TALLAHASSEE Floridians will now have less time to apply for Medicaid coverage if they want healthcare costs retroactively covered, after federal officials approved a state request Friday to shorten how far back the state’s program can pick up the bill.
The change, which critics have charged will limit access to healthcare for the poor, elderly and those with disabilities, means those who qualify for the safety-net program now have up to 30 days of retroactive eligibility once they qualify for Medicaid, as opposed to the original 90 days. After approval from the federal Centers for Medicare & Medicaid Services, which oversees the safety net program, the 30-day policy will go into effect Feb. 1 and remain in place until June 30 unless state lawmakers vote to extend the change.
The state Agency for Health Care Administration requested the policy change in the spring, after lawmakers earlier this year voted to support shortening the retroactive eligibility period over the objections of some Democratic colleagues. State Medicaid officials had previously estimated the eligibility would affect about 39,000 people annually — with pregnant women and children exempt — and amount to $98 million. The agency also contended that the change would not harm applicants so long as they submitted their paperwork on time.
But during a public comment period, the federal agency received hundreds of comments, all critical of the change: that it would financially hurt providers and patients, impede continuous care or limit access to healthcare services for older patients and those with disabilities in particular.
Some also contended that limiting retroactive eligibility to the start of the month a patient applied for benefits could harm those who became eligible late in the month, shrinking the window they had to submit their paperwork.
In the letter giving the state approval, Seema Verma, Centers for Medicare & Medicaid Services administrator, acknowledged the comments but wrote the state would be required to have a “robust outreach and communication strategy” with providers and beneficiaries that would also be posted on the website.
Medicaid coverage would also date back to the first day of the month an application was filed, even if there was a delay in processing, according to the letter, “which may help mitigate these concerns.”
Verma also asserted that the change, requested under an amendment process that is meant to encourage “innovative” healthcare, would enable the state to determine if shortening the retroactive eligibility period could stop people from only intermittently having coverage.
“Florida will be required to test its hypothesis that the waiver will incentivize individuals to obtain and maintain health coverage, even when healthy, or to apply for coverage as soon as possible after the finding or diagnosis that gives rise to their Medicaid eligibility,” she wrote. The federal agency is also requiring the state to conduct an independent evaluation within four months of the approval.
The federal agency has approved similar changes in Iowa and Kentucky, though both states also expanded Medicaid eligibility under the Affordable Care Act to include able-bodied adults. Florida has not expanded who is eligible for the program.
The federal agency also approved several other Medicaid changes the state had proposed, from providing a new state Medicaid managed dental plan to making changes to the Low Income Pool, a Medicaid funding program.
The agency approved community behavioral health providers as participants in the funding program, which could expand their access to funding for services treating mental health and substance abuse. It also agreed to a reclassification of regional perinatal care centers, which serve women with high-risk pregnancies and newborns with special health needs, allowing them to access more funding.
The U.S. Department of Education is reversing course after being sued over changes to its handling of disability discrimination complaints in schools.
Just before Thanksgiving, the Education Department rescinded a provision adopted in March that allowed the agency’s Office for Civil Rights to dismiss any complaint that is part of a pattern of complaints by the same person or group that places an “unreasonable burden on OCR’s resources.” As part of the changes earlier this year, the department also eliminated the appeals process for complaints. The opportunity to appeal has now been reinstated.
“It’s good they’re saying they’re going to fix this, we just have a lack of trust in them because of their behavior,” said Eve Hill, lead attorney for the three groups that sued. “What we need is a commitment that’s enforceable.”
The lawsuit, which was filed in May by the National Federation of the Blind, the Council of Parent Attorneys and Advocates and the National Association for the Advancement of Colored People, alleges that the changes in handling complaints of discrimination based on disability or race were intended to strip students of their rights.
Hill said she will seek a settlement agreement or other legally binding resolution to ensure that the complaint process is not changed again.
She said it was troubling to dismiss complaints solely because they came from the same person, noting that a student might encounter violations of the law when entering school for the first time and then face them again when entering new grades and schools.
“People with disabilities get discriminated against more than once in their life, particularly if you’re talking about a child,” Hill said. “The fact that one person experiences discrimination more than once, can’t prevent them from challenging that discrimination.”
