Critics say more families are losing access to disability services provided under Medicaid waivers, thanks to a loophole in Texas law.
But in June, when it was time to renew Berk’s plan once again, HHSC contested his need for massage therapy.They had little more than a week to get his budget approved on time.They were wrong.
When families sign their loved ones up for a Medicaid waiver, they have two options for how their care is delivered: State law specifically says that people who hire an HHSC contracted provider must continue to receive services when their budget is in review.In fact, another portion of state law says that a financial management services agency cannot request payment from HHSC for items not included in an approved budget.
Davis added that the Electronic Visit Verification system, which verifies when an attendant clocks in and out of work, further complicates matters. This means disabled Texans who have chosen to have more control over their care — and whose budgets expire while still under review — are being punished for choosing that option, Walton said.
“He likes predictability – as long as things go as scheduled, then life’s good,” Lisa said. “If something does go off schedule, it throws him.” Lisa first was told by an Acumen representative, she said, that Berk’s attendants could not be paid until the budget was approved. Her attendants worked for about a week in July before she realized they wouldn’t get paid. She couldn’t, in good conscience, let them continue.
“I agree a ‘remedy to this situation’ is needed,” said Wendy Ivy, HHSC’s manager for Intellectual and Development Disability Waivers Utilization Review, in an email. “One way to assist with timely reviews will be to help provide all required information within the required time frames.”Then Jacqueline Clark, HHSC’s CLASS Policy Specialist, appeared to contradict herself in an email to Lisa and Walton.
Lisa Sutherland talks with her son, Berk, last month at her home in Austin. Berk relies on attendants — paid for through a Medicaid waiver — to live outside his childhood home. But in July, his attendants did not get paid because of a dispute with the state over his yearly services budget.Berk’s budget was finally approved July 22, though emails show Lisa still was working with Acument to get his services reinstated the last week of July.
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