As Predicted . . .

Taylor is out now clubbing Sonny like a baby seal over the Katie Beckett Program.

I received an email from Eric Johnson that attempts to shed light on the cuts. The short answer, according to the Senate President Pro Tempore, is that the state had to do it to comply with federal mandates.

His response is below the fold.

In November 2004, at the direction of the federal government, the Georgia Department of Community Health (DCH) began correctly complying with the federal regulations governing the Medicaid program known in Georgia as the Katie Beckett program. As a result, Georgians have seen some changes to the program.

After a review of existing participants in light of the existing federal regulations, approximately 2,000 children currently in the program were determined to be improperly enrolled. Acknowledging the fact that these children could not be kept in the Medicaid program without violating federal regulations, this session the General Assembly directed the Georgia Department of Human Resources (DHR) to create a foundation that could raise money to support this group of children, as well as any others that the foundation might deem eligible. The General Assembly appropriated $7.6 million in the FY2006 Amended General Budget to help these families. Of these funds, $5.2 million is scheduled to be used for families who were deemed ineligible under federal guidelines. The remaining $2.4 million is to be distributed by the foundation to assist other families with disabled children. The General Assembly did not approve any spending reductions this year and by creating a foundation, the General Assembly believes these families can be provided assistance for years to come. The foundation is scheduled to be operational by April 2007.

In addition to changes in the eligibility for the Katie Beckett Waiver program, the prior authorization process for therapy services that went into effect on September 1, 2006 applies to all children, not just Katie Beckett participants. While there are about 4,300 children currently enrolled in the Katie Beckett aid category, over 26,000 children have historically been getting therapy services through Medicaid each year. The prior authorization process is a review to determine whether the prescribed therapies are medically necessary in amount, duration, and scope. Until now, no one has reviewed whether those services are, in fact, medically necessary. It has been determined that it is more desirable to review them prospectively than to come back after the fact and recoup money for services that turned out to be unnecessary.

According to DCH, it is most important for families to know that medically necessary services can be approved. The fact that documentation is required to justify those services is not new in the health insurance industry. In fact, most health plans require prospective medical review after an evaluation visit. Medicaid will allow up to 8 units of therapy services each month without medical review. That can equate to as many as 8 visits per month, depending upon the discipline.

The actual review process for eligibility for the Katie Beckett program already includes Bachelor and Master level pediatric nurses; co-medical directors including a pediatrician and pediatric neurologist. In addition, several other pediatric specialists are available for consultation. The prior authorization process includes those noted above as well as pediatric therapy specialists who will be reviewing the requests for services above 8 units per month.

I hope this information is helpful to you in understanding the changes in Georgia’s Medicaid program for all Georgia’s children.

35 comments

  1. RandyMiller says:

    What kind of persons character is it that would parade these unfortunate children out for their own personal gain? This really is beyond low and Taylor better hope there’s no such thing as a hell. Someone on an earlier posting said if Taylor had been on the Titanic, he would’ve slipped into a lifeboat in womens clothing. I have to agree with them, because now he’s using these kids as the dress and the lifeboat.

  2. Lorie says:

    This is an issue I’ve been trying to get Sonny to address for the last 2 years. My son is one of those unfortunate children. DCH is NOT following federal regulations. They have continually changed them for the last two years without rereviewing the applications denied incorrectly. They did NOT have qualified personnel to review the applications. They recently got more qualified personnel. We have health insurance but it’s self insured and through a federal loophole, they can exclude anything they want and are not required to follow state mandates. Medicaid is the only choice we have and believe me, it’s not somethi.ng I’m proud of but I can’t get my child on it.

  3. I’ll just go ahead and get this out of the way so we can get back to serious debate:

    There probably wouldn’t have been clothes large enough to fit him.

    Now, back to serious debate. What is worse, Perdue constantly cutting the Katie Beckett program, or those affected showing up at an event for his opponent and pointing out that yes, he did it.

    What should we expect from the same party that applauds a woman who calls the 9/11 widows whores.

  4. Plain and simple, it’s just wrong to cut the Medicaid budget, but then find the money to renovate the Speaker’s Office.