Marcie Lipsitt, a Michigan mother of a son with special needs, received a letter in November from the Education Department saying that it would now investigate her 662 complaints that were dismissed after the procedure change earlier this year. She files web accessibility complaints against school districts on behalf of students with vision, hearing and fine motor disabilities.
“I feel vindicated that they reopened these complaints because these complaints were all meritorious,” Lipsitt said. “I have believed since March 5 when they unleashed these revisions that they were unlawful and un-American.”
In making the Education Department’s recent announcement, Assistant Secretary for Civil Rights Kenneth L. Marcus said he had reviewed the Office for Civil Rights’ case processing manual and received constructive feedback on it.
“While we continue to work to improve the timeliness of OCR’s case processing, we have determined that additional revisions will help improve our work and allow us to be more responsive to students, stakeholders and our staff,” Marcus said.
Lipsitt said the civil rights complaint process is an important way of empowering families to report violations of the law without spending money on legal fees.
“Civil rights complaints are free,” she said. “You don’t need a lawyer. These are administrative and they can achieve the same results as federal lawsuits.”
One day, MRI brain scans may help predict whether older people will develop dementia, new research suggests.
In a small study, MRI brain scans predicted with 89 percent accuracy who would go on to develop dementia within three years, according to research at Washington University School of Medicine in St. Louis and the University of California San Francisco.
The findings, presented Sunday, Nov. 25 at the Radiological Society of North America meeting in Chicago, suggest that doctors may one day be able to use widely available tests to tell people their risk of developing dementia before symptoms arise.
"Right now it's hard to say whether an older person with normal cognition or mild cognitive impairment is likely to develop dementia," said lead author Cyrus A. Raji, MD, PhD, an assistant professor of radiology at Washington University's Mallinckrodt Institute of Radiology. "We showed that a single MRI scan can predict dementia on average 2.6 years before memory loss is clinically detectable, which could help doctors advise and care for their patients."
Alzheimer's disease is a progressive, irreversible brain disorder that destroys memory and thinking skills. The disease affects 5.5 million Americans, according to the National Institutes of Health (NIH).
Neurologists can get a ballpark estimate of a patient's risk of Alzheimer's dementia using the Mini-Mental State Examination questionnaire, or by testing for the high-risk form of the gene ApoE, which increases a person's risk of Alzheimer's by up to 12-fold. Both tests were about 70 to 80 percent accurate in this study. Other assessments, such as PET scans for plaques of Alzheimer's proteins in the brain, are good at detecting early signs of Alzheimer's disease, but available to few patients. PET scans cost thousands of dollars and require radioactive materials not found in a typical hospital.
MRI brain scans are widely available and give doctors a glimpse into what's going on inside a person's brain. Raji and colleagues at the School of Medicine including Tammie Benzinger, MD, PhD, a professor of radiology, Parinaz Massoumzadeh, PhD, and Adedamola Adedokun, as well as radiologist Pratik Mukherjee, MD, PhD, of the University of California San Francisco, analyzed MRI scans for physical signs of impending cognitive decline.
They used a technique called diffusion tensor imaging to assess the health of the brain's white matter, which encompasses the cables that enable different parts of the brain to talk to one another.
"Diffusion tensor imaging is a way of measuring the movement of water molecules along white matter tracts," Raji said. "If water molecules are not moving normally it suggests underlying damage to white tracts that can underlie problems with cognition."
Using information from the Alzheimer's Disease Neuroimaging Initiative - a multisite collaboration that pools data, funding and expertise to improve clinical trials for Alzheimer's disease - Raji and colleagues identified 10 people whose cognitive skills declined over a two-year period and matched them by age and sex with 10 people whose thinking skills held steady. The average age of people in both groups was 73. Then, the researchers analyzed diffusion tensor MRI scans taken just before the two-year period for all 20 people.
The researchers found that people who went on to experience cognitive decline had significantly more signs of damage to their white matter. The researchers repeated their analysis in a separate sample of 61 people, using a more refined measure of white matter integrity. With this new analysis, they were able to predict cognitive decline with 89 percent accuracy when looking at the whole brain. When the researchers focused on specific parts of the brain most likely to show damage, the accuracy rose to 95 percent.
