES

> >

> > * The list members come from many backgrounds, ages and beliefs So all

> > members most be tolerant and respectful to all members.

> >

> > * Some adult language and topics (like sexual health, swearing..) may

> > occur occasionally in emails. Over use of inappropriate language will

> > not be allowed. If your under 16 ask your parents/gaurdian before you

> > join the list.

> >

> > * No SPAMMING or sending numerous emails unrelated to the topics of

> > spinal muscular atrophy, health, and the daily issues of the

disabled.

> >

> > Post message:

> > Subscribe: -subscribe

> > Unsubscribe: -unsubscribe

> >

> > List manager: (Sexy Mature Artist) Email: Esma1999@...

> >

> >

> >

> >

> > oogroups.com

> >

> > List manager: (Sexy Mature Artist) Email: Esma1999@...

> >

> >

> >

> >

> >

> >

[Guest guest]

Yeah... unfortunately the legislature now has 3 choices:

1) keep the coverage restoration

2) figure some other way to exclude people from coverage

3) drop coverage of DME entirely

Given the present legislature makeup and attitude, I'm really worried

that they'll take option #3.

Alana wrote on 03/12/07 15:47:

> Anyone from Missouri on this list?

>

>>From National Council on Independent Living

>

> On March 2, 2007, a federal district court ordered Missouri to cease

> enforcement of a 2005 emergency Medicaid regulation that reduces the

> availability of durable medical equipment (DME) for most of the

> state's categorically needy Medicaid beneficiaries (Lankford v.

> Sherman, W.D. Mo., No. 05-4285, 3/2/07). Acting on remand from the

> U.S. Court of Appeals for the Eighth Circuit, Judge Dean Whipple of

> the U.S. District Court for the Western District of Missouri issued a

> permanent injunction requiring the state to " amend its current DME

> program to comply with Medicaid's reasonable-standards requirement "

> that state Medicaid programs use reasonable, nondiscriminatory

> standards in treating recipients. Seven disabled Medicaid recipients

> and 10 public advocacy groups filed the lawsuit in August 2005,

> claiming the emergency regulation precluded them from Medicaid

> coverage for items such as orthotics, catheters, hospital beds, bed

> rails, lifts, and repair items. The regulation did maintain full DME

> coverage for categorically needy blind recipients.

>

> Full text of the decision is available at http://op.bna.com/hl.nsf/r?

> Open=thyd-6z4u7h.

>

>

>

>

>

> A FEW RULES

>

> * The list members come from many backgrounds, ages and beliefs So all

> members most be tolerant and respectful to all members.

>

> * Some adult language and topics (like sexual health, swearing..) may

> occur occasionally in emails. Over use of inappropriate language will

> not be allowed. If your under 16 ask your parents/gaurdian before you

> join the list.

>

> * No SPAMMING or sending numerous emails unrelated to the topics of

> spinal muscular atrophy, health, and the daily issues of the disabled.

>

> Post message:

> Subscribe: -subscribe

> Unsubscribe: -unsubscribe

>

> List manager: (Sexy Mature Artist) Email: Esma1999@...

>

>

>

>

> oogroups.com

>

> List manager: (Sexy Mature Artist) Email: Esma1999@...

>

>

>

>

>

>

[Guest guest]

Alana,

The ones who voted in the Medicaid cuts that knocked 100,000 people off

the roles are the ones controlling things. They pretty much aren't

listening to anyone else. In fact, they held secret meetings (that

excluded the Democratic Party) on the future of Medicaid-type services

here. In case you don't know, they voted to END Medicaid as a program

here in the summer of 2008. They did this knowing that they had nothing

planned out to replace it. It is to be replaced by Missouri HealthNet.

They saved something like $168 million last year by cutting, and ran

something like a $200 million surplus for the year, adding to the

surplus from the previous year. I hear they gave up something close to a

billion dollar in matching Federal dollars with these cuts. All these

figures are off the top of my head, so I may be off a bit on them, but

the gist of them is right.

Now, the same people that have done this have instituted tax cuts (in

the House) of $200-$485 million (they're not sure of the exact impact

yet). Even its proponents say that the state budget -- with all the

present Medicaid cutbacks -- cannot withstand this much of a tax cut.

They are saying that the exact amount of the cuts and the problems

associated with them " will be fixed in the Senate. "

That's not the half of it. Prevention is going to be the key mantra.

Everyone is to have a " Healthcare Home. " All that is just a fancy term

for being in an otherwise-named HMO with a family practice doctor as the

gate-keeper for all care.

The doctor is also supposed to come up with a plan of care for you that

you must follow in order to " make points. " If you make enough points,

such as losing weight, and eat right, and quit smoking, and make all

your doctor's appointments, then maybe you can use the points to get

meds, or glasses, or maybe a trip to the dentist. Never mind that there

are basically no dentists that will take Medicaid, and the only glasses

that Medicaid will pay for are so useless that going without is almost

as good...

The ones making all of these decisions are not listening to anyone else.

The initial impetus for all of it was our Governor Blunt.

It's not a good time to move to Missouri...

Alana wrote on 03/12/07 17:20:

> Are you working with advocates to sway it? Any legislative staffers

> proving to helpful?

>

>

>

>>Yeah... unfortunately the legislature now has 3 choices:

>>

>>1) keep the coverage restoration

>>2) figure some other way to exclude people from coverage

>>3) drop coverage of DME entirely

>>

>>Given the present legislature makeup and attitude, I'm really worried

>>that they'll take option #3.