    I think Roy Barnes said it best…”I would’ve scraped the gold off of the dome before I allowed cuts to be made to children’s healthcare.”

  5. GaChick says:

    $40,000,000 windfall land deal for Sonny.
    $100,000 tax cut for Sonny.

    Cuts to Disabled Children in Georgia.
    Cuts to Education in Georgia.
    Cuts to HOPE Scholarships in Georgia.

    Boss Hawg Perdue sure knows how to take care of himself while giving the citizens of Georgia the finger.

  6. Eddie T says:

    My girlfriend does behavioral therapy for these kids–those of you thinking this is just some political cheapshot are either disgusting or don’t understand just how disgusting what’s going on is.

    Taylor didn’t make these cuts–Perdue did. Don’t go after Taylor for doing the right thing and letting the people of Georgia know just where Perdue’s priorities lie.

    It can cost hundreds of thousands of dollars a year to take care of a special-needs child, and the state of Georgia is leaving them out to dry. Yup, that’s what Sonny did.

  7. mercergirl says:

    Listen I agree with Andre, however I’m so tired of people thinking we can help everyone. Where do you stop? I would love to help out every disadvantaged child, but where is the limit? And what illnesses do you cover?

    I honestly do not know a lot about these laws and federal guidlines HOWEVER I do not that not everyone can be helped- there simply isn’t enough money for it. (Although it is hard to explain renovating an office as opposed to helping children.)

  8. GaChick says:

    mercergirl

    With the billions we’re spending in Iraq, we could help everyone…even you. Ask George.

  9. defnotrep says:

    I’m so surprised Sonny would do this since he’s such a good Christian. Maybe Sadie Fields will take this on as a real cause.

    I’m sorry to be so sarcastic but gees Sonny deserves it for dissing these children and families. What kind of person would do this.

  10. buzzbrockway says:

    Obviously those of you blasting Sonny did not read what Sen. Johnson wrote. A foundation was created and millions of dollars were given by the State to help these children.

    Isn’t the idea to help people and if so, isn’t that what’s already been done?

  11. Lorie says:

    The foundation is a joke. Over 2000 children were kicked off the waiver. That doesn’t count the numerous children who were initially applying and denied. They weren’t given the “debit card” and how far does the remaining $2.2 million go for all of these children? Is it fair to have these overburdened parents go out fundraising to get more money to replenish this foundation?

  12. GaChick says:

    It also says that this Foundation doesn’t start up until April of 2007. So, what do these people do in the meantime?

    And knowing bureaucrats, it’ll take another 6 months for any money to start flowing.

    Bottom line:
    Sonny CUT funding for these kids.
    Mark will RESTORE the funding.

  13. defnotrep says:

    buzz,

    see the mother’s comments above to answer your own question.

    there are 10oo’s of families out there that have been impacted by Sonny Perdue’s cuts. It’s really a fiasco.

  14. rightofcenter says:

    The only way Mark is going to restore funding is if his daddy decides to underwrite this when Mark moves back to Albany in January.

  15. Mad Dog says:

    rightofcenter,

    Nice attempt to change the subject.

    Perdue cut the legs out from under children who were already being helped legally by the state of Georgia.

    Then, they remodel the Capital offices to celebrate electoral victory after 130 years in the cold.

    Put them all back out in the cold along with rightofcenter.

    $300 billion for Iraq. Not a penny for Tiny Tim.

  16. Chris says:

    I tried my best to refrain from speaking on this issue, but I can’t. Get the government completely out of healthcare.

  17. mercergirl says:

    GaChick-

    I have a full time job along with being in school- I am completly self sufficient.

    I do however have medical bills, I lot of them. Do you see me asking asking for help? Hell no. I have ZERO sympathy

  18. fulldawg says:

    I can sincerely say I have never seen this level of disregard in the Governor’s Office for people with special needs.
    I have been told that the state programs have been cut so there are little services anymore for this population. The employees are running the paper chase to keep what little funding is still available to help who they can.
    It is a sad, pathetic case indeed from the present adminstration and the majority party.
    I have only observed this after working with special needs children and adults in Georgia for 30+ years.

