No car, no care? Medicaid is facing cuts in some countries.

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Driver Donavan Dunn unloads Maddie Holt after driving her to Seattle Children’s Hospital on Nov. 21, 2017. “I have to drive different,” says Dunn. “It’s always in the back of my mind that I have somebody on board that’s fragile.” (Heidi de Marco/KHN)

No car, no care? Medicaid is facing cuts in some countries.

Maddie Holt, 5, of Everett, Washington, couldn’t walk or speak, could barely see or hear, and was in a wheelchair waiting for the hospital.

The 27-pound girl wore polka dots and a floral shirt, and a bright red headscarf, with two golden ponytails sticking out of her head.

Her parents can’t drive. They all have vision problems with disabilities; Besides, they can’t afford a car. When Maddie was born in 2012 with a rare and often fatal genetic disease called Zellweger syndrome, Meagan and Brandon Holt, then in their early 20s, fell into a world of extreme need and extreme poverty.

“When Maddie was sick, we lost everything,” says Meagan Holt, 27.

Every month, Maddie sees an expert group at Seattle children’s hospital that makes her almost blind, deaf, frequent, and life-threatening liver problems.

Maddie by medicaid services, making the single time for more than an hour’s journey, the only way to become more than 50 years ago America’s health insurance program is to provide security for the poor.

Driver Donavan Dunn covers Maddie Holt with her blanket after securing her wheelchair. Dunn says he received special training to transport patients like Maddie, who is loaded onto a motorized platform, wheelchair and all, into the van and then carefully strapped in. (Heidi de Marco/KHN)

The most vulnerable design for medicaid.

Called non-emergency medical transport (NEMT), its benefits are as old as medicaid itself. It needs to transport certain people to and from medical services, such as mental health counseling sessions, substance abuse treatment, dialysis, physical therapy, adult day care, and, in Maddie’s case, visiting experts.

“It’s very important,” holt said. “Now she’s old and maimed, and that’s crucial.”

However, because of the cost out of control and responsible for the health of patients, the republicans vowed to reduce income, cuts in federal funds, and give states more power to eliminate they think can’t afford the service.

One in five americans (74 million people) now rely on medicaid to pay for health care. According to a recent estimate in 2013, this will include nearly $104 million in NEMT travel each year, costing nearly $3 billion.

Supporters of NEMT say the strategy will cut costs and reflect more closely on private insurance interests, which usually do not include transport.

They also believe the changes will help curb government investigators’ warnings in 2016 that the plan is “high risk of fraud and abuse”. In recent years, the center for medicare and medicaid services (CMS) reported that NEMT providers in Massachusetts were jailed and fined more than $475,000 for driving charges. Two Connecticut ambulance plans have paid nearly $600,000 to address their demand for transport services for dialysis patients who do not have ambulances to transport medical needs.

In march last year, indiana republican Congressman Susan Brooks (Susan Brooks) put forward a resolution, the resolution will provide NEMT, revocation of federal efforts to provide “flexibility” state to state. This effort has stalled.

Another republican proposal in 2017 would reduce the federally funded NEMT program. It failed, but other efforts in individual countries remained.

The current flexibility is through immunity.

But the country already has some flexibility. In a letter in March 2017, Tom Price, a former health and human services minister, and Seema Verma, a CMS administrator, encouraged the country’s governors to consider NEMT exemptions.

“We want to empower all countries to promote innovative solutions to the next wave of medical assistance challenges,” they wrote. The trump administration has used the national exemption to bypass or disband some of the Obama administration’s more expansive health policies and has approved some state requirements.

At least three states – Iowa, indiana and Kentucky – have received federal exemptions and delays, allowing them to reduce medicaid services. The state of Massachusetts waivers.

Critics worry that the trend will worsen, leading to the inability of poor patients to seek medical care.

Joan Alker, executive director of the center for children and families at Georgetown university, said: “I wouldn’t be surprised by more waivers.

Because medical transport is often not covered by the commercial insurance plans used by most americans, many are unfamiliar with it and may be seen as unnecessary. Eliot Fishman is a senior executive at Family USA, a nonprofit, nonpartisan consumer health advocacy group. .

In former federal medicaid officials, Mr. Fishman said the transportation program was “critical” not only for severely disabled children but also for non-elderly, low-income adults.

In a 2014 survey of medicaid users, CMS found that lack of transportation was the third biggest obstacle to adult care for disabled adults, and 12.2 percent of patients reported being unable to travel to the doctor’s office.

“It’s not an easy thing,” fishman said. “We are talking about the life-saving aspects of medicaid.”

According to a 2005 study by the national academy of sciences, about 3.6 million americans miss or delay non-emergency medical care each year because of traffic problems.

The same research analysis to facing 12 kinds of common diseases of patients to provide the cost of NEMT, and found that provide additional transportation is usually a cost-effective, because in patients undergoing health to make an appointment to keep healthy.

Medicaid is required to provide NEMT services, using the most appropriate and cheapest means of transportation, whether it be taxis, vans or public transport.

Supporters of reforming NEMT point out that disabled children, such as Maddie, and other severely disabled people, have little risk of losing their services. In Iowa and indiana, medicaid is still available for several types of patients, including those classified as “physically weak”, although the definition of eligibility may vary widely.

In addition, despite the first exemption in 2007, Anthem, a management medical institution, continued to deliver medicaid patients in indiana.

Leave out and struggle

But some medicaid customers still do not have transport services. Fallon Kunz, 29, of Mishawaka, India, suffers from cerebral palsy, migraines and chronic pain. She USES a powered wheelchair. When she was a child, she said, she was entitled to a medical appointment.

Kuntz is studying psychology online at the university of southern New Hampshire. She lives with her father, who lives outside the medical bus route. Medical appointments for chronic diseases are a constant struggle, she says. Taxis are too expensive: $35 for a wheelchair.

“The only way I can get a doctor’s appointment is to go two miles in a wheelchair,” she said. “despite all the weather, from home, across the bridge, to the grocery store. “It’s a bus stop outside the grocery store. I can take the bus there.”

Sometimes she was too miserable, or the weather in indiana – warm and wet in summer, cold and windy in winter – too much to fight, and she would skip the date.

She said on a Tuesday in December: “I didn’t go today because it was so cold and my legs hurt so much. “I don’t want to be blown off the sidewalk.”

In Maddie Holt’s case, she was one of the hundreds of Children who were sent to Seattle Children’s every month to meet NEMT conditions. Washington medical steer clear (Washington Health Care Authority) is responsible for monitoring the state of New York medicaid (Health) Apple, according to a survey in September last year, more than 1300 customers spent more than $33000 in fees.

As a matter of fact, the hospital has a very large demand, so the hospital set up a transportation readiness service to help organize the entry and exit.

Seattle children’s club international communication and guest service manager Julie bove grams (Julie Povick) said: “when we realized how many traffic tools is an obstacle to your booking, we decided to take some measures.

Povick added: “most of our patients are in survival mode. “You need a lot of hands.”

However, Verma, the designer of the indiana medicaid program, believes too many handheld operations can be “counterproductive” to patients and bad for the country.

Verma, 2016 issue of the journal health affairs, said: “[indiana health plans] ninety percent of the member of the report have their own transport or rely on friends and family’s ability to deliver health care to make an appointment.

But some people can’t.

“I’m a college student and I have a cat,” said kuntz. “I’m just an ordinary person trying to do things, and the traffic in this area is ridiculous.”


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