A IMPORTANT MESSAGE AND CALL TO ACTION FROM OUR DIRECTOR OF FAMILY SUPPORT SERVICES FOR PENNSYLVANIA FAMILIES, FOLLOWING YESTERDAY'S RALLY AT THE ROTUNDA PROTESTING MA CO-PAYS:
Good afternoon everyone,
I truly appreciated the opportunity to be able to advocate in this capacity to fight for our consumers and families. I truly believe though in my heart, that anyone could have gone up to that podium and did what I did yesterday. Our passion and fight is fueled and inspired by loved ones and/or consumers who have touched our hearts, who need our tireless advocacy efforts to give them every chance in this world to be successful.
In brief, we consider the rally to have been a success, despite the fact that we did not pull the attendance we had hoped for. We know how difficult travel is, the cost involved, and other factors. Thankfully, the rally is getting local, state, and through some bloggers and organizations, national attention.
Many articles and news stories, however, are unfairly projecting false, “regurgitated information” from the DPW. They talk about families needing to “contribute their fair share,” or how “it’s only $1-$3 per service,” or… “we’re looking at 200% of the poverty level,” or “we have no choice with this economy.”
Yes, WE DO HAVE A CHOICE.
Here are some facts that may
be used as rebuttals, and talking points for staff who are willing, and families, the rest of the week:
Point 1: 200% of the poverty level, for your average middle class, is not an exorbitant amount of money. $42,000, for example, spread across a family of four, is tough enough when figuring in a mortgage, utilities, groceries, clothing, car payments, private insurance premiums, etc. Figure into that the costs involved with caring for a child with a diagnosis who requires countless extra expenses, and you will have a family facing dire struggle. Even families pulling *double* this amount could easily struggle. Some families have caregivers with their own health-care related expenses. The point is that we do not know a family’s unique situation, and to not give consideration to that and just automatically expect up to 5% of a family’s income because their child or teen has a diagnosis is ludicrous. No other category of Medical Assistance will require this outrageous contribution.
Point 2: The bulletin bypassed the state regulatory process as per Act 22, which permits the DPW Secretary, Gary Alexander, to move forward by any means “necessary” to control or alleviate the budget. This bulletin is being pushed through “quietly” (er, not so quiet now) at the eleventh hour as implementation for new recipients is slated to start Monday.
Point 3: “Imposing co-pays will save $9.4 million a year.” THIS IS FALSE. Less than half of the money collected would go to the State of Pennsylvania due to Federal Match Dollars. The state has to *spend money* to *get money.*
Point 4: In terms of those affected by autism, EXISTING LEGISLATION – which is Act 62; a powerful law – if enforced, would force the hand of 70% of private carriers who would no longer permitted to find a way to exclude the diagnosis. Furthermore, enforcing the Mental Health Parity Act would force private carriers to release the $36,000 annual cap on services. Though autism is not a “mental health disorder,” oftentimes our consumers have co-morbid mental health diagnoses and presenting symptomology.
Point 5: This isn’t just about children with autism. Children with any diagnosis qualifying them under PH95 will be hit. Our children and teens impacted by a behavioral health diagnosis only have little to no support from a private insurance carrier. Families who have a child or teen with a diagnosis aside from autism and cannot afford the co-pay, may go without services altogether. Nothing else pays for BHRS, or Family Based Mental Health Services.
Point 6: The DPW’s EVS tracking system is more often than not, inaccurate. Income data is not properly tracked, as proven by a number of individuals who have received their FAQ’s sheet from Secretary Alexander and their co-pay contribution letter. Some individuals are seeing an erroneous inflation of between 50-150% of their actual income. On another note, the DPW also lacks the ability to send annual renewal paperwork on time, which results in a lapse of services. Sadly, their track record is not reliable.
Point 7: Collection methods and a solid structure have not been established for October and November implementation. MCO’s and providers are unaware of how to move forward with a change that takes place in a matter of days.