>>

>>

>

>

>

>

>

> A FEW RULES

>

> * The list members come from many backgrounds, ages and beliefs So all

> members most be tolerant and respectful to all members.

>

> * Some adult language and topics (like sexual health, swearing..) may

> occur occasionally in emails. Over use of inappropriate language will

> not be allowed. If your under 16 ask your parents/gaurdian before you

> join the list.

>

> * No SPAMMING or sending numerous emails unrelated to the topics of

> spinal muscular atrophy, health, and the daily issues of the disabled.

>

> Post message:

> Subscribe: -subscribe

> Unsubscribe: -unsubscribe

>

> List manager: (Sexy Mature Artist) Email: Esma1999@...

>

>

>

>

> oogroups.com

>

> List manager: (Sexy Mature Artist) Email: Esma1999@...

>

>

>

>

>

>

[Guest guest]

One of many articles:

‘HealthNet’ gets hearing

http://www.columbiatribune.com/2007/Mar/20070307News033.asp

[Guest guest]

Can I quote you in my blog? I blogged a similar situation with 323,000

culled from the rolls of Tennessee Medicaid. See that here:

http://nickdupree.blogspot.com/2007/03/more-about-culling-of-sick-in-tn-also.htm\

l

Jeff wrote:

> Alana,

>

> The ones who voted in the Medicaid cuts that knocked 100,000 people off

> the roles are the ones controlling things. They pretty much aren't

> listening to anyone else. In fact, they held secret meetings (that

> excluded the Democratic Party) on the future of Medicaid-type services

> here. In case you don't know, they voted to END Medicaid as a program

> here in the summer of 2008. They did this knowing that they had nothing

> planned out to replace it. It is to be replaced by Missouri HealthNet.

> They saved something like $168 million last year by cutting, and ran

> something like a $200 million surplus for the year, adding to the

> surplus from the previous year. I hear they gave up something close to a

> billion dollar in matching Federal dollars with these cuts. All these

> figures are off the top of my head, so I may be off a bit on them, but

> the gist of them is right.

>

> Now, the same people that have done this have instituted tax cuts (in

> the House) of $200-$485 million (they're not sure of the exact impact

> yet). Even its proponents say that the state budget -- with all the

> present Medicaid cutbacks -- cannot withstand this much of a tax cut.

> They are saying that the exact amount of the cuts and the problems

> associated with them " will be fixed in the Senate. "

>

> That's not the half of it. Prevention is going to be the key mantra.

> Everyone is to have a " Healthcare Home. " All that is just a fancy term

> for being in an otherwise-named HMO with a family practice doctor as the

> gate-keeper for all care.

> The doctor is also supposed to come up with a plan of care for you that

> you must follow in order to " make points. " If you make enough points,

> such as losing weight, and eat right, and quit smoking, and make all

> your doctor's appointments, then maybe you can use the points to get

> meds, or glasses, or maybe a trip to the dentist. Never mind that there

> are basically no dentists that will take Medicaid, and the only glasses

> that Medicaid will pay for are so useless that going without is almost

> as good...

>

> The ones making all of these decisions are not listening to anyone else.

> The initial impetus for all of it was our Governor Blunt.

>

> It's not a good time to move to Missouri...

>

> Alana wrote on 03/12/07 17:20:

>

> > Are you working with advocates to sway it? Any legislative staffers

> > proving to helpful?

> >

> >

> >

> >>Yeah... unfortunately the legislature now has 3 choices:

> >>

> >>1) keep the coverage restoration

> >>2) figure some other way to exclude people from coverage

> >>3) drop coverage of DME entirely

> >>

> >>Given the present legislature makeup and attitude, I'm really worried

> >>that they'll take option #3.

> >>

> >>

> >

> >

> >

> >

> >

> > A FEW RULES

> >

> > * The list members come from many backgrounds, ages and beliefs So all

> > members most be tolerant and respectful to all members.

> >

> > * Some adult language and topics (like sexual health, swearing..) may

> > occur occasionally in emails. Over use of inappropriate language will

> > not be allowed. If your under 16 ask your parents/gaurdian before you

> > join the list.

> >

> > * No SPAMMING or sending numerous emails unrelated to the topics of

> > spinal muscular atrophy, health, and the daily issues of the disabled.

> >

> > Post message:

> <mailto:%40>

> > Subscribe: -subscribe

> <mailto:-subscribe%40>

> > Unsubscribe: -unsubscribe

> <mailto:-unsubscribe%40>

> >

> > List manager: (Sexy Mature Artist) Email: Esma1999@...

> <mailto:Esma1999%40aol.com>

> >

> >

> >

> >

> > oogroups.com

> >

> > List manager: (Sexy Mature Artist) Email: Esma1999@...

> <mailto:Esma1999%40aol.com>

> >

> >

> >

> >

> >

> >

[Guest guest]

Oh... I'd rather you didn't, mainly because that was all off the top of

my head. I would be glad to send you a whole bunch of articles about it,

though, if you like.

jeff

Nick Dupree wrote on 03/12/07 23:50:

> Can I quote you in my blog? I blogged a similar situation with 323,000

> culled from the rolls of Tennessee Medicaid. See that here:

>

>

http://nickdupree.blogspot.com/2007/03/more-about-culling-of-sick-in-tn-also.htm\

l

>

>

>

> Jeff wrote:

>

>

>>Alana,

>>

>>The ones who voted in the Medicaid cuts that knocked 100,000 people off