"We could tell that the individuals who went on to develop dementia have these differences on diffusion MRI, compared with scans of cognitively normal people whose memory and thinking skills remained intact," Raji said. "What we need now, before we can bring it into the clinic, is to get more control subjects and develop computerized tools that can more reliably compare individual patients' scans to a baseline normal standard. With that, doctors might soon be able to tell people whether they are likely to have Alzheimer's develop in the next few years."
Although there are no drugs available yet to prevent or delay the onset of Alzheimer's disease, identifying those at high risk of developing dementia within the next few years could still be beneficial, the researchers said. People could make decisions on their financial and living arrangements while they are still in full control of their faculties.
WASHINGTON — New research linking veterans’ high blood pressure with wartime exposure to chemical defoliants could dramatically expand federal disability benefits for tens of thousands of Vietnam-era troops.
The findings, from the National Academies of Sciences, Engineering and Medicine, conclude that “sufficient evidence” exists linking hypertension and related illnesses in veterans to Agent Orange and other defoliants used in Vietnam, Thailand and South Korea in the 1960s and 1970s.
They recommend adding the condition to the list of 14 presumptive diseases associated with Agent Orange exposure, a group that includes Hodgkin’s Disease, prostate cancer and Parkinson’s Disease. That’s an upgrade from past research that showed a possible but not conclusive link between the toxic exposures and high blood pressure problems later in life.
If Veterans Affairs officials follow through with the recommendation, it could open up new or additional disability benefits to thousands of aging veterans who served in those areas and who are now struggling with heart problems.
Veterans who struggle with high blood pressure issues are eligible for health care at VA facilities. But the illness is eligible for disability benefits in only select cases.
Adding an illness to VA’s presumptive list means that veterans applying for disability benefits need not prove that their sickness is directly connected to their time in service. Instead, they only need show that they served in areas where the defoliant was used and that they now suffer from the diseases.
That’s a significant difference, since proving direct exposure and clear health links can be nearly impossible for ailing veterans searching for decades-old paper records.
A change in the designation of hypertension by VA could also add significant new costs to the department’s disability payout expenses.
In 2010, when then Veterans Affairs Secretary Eric Shinseki expanded the list of presumptive illnesses for Agent Orange exposure to include ischemic heart disease and Parkinson's, the department estimated additional costs of more than $42 billion over a decade.
It’s unclear how many veterans suffer from high blood pressure and would be eligible for disability payments if the change is made. In a statement, VA spokesman Curt Cashour said the department “is in the process of evaluating this report and appreciates the work” of the group.
Regardless the cost, officials from the Veterans of Foreign Wars are already calling for VA officials to move ahead with adding hypertension to the list.
“There is no doubt in anyone’s mind that Agent Orange made veterans sick, it made their children sick, and it brought pain and suffering and premature death to many,” VFW National Commander B.J. Lawrence said in a statement. “Even though it’s been a half century since they were exposed, the results of that exposure is something they continue to live with daily.”
Over the last year, advocates for “blue water” Navy veterans — sailors who served in ships off the coastline of Vietnam — have been fighting with department officials over a decision to deny them presumptive status in Agent Orange related claims.
VA officials have insisted that scientific evidence does not exist linking their illnesses to exposure to the defoliant miles away from the Vietnam mainland.
The new study is available at the National Academies Press website.
HOUSTON — When Olivia Shanks landed in the hospital, it changed her life.
She didn’t arrive as a patient, though — she came to work. The 21-year-old, who has high-functioning autism, has struggled to get places on time. Some basic workplace tasks stressed her out. Dependence on others dinged her self-confidence.
Her work in Memorial Hermann Southwest Hospital’s food-services department came via one of Houston’s nonprofit groups providing job training and support for a population that’s exploding but finds few opportunities to live as fully as possible.
“I basically learned everything here. I didn’t know how to organize silverware,” said Shanks, who also learned about teamwork and following a schedule. “Even though I’m still not good at it, I’ve gotten less scatterbrained with time management or pressure.”
The climb of autism diagnoses is alarming. This year, the Centers for Disease Control and Prevention upped its estimate to 1 in 59 U.S. births — twice the 2004 rate of 1 in 125. National advocacy group Autism Speaks estimates 500,000 teens with autism will reach adulthood over the next 10 years.