    I’ve always heard “A society is judged by how it treats the least among them.

  19. GaChick says:

    mercergirl

    ZERO sympathy. Gee girl, you do need to get some help. Your bills must be mental health related for you to be this callous.

    I believe everyone, even you, should have healthcare and not be burdened with the possibility of bankruptcy due to a medical emergency.

    Being so young and in school, I’m amazed that you are so uncaring. How can you let these disabled kids not get the medical care they need and maybe die?

  20. RandyMiller says:

    My question is where was Taylor when this thing broke 2 years ago? Planning some Caribbean
    wedding for trophy wife #3 at a 5 star resort?
    If Taylor had really cared he’d have stepped out front then, way out front. This is all too contrived, it’s as if Taylor said “hey, I can use these kids come election year, now where’s that bucket of KFC?” I can’t buy it, and I don’t think most Georgia voters will either.

    There are no easy answers to this problem, but I’ve served as an advocate for some medicaid patients and saw my share kicked off during the Barnes-Taylor admin.

    And GaChick, you need an ecn 1001 course, no, scratch that, ecn 0099, it’s entitled “money doesn’t grow on trees.” Winter pre-registration begins soon. My advice, don’t miss it.

  21. defnotrep says:

    RandyMiller,

    Here we go again….

    Nice try again to change the subject. Repubs…spin, spin, spin….obsfucate…circumlocution!!!!

    Taylor had no power to change anything. This is completely Sonny’s doing by his own actions.

    Sonny found the time and money to renovate the capital and give raises to his staff….just not to take care of suffering, sick children and their families….while grinning all the way…what arrogant heartlessness.

    “In times of universal deceit, telling the truth will be a revolutionary act.” george orwell

    Sonny Perdue is going to lose.

  22. df says:

    I am a 30+ year voting Republican, a Reagan Republican. I believe every human being is endowed by their Creator with certain inalienable rights. I believe every person has a God-given right to maximize their fullest potential.

    My wife and I are the parents of a brain-injured child who is a Medicaid recipient via the Katie Beckett deeming waiver. Jimmy is now 12 years old and suffers from an hypoxic-ischemic brain injury that has impaired his mobility, balance, and speech. Though he is still not yet sitting up or walking, his speech, language, and cognitive skills meet or exceed his able-bodied peers. He is in the 7th grade at Henderson Middle School in Dekalb County where he attends all regular-ed classes and zero special-ed classes. He has his own fulltime paraprofessional to help him perform motor functions that he is unable to perform on his own.

    Throughout his life it has been our goal to see him removed from Medicaid when he no longer needs Medicaid. However, to achieve this goal he will have to be able to sit up on his own, to stand, to walk, to be self-sufficient.

    In 1999, just after his fifth birthday, we learned of a drug that is FDA-approved for the treatment of the hypoxic-ischemic brain-injuries called carbon monoxide poisoning, decompression sickness (DCS), and air embolism. Medicare, Medicaid, and every health insurance policy has paid for the use of this drug to treat these hypoxic-ischemic brain-injuries for over 30 years.

    We asked Georgia Medicaid to cover the cost of the drug for our son, but they refused. We then asked our church, and the church paid for him to receive 42 treatments. He underwent functional brain imaging prior to receiving the drug and then again 21 treatments later. The functional brain study showed an improvement of 25.4%.

    At the same time we learned no American medical school educates future physicians on the use of this drug. We made a second request, including Jimmy’s before/after brain scans plus 300 pages of documentation on the use of this drug for hypoxic-ischemic brain-injuries like our child’s. We also included a videotape of 10 brain-injured children before/after receiving the drug.

    Georgia Medicaid denied us again. We couldn’t tell if they reviewed any of the information we submitted (they had not), so we appealed and resubmitted all the information. We were denied again.

    We requested a hearing before an Administrative Law Judge (ALJ). We lost. We appealed to Dekalb Superior Court on the grounds that Georgia Medicaid was not in compliance with the Federal Medicaid law for children.

    On October 11, 2001, we won.

