Parents and nursing providers concerned about proposed Medicaid change

JACKSON, Miss. (WLBT) – Mississippi’s Division of Medicaid is considering a reduction in the amount of payments it makes for services for families of special needs children.

This proposed Medicaid change was just filed last week, but they’ve already received 20 pages worth of public comment. And those are coming from both providers and families who rely on something called private duty nursing.

Katie Conway was told her son Taylor Reed may live his life in a vegetative state. He’s a walking miracle now.

“He has intractable epilepsy,” explained Conway. “He’s non-verbal. He’s incontinent. He can’t really leave the house because he has no immune system.”

And he’s learning to do more on his own thanks to private duty nursing.

“He’s learned to step into his high-chair which I know sounds silly but it’s huge because picking up a seven-year-old little boy to get into his chair every five minutes is hard,” added Conway. “He’s learned to step into the bathtub, step out of the bathtub. They’ve taught him all this.”

Conway’s family relies on Medicaid to receive that in-home care.

“Losing them… I don’t even want to think about it,” Conway said.

But the newly proposed change in the amount of money Medicaid will pay for these kinds of services could reduce the access to this kind of care.

“The rates they have cut the most are the rates we receive for the most critical type patients,” said owner of PediCare Nursing Agency Melissa Flanagin.

Flanagin says the proposed cuts would barely cover paying her nurses, much less any other costs of running the business.

“If we are no longer able to do that portion and we only get reimbursed to pay the nurse then, as an agency, we won’t any longer be able to provide the services that we do right now,” Flanagin said.

And she says that could result in more hospital stays for many of the patients.

Medicaid is responding now, saying this isn’t about the reimbursement rates dropping. Instead, the Senior Director of External Affairs says some of the unlicensed, unregulated agencies have been exploiting a coding loophole for their own financial gain.

He also says they will do everything in their power to ensure the children receive the care and services they need.

“We have received comments from numerous families of those currently receiving private duty nursing (PDN) services who are concerned about the effect of this change on the ability of their child to obtain or maintain services. To those families, let me say this: we will do everything in our power to ensure your child continues to receive the care and services he or she needs.

This story is not about Medicaid slashing an already low reimbursement rate and jeopardizing access for vulnerable children; that’s absolutely not the case here. The story is how some of these unlicensed, unregulated PDN agencies have managed to exploit a coding loophole for their own financial gain at the expense of Mississippi taxpayers.

While we appreciate the services provided by our PDN agencies and wholeheartedly support the goal of providing appropriate care and services to children with complex medical conditions, I personally believe that some of these agencies have been receiving grossly excessive reimbursements from Medicaid at the expense of Mississippi taxpayers for far too long. It seems absurd to me that PDN agencies, some of which are owned and operated by nurses out of their own homes, would receive significantly higher reimbursement rates than many nurses in the state, including critical care nurses and home health nurses.

It’s very disappointing that some PDN companies have resorted to using scare tactics on the families of these vulnerable children as a way to continue lining their pockets with taxpayer dollars.”

-Wil Ervin

Mississippi Division of Medicaid Senior Director, External Affairs

Flanagin says the children of Mississippi shouldn’t be punished for the greed of a few adults, and families like the Conways are praying it doesn’t change.

“Having a child on Medicaid for the rest of his life was never part of our plan,” noted Conway. “That’s not something we thought would every happen to us and we would ever need. But it is and you never know when you’re going to need it and it’s going to affect your family.”

Medicaid’s public notice indicates the proposal was made on September 5th and set to take effect on October 1st if approved by the Centers for Medicare and Medicaid Services.