Yet nearly half of 25-year-olds with the disorder have never held a paying job, according to Autism Speaks. Ninety percent of adults with autism are unemployed or underemployed.
Some are too impacted to work once they age out of school-based vocational services by 22. But many who could work face depression and isolation, idle on their parents’ couch, financially dependent on them, government or community organizations. Research shows job activities that encourage independence reduce symptoms and increase daily living skills.
Autism spectrum disorder is a complex developmental disability. Symptoms typically appear in early childhood and inhibit communication and interaction to varying degrees. Though some of the increase in incidences can be attributed to better diagnosis, the cause remains unknown.
In Houston and elsewhere, autism-focused groups are promoting workplace inclusion. They collaborate with employers and tout the untapped potential of those whose traits include reliability, loyalty and focus.
The business world is beginning to see the benefits.
Shanks was 19 before she got an autism diagnosis. Out of high school and out of a routine, she was sitting at home in River Oaks uncertain about her future. But that began to change thanks to Houston nonprofit Social Motion Skills.
The organization offers T3 (Transition, Training, Taxpaying), a program that pairs a job coach with young adults with autism and similar special needs. The workers are eventually weaned off the coach, who stays in touch as issues arise.
T3 partners are: Memorial Hermann Southwest Hospital; Aspire Accessories, a gift shop where artisans learn light manufacturing, retail and customer service; Clear Lake Infiniti, where clients hone interpersonal skills as customers drop off cars for service; FedEx’s ground hub in Cypress; and Michael E. DeBakey VA Medical Center.
Workers are either permanent employees or interns. Both arrangements expose them to direct deposit, banking and paying taxes.
The intern model is low risk: Memorial Hermann, for example, adds to its pool of 275 volunteers while Social Motion Skills pays its interns minimum wage (tuition to the nonprofit to participate covers the job coach’s salary).
In the kitchen and cafeteria, job coach Rachel Pasternak worked on sociability with Shanks and two others for six weeks this spring. The goal is “to get them secure enough in themselves to apply for a job — and get it.”
Shanks did: Her experience in a hospital setting helped her land a position, with benefits, as a patient transporter at DeBakey VA Medical Center.
Her mother, Stephanie Shanks, said the internship encouraged Olivia to be a self-starter. “She’s well on her way to independence,” Stephanie said.
At Memorial Hermann, Shanks and her peers got no special treatment, said Elana Hoffman, who oversees the volunteers.
“At first, they were nervous that we were there, but now the staff looks around and notices when we’re not,” said Stacy Anderson, Social Motion Skills’ transition director.
At FedEx’s ground hub in Cypress, 13 Social Motion Skills clients unload trailers.
“This is working out very well. For some of these kids, this is their first job, and they don’t know really what to expect,” senior manager Brady Bates said. With their job coach on hand, they learn the job via a steady, repetitive workflow with few interruptions.
“FedEx believes in diversity and inclusion,” Gulf Coast District managing director Clay Roach said. “(This) is a way to not only invest in our community, but afford these kids an opportunity at a real career.”
In an op-ed piece for the Houston Business Journal, “Your next great employee might have Autism,” Social Motion Skills founder and executive director Wendy Dawson said both employee and employer benefit — when the job is the right fit.
“Roles that require sorting products, performing data entry, or filing draw on the unique strengths of autistic workers, who are usually extremely detail-oriented and procedure-driven,” Dawson wrote. “While a non-autistic person might resent the repetitive nature of such tasks, many autistic people truly enjoy this sort of work. Moreover, supervisors can count on them to show up on time and to be loyal employees.”
Building their own
The Monarch School and Institute, a private facility for those with special needs in west Houston, teaches children and adults with autism and neurological disabilities. Its Life Academy serves as a “practice center” for home-living and personal skills and employment.
One goal is lessening rigid thinking. “A lot of our learners may see a coworker not following the rules 100 percent, and that may frustrate them,” coordinator Samantha Sanchez said. “We provide our students with tools that they need to stay regulated.”
Historically, employers have voiced concerns: “I don’t think we know how to handle someone like that. What if there’s bullying? Can this individual stand up for themselves?”