    Next, Georgia Medicaid, under the personal request of then-governor Roy Barnes, appealed the Dekalb decision to the Georgia State Court of Appeals.

    That’s when I began to campaign for the election of Sonny Perdue.

    In late November, 2002 we won again. Our 1999 coverage request was then sent back to Georgia Medicaid for re-consideration under the “new” standard.

    The State Appeals Court found Georgia not providing services according to the Federal mandate and declared every Georgia Medicaid recipient child must receive:

    “Such other necessary health care, diagnostic services, treatment, and other measures to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan.”

    This Federal mandate became law for all 50 states in 1989, but Georgia has never complied. This one-sentence paragraph could be the ultimate patient’s Bill of Rights. It demands children be provided what is “necessary to correct or ameliorate” their condition.

    If correction or amelioration is not possible via traditional routes, the state is required to find “other measures” to correct or ameliorate. Finally, if what is found, discovered, or invented to correct or ameliorate is not currently available under the state Medicaid plan, it is to be provided anyway “whether or not such services are covered under the State plan.”

    Therefore, the Federal direction to every state is to find every way to say “yes” and rarely say “no.”

    The ultimate Federal goal is to save money. Here’s why. “Correction” is a cure. Once disease is cured there’s no longer any need for public assistance. “Amelioration” is to improve or make more tolerable, which, by definition, reduces the amount of needed healthcare–thus reducing the cost of healthcare.

    Perhaps most powerful, the Federal mandate is also designed and engineered to empower the only group of people who have an emotional investment to find cures for sick children.

    Parents.

    Three years after the State Appeals Court decision, on November 23, 2005, Georgia Medicaid director Mark Trail personally denied our 1999 request. We requested another hearing, appearing June 15, 2006 before the same ALJ who first heard our case in 2000.

    Two weeks after the hearing we received a registered letter informing us Jimmy no longer qualified for Medicaid via the Katie Beckett deeming waiver. The person who booted him out of the program was Georgia Medicaid’s only expert witness at the hearing just two weeks before.

    On August 9th, the same judge who ruled against us in 2000 took a 180-degree turn and this time ruled in our favor. Under the 1989 Federal parameters, we won. Evidence that the FDA-approved drug corrects and ameliorates our son’s hypoxic-ischemic brain-injury is overwhelming.

    August 9, 2006 also marked the 61st anniversary of the atomic bomb drop on Nagasaki, Japan. I wonder how that was celebrated at 2 Peachtree Street.

    Next we had to get his Katie Beckett eligibility restored. It seemed stupid to have the doc who testified against us turn around and kick him off the program. I spoke with a state senator who “has the Governor’s ear.” She told me the Katie Beckett eligibility criteria had been revised because of our case.

    Mark Trail claims the Centers for Medicare and Medicaid Services (CMS) forced Georgia Medicaid to change its Katie Beckett eligibility criteria.

    So does Sonny Perdue.

    I’ve checked with officials at CMS, and they confirmed they never directed Georgia Medicaid to revise its Katie Beckett eligibility criteria as Perdue and Trail claim.

    As much as I hate to admit that a democrat is right, Mark Taylor is right on this one. While Sonny Perdue has used the state government to enrich himself with his $100,000 tax break–he’s dumped the most medically needy children out in the cold.

    At the same time Georgia Medicaid is still denying the FDA-approved drug that would probably help just about all 2000 disabled children thrown out of the program. They’re appealing the August 9th ALJ decision.

    They actually appeal it to their own commissioner, Dr. Rhonda Medows, who used to be the Florida Medicaid commissioner.

    When she was commissioner in Florida, she approved this drug to any child who needed it, without restriction. I can’t imagine she would not uphold the ALJ decision. Every judge who’s ruled on our case since 2000 has decided in our favor.

  23. mercergirl says:

    GaChick-

    I think you need some help, since you are obvious so deranged as to think that even without the war in Iraq that we could possibly be able to pay for everyone’s medical care.

    Btw- are you a socialist?

    Also, please note you are the one who started the personal attacks. Typical democrat.