Point 8: Per federal law, providers cannot prevent the delivery of services to consumers and families unable to pay. Providers who do not have additional funding streams and programs to offset costs may not be able to absorb this burden. They certainly will not be in a position to hire additional administrative personnel to manage this change. Smaller providers could easily fold (as they will have no means of collecting the funds), resulting in even more families and children not receiving treatment. They will struggle to find a provider that has available staff to provide their care. The larger providers will get bombarded with referrals and may not be able to handle such an immediate influx of requests.
Point 9: School districts will suffer from a tremendous cost-shift if parents are unable to pay for BHRS in the school setting. Families may open their IEPs, ask for a BSC or TSS to be listed as a related service, thus making the school district responsible for payment. Yes, school districts may bill Medical Assistance for school-based services – however, BHRS is not a “school-based service.” As we await clarity on this point, one can’t help but wonder if, circumstances move forward as described, if taxpayers will end up facing an increase in local taxes as a result.
Point 10: GOVERNOR CORBETT HAS THE POWER TO RIGHT THIS TERRIBLE WRONG. One phone call will end this nightmare.
~*~ HERE IS WHAT YOU CAN DO:
1. Continue to contact legislators. Yes, they are in session. Yes, you will likely get a person on the phone at the local office who appears to have little or no interest in what we have to say. That doesn’t matter – keep calling, and put pressure on them. Find their contact information here: http://www.legis.state.pa.us/
2. Fax them a letter – either personalized, or use a sample and also a copy of the policy brief from www.pennautism.org. Truly, all materials needed are right there, accessible to all.
3. Continue to email or call families and community contacts and get them involved. Case managers, other therapy providers (speech, OT, etc.) and especially SCHOOLS have great reason for concern.
4. Fax a copy of your letter, maybe with a family picture, to Governor Corbett himself: 717-772-8284. You can call his office at 717-787-2500. Put a voice and a face to our stories!
AS IT STANDS, WE HAVE THREE DAYS TO ACT. THE TIME IS NOW!
As information becomes available, I will send it on.
With gratitude,
Catherine Hughes
Director of Family Support Services
Family Behavioral Resources
AERI Behavioral Health Services / Autism Education and Research Institute
... and proud parent.
Good afternoon everyone,
I truly appreciated the opportunity to be able to advocate in this capacity to fight for our consumers and families. I truly believe though in my heart, that anyone could have gone up to that podium and did what I did yesterday. Our passion and fight is fueled and inspired by loved ones and/or consumers who have touched our hearts, who need our tireless advocacy efforts to give them every chance in this world to be successful.
In brief, we consider the rally to have been a success, despite the fact that we did not pull the attendance we had hoped for. We know how difficult travel is, the cost involved, and other factors. Thankfully, the rally is getting local, state, and through some bloggers and organizations, national attention.
Many articles and news stories, however, are unfairly projecting false, “regurgitated information” from the DPW. They talk about families needing to “contribute their fair share,” or how “it’s only $1-$3 per service,” or… “we’re looking at 200% of the poverty level,” or “we have no choice with this economy.”
Yes, WE DO HAVE A CHOICE.
Here are some facts that may
be used as rebuttals, and talking points for staff who are willing, and families, the rest of the week:
Point 1: 200% of the poverty level, for your average middle class, is not an exorbitant amount of money. $42,000, for example, spread across a family of four, is tough enough when figuring in a mortgage, utilities, groceries, clothing, car payments, private insurance premiums, etc. Figure into that the costs involved with caring for a child with a diagnosis who requires countless extra expenses, and you will have a family facing dire struggle. Even families pulling *double* this amount could easily struggle. Some families have caregivers with their own health-care related expenses. The point is that we do not know a family’s unique situation, and to not give consideration to that and just automatically expect up to 5% of a family’s income because their child or teen has a diagnosis is ludicrous. No other category of Medical Assistance will require this outrageous contribution.