Mark Foley defies history. The general manager at MOD Pizza’s west Galleria location has hired several of Monarch’s 15 to 20 off-campus “learners” and holds them accountable like any of his staff. He noted one didn’t work out because he made excuses for slow or poor performance. “Everyone at MOD is special,” Foley said. “Check the disability at the door.”
Still, Monarch showed him the need for accommodations, including shorter or fewer shifts. Those are worth the tradeoff for handling tasks most other employees don’t like. Aaron Glick assembles pizza boxes “faster and better than anyone,” Foley said. “The (rest of the) employees love it because they hate folding boxes.”
Sanchez cited a bigger benefit.
“The dependence on (government) assistance is going to have a huge financial impact,” Sanchez said. “When people say things like, ‘It takes so much energy to train them. Is it even worth it?’ It is absolutely worth it.”
Employees with disabilities, including autism, aren’t a drain on business, said Joe Bontke of the Equal Employment Opportunity Commission’s local office. Accommodations save much more than they cost by reducing turnover and down time, he said.
Businesses with $1 million or less in gross receipts or 30 or fewer employees qualify for a tax write-off for making accommodations. That “sweetens the pot,” Bontke acknowledged, but the employers he’s worked with found “the benefit comes from the understanding that it’s just good for business. They didn’t champion the dollar amount.”
MOD Pizza is 32-year-old Glick’s first job. His two shifts a week include busing tables and refilling silverware containers. “I’ve been a help to the company, doing what I can do,” he said.
Foley teared up thinking about grateful parents who tell him they fear what will happen to their adult children once they’re gone. “I have to make this work,” he said softly.
On Monarch’s campus, Hannah Hess, 26, spent the summer organizing the new library. For the aspiring writer, earning $10 an hour surrounded by books was ideal.
“I love being called a bibliophile, not a bookworm because that just sounds gross,” Hess said. Like many with autism, she spoke fervently about her interests but avoided eye contact. Then her phone buzzed. “Ugh, cantankerous phone,” she said. “I love the word ‘cantankerous.’ I’m developing my vocabulary.”
Hess’ phone is Bess. Her tablet is Ned. “I name my devices. Don’t judge me,” she said before turning back to checking out books.
Masters of technology
Nicholas, 19, whipped through screens of light fixtures to choose for a house he was digitally assembling. He studies video-game level design at nonPareil Institute’s Houston facility, which requested its crew members not be fully identified. The institute is a technology-training nonprofit.
Nicholas has communication challenges. “I need to put lights in the bathroom,” he announced without looking up. Asked what his favorite thing is to add to the scene, he didn’t answer. Prompted, he said, “trees on the grass.”
The institute produces games and apps for iOS and Android, along with print and electronic comic books.
“Nonpareil” means “no equal.” The institute harnesses the technology interest common in people with autism. Founded in Plano by Gary Moore and another father who saw a limited future for their own sons, it aims to provide self-sufficiency and a sense of purpose.
“Crew,” as trainees are called, pay tuition to attend. Some also work at nonPareil part time as lab assistants or instructors. Most of the 74 enrolled in Houston are high functioning; a few even hold a degree in computer science.
Code instructor Chris McCrimmons uses his project-management background to get “crew” to break down tasks and review trends — “What was blocking us?” Members respond to the process-driven format, he said.
NonPareil strives to break a defeating job cycle of adults with autism. “They get a part-time job, they’re there a couple of months and start to have issues,” Moore said. Classes address team-building and connecting with others, concepts vital to success in the workplace.
This year staff composed of former crew worked on Trade ‘Em, an app that lets users store, use or trade gift cards. Current crew served as testers. The results led Amarillo-based Trade ‘Em CEO Kristopher Barnings to “show that they are being underutilized.” Next year, Barnings’ support will be to the tune of $210,000 a month.
Christian Hitz, 26, who has autism, relocated from Plano to work full time as a nonPareil art instructor. If it wasn’t for the teaching job he’d probably be bored working in a warehouse. “This is more fun, more entertaining,” Hitz said. “It’s a relaxed job opportunity.”
In the Houston business world, he is both contributing and being fulfilled.
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