  24. mercergirl says:

    Also, (sorry to post back to back- I hate it too) I don’t have to have sympathy for anyone because I don’t expect it myself. I work hard to take care of myself and my family and perhaps other people such as myself should as well. I can promise you there are jobs everywhere for those who are willing to work. I refuse to think its ok to pay a child’s medical care because their parent is too lazy to get their sorry ass off of the couch.

    Now, that being stated, if a parent work to be in a case where they are truly trying and just cannot come up with the money, I do have more sympathy there. However again, where is the line drawn? Which disabilities would you provide for? Give me a solid answer and a plan and I will consider listening more to you. I doubt you can come up with a feasible plan.

  25. patriot says:

    I wonder how many of these afflicted children and their distressed American families could be helped IF we weren’t paying for the births and (frequently minor, routine) medical needs of those who are here illegally, and their “anchor babies”?

    I believe that this budget problem is another example of our resources being strained in so many areas… schools, law enforcement, Social Security, not to mention National Security… largeley because of the failure to close the borders and provide for Americans first.

  26. patriot says:

    I wonder how many of these afflicted children and their distressed American families could be helped IF we weren’t paying for the births and (frequently minor, routine) medical needs of those who are here illegally, and their “anchor babies”?

    I believe that this budget problem is another example of our resources being strained in so many areas… schools, law enforcement, Social Security, not to mention National Security… largeley because of the failure to close the borders and provide for Americans first.

  27. RandyMiller says:

    From the ajc:

    “Mark Taylor engaged in the most disgusting form of politics imaginable by asking Katie Beckett families to write checks to his campaign that could be written to therapist.”

    The big guy folks……really looking out for the little guy.

  28. defnotrep says:

    Gees RandyMiller…after DF’s post is that all you can contribute.

    Sonny and company are wrong, wrong, wrong on this.

    Wonder how you and MercerGirl would feel if you had one of these special needs children.

  29. dingleberry says:

    Everyone on here is making exceptionally good points. But you’re all wrong about the solution.
    Yes, Perdue has been part of the problem. He’s a RINO. Taylor has been part of the problem, he’s a LIBERAL DEMOCRAT.

    Why on earth, though, would you support these guys knowing full-well that both of them are part of the same problem?

    There is someone running for Governor who is not part of the problem: http://www.hayesforgovernor.com/

  30. dingleberry says:

    You may have noticed that he is not part of the problem.

    The latest example was the debate. While Perdue and Taylor picked at eachother like pre-teen drama queens, Hayes actually addressed issues that would affect Georgia voters: Elimination of the State Income Tax, Implementation of the Fair Tax, Spending and Budget Cuts.

    What did Perdue or Taylor have to offer? Not a damn thing, because they’re both part of the problem.

    Vote for the solution..

  31. fulldawg says:

    Ahem RandyMiller;

    You somehow neglected to expose the “quoter” and a URL to prop up your previous post. I’ll help you out a bit, ok?

    “Mark Taylor engaged in the most disgusting form of politics imaginable by asking Katie Beckett families [those who get supplemental health funds] to write checks to his campaign that could be written to therapists,” said Perdue’s campaign spokesman, Derrick Dickey.

    http://www.ajc.com/metro/content/metro/stories/2006/10/18/1019methealth.html

    I have always heard to site your source,

    and to consider the source……

  32. defnotrep says:

    df,

    Thank you for writing your experience. It’s really hard to know what to say to you. I write then I delete. I can’t say I know what you’ve been through.

    Raising children is the hardest work one will ever do. I’m thinking having a special needs child must be physically challenging as parents and mentally tough as well.

    It’s unreal that our government is so broken that you have to fight them for basic care for the circumstances of your child. It’s just got to be fixed…whether it’s Sonny or Mark.

    I will help any way I can to do this. My son went to Henderson Middle. I live in the Tucker area.

    My email address is [email protected]. Please email me and let me know how you and your family are doing. If you ever need a night out, let me know….I’m a good sitter. My son is grown now…well mostly….

    This is going to get fixed.

  33. Demonbeck says:

    Seriously, Erick, fix the misspelled word on the subject line. It’s embarassing (or is it embarrassing? or embarasing? or embarrasing?)

Comments are closed.