Point 2: The bulletin bypassed the state regulatory process as per Act 22, which permits the DPW Secretary, Gary Alexander, to move forward by any means “necessary” to control or alleviate the budget. This bulletin is being pushed through “quietly” (er, not so quiet now) at the eleventh hour as implementation for new recipients is slated to start Monday.
Point 3: “Imposing co-pays will save $9.4 million a year.” THIS IS FALSE. Less than half of the money collected would go to the State of Pennsylvania due to Federal Match Dollars. The state has to *spend money* to *get money.*
Point 4: In terms of those affected by autism, EXISTING LEGISLATION – which is Act 62; a powerful law – if enforced, would force the hand of 70% of private carriers who would no longer permitted to find a way to exclude the diagnosis. Furthermore, enforcing the Mental Health Parity Act would force private carriers to release the $36,000 annual cap on services. Though autism is not a “mental health disorder,” oftentimes our consumers have co-morbid mental health diagnoses and presenting symptomology.
Point 5: This isn’t just about children with autism. Children with any diagnosis qualifying them under PH95 will be hit. Our children and teens impacted by a behavioral health diagnosis only have little to no support from a private insurance carrier. Families who have a child or teen with a diagnosis aside from autism and cannot afford the co-pay, may go without services altogether. Nothing else pays for BHRS, or Family Based Mental Health Services.
Point 6: The DPW’s EVS tracking system is more often than not, inaccurate. Income data is not properly tracked, as proven by a number of individuals who have received their FAQ’s sheet from Secretary Alexander and their co-pay contribution letter. Some individuals are seeing an erroneous inflation of between 50-150% of their actual income. On another note, the DPW also lacks the ability to send annual renewal paperwork on time, which results in a lapse of services. Sadly, their track record is not reliable.
Point 7: Collection methods and a solid structure have not been established for October and November implementation. MCO’s and providers are unaware of how to move forward with a change that takes place in a matter of days.
Point 8: Per federal law, providers cannot prevent the delivery of services to consumers and families unable to pay. Providers who do not have additional funding streams and programs to offset costs may not be able to absorb this burden. They certainly will not be in a position to hire additional administrative personnel to manage this change. Smaller providers could easily fold (as they will have no means of collecting the funds), resulting in even more families and children not receiving treatment. They will struggle to find a provider that has available staff to provide their care. The larger providers will get bombarded with referrals and may not be able to handle such an immediate influx of requests.
Point 9: School districts will suffer from a tremendous cost-shift if parents are unable to pay for BHRS in the school setting. Families may open their IEPs, ask for a BSC or TSS to be listed as a related service, thus making the school district responsible for payment. Yes, school districts may bill Medical Assistance for school-based services – however, BHRS is not a “school-based service.” As we await clarity on this point, one can’t help but wonder if, circumstances move forward as described, if taxpayers will end up facing an increase in local taxes as a result.
Point 10: GOVERNOR CORBETT HAS THE POWER TO RIGHT THIS TERRIBLE WRONG. One phone call will end this nightmare.
~*~ HERE IS WHAT YOU CAN DO:
1. Continue to contact legislators. Yes, they are in session. Yes, you will likely get a person on the phone at the local office who appears to have little or no interest in what we have to say. That doesn’t matter – keep calling, and put pressure on them. Find their contact information here: http://www.legis.state.pa.us/
2. Fax them a letter – either personalized, or use a sample and also a copy of the policy brief from www.pennautism.org. Truly, all materials needed are right there, accessible to all.
3. Continue to email or call families and community contacts and get them involved. Case managers, other therapy providers (speech, OT, etc.) and especially SCHOOLS have great reason for concern.
4. Fax a copy of your letter, maybe with a family picture, to Governor Corbett himself: 717-772-8284. You can call his office at 717-787-2500. Put a voice and a face to our stories!
AS IT STANDS, WE HAVE THREE DAYS TO ACT. THE TIME IS NOW!
As information becomes available, I will send it on.
With gratitude,
Catherine Hughes
Director of Family Support Services
Family Behavioral Resources
AERI Behavioral Health Services / Autism Education and Research Institute
... and proud parent.
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