Friday, April 19, 2013

Have a Special Needs or Disabled Child who is getting ready to go to high school? Read this!

I woke up this morning to an interesting find in my inbox... The State of Virginia has passed and adopted new regulations which will go into effect for the 2013-2014 school year which will affect all students entering 9th grade.

If your child's IEP states that they will be working towards a modified diploma, please read this information carefully! As of 2013-2014 there will be no more modified diplomas for students through the 9th grade. Students who are in the 10th, 11th, or 12th grades as of 2013-2014 are not affected by this new regulation.

So what happens now? Well, your child will have to choose from either a standard or advanced diploma. The Board of Education has enacted emergency amendments to the Standards of Accreditation. These were originally adopted in June 2012, to give students with disabilities the chance to earn a Standard Diploma through "credit accommodations" which basically allows children with disabilities to substitute classes for credit on their particular diploma path. These credit accommodations MUST be outlined in the student's IEP or 504 plan to be counted, so now is a good time to review your child's IEP or 504 plan and see what accommodations may be needed to ensure that they are able to meet the requirements for a standard diploma!

The actual text of these emergency amendments is:

8 VAC 20-131-5. Definitions.

"Credit accommodations" means adjustments to meet the standard and verified credit requirements for earning a Standard Diploma for students with disabilities.

8 VAC 20-131-50. Requirements for graduation.

2. Requirements for a Standard Diploma

3. The Board of Education shall establish, through guidelines, credit accommodations to the standard and verified credit requirements for a Standard Diploma. Such credit accommodations for students with disabilities may include:

a. Approval of alternative courses to meet the standard credit requirements;

b. Modifications to the requirements for local school divisions to award locally awarded verified credits;

c. Approval of additional tests to earn a verified credit;

d. Adjusted cut scores required to earn verified credit; and

e. Allowance of work-based learning experiences.

The student’s Individual Education Program (IEP) or 504 Plan would specify any credit accommodations that would be applicable for the student.

Essentially, this is meant to give special needs and disabled students the chance to earn the same diploma as their non-disabled counterparts, thus moving Virginia into the 21st century and adhering to the spirit of IDEA 2004.

The modifications proposed would affect the SOL assessments,and include modification to the requirements for local school divisions to award locally awarded verified credit and course offerings to earn standard and verified credits.

In addition to the current options available for students with IEP or 504 accommodations on SOL and other standardized tests used to verify credits (including the accommodations for students with disabilities provided on all SOL assessments, substitute tests for verified credit approved by the Board of Education, and Virginia Modified Achievement Standards Test (VMAST) available in Algebra I and end-of-course reading for certain students with disabilities) the following changes are enacted in this emergency amendment:

"Assessments Used to Verify Credits

1. Identify and approve additional substitute tests to earn a verified credit. The Board of Education may from time to time approve additional tests that are recommended by the Superintendent of Public Instruction for the purpose of awarding verified credit. The Virginia Department of Education may partner with a local school division in the procedure to nominate an additional test. Such additional tests, which enable students to earn verified units of credit, must, at a minimum, meet the following criteria:

a. The test must be standardized and graded independently of the school or school divisions in which the test is given;

b. The test must be knowledge based;

c. The test must be administered on a multistate or international basis, or administered as part of another state’s accountability assessment program; and

d. To be counted in a specific academic area, the test must measure content that incorporates of exceeds the SOL content in the course for which verified credit is given.

2. Permit the continued use of the Virginia Modified Achievement Standards Test (VMAST) for verified credit purposes for Algebra I and EOC reading. The student must meet all eligibility requirements in effect for the 2012-2013 school year and meet all of the following criteria to be eligible to take the VMAST for verified credit purposes:

a. Student must pass the high school course; and

b. Score 374 or below on the end-of-course Standards of Learning test after taking the test at least twice.

Beginning in 2014-2015, scores of students who participate in VMAST will no longer be included in the participation rate or pass rate calculations for federal accountability, as required for approval of Virginia’s Elementary and Secondary Education Act (ESEA) flexibility application."

Now, this is a MUCH higher standard than the previously available Modified Standard Diploma, but, depending on how the child's IEP and 504 plan accommodations are written it could supply a substantial benefit in their access to educational programming available through their school. The previous regulations called for locally awarded verified credits, up to 4 credits towards their diploma, in science or social science/history. The new regulations take this further:

"Locally Awarded Verified Credits

3. Permit local school boards to award locally awarded verified credits in reading, writing, and mathematics, in addition to science and history,to students with disabilities. Use the same criteria for awarding credits currently approved for science and history.

Eligible students must:

a. Pass the high school course,

b. Score within 375-399 scale score range on any administration of the Standards of Learning test after taking the test at least twice, and

c. Demonstrate achievement in the academic content through an appeal process administered at the local level."

So, as you can see this allows for modification of the curriculum and awarding of credits in math, reading, and writing in addition to the current verification of credits available for science and social sciences. This is a great benefit for children with math, reading, and writing difficulties accommodated in their IEPs and 504s. It also allows the districts (or boards, as the language reads in the latest draft) to change their course offerings for students with disabilities. This is the only part that I have found disconcerting, simply because it is worded to sound as though these courses would be specifically available to only disabled students and would not include their non-disabled counterparts, which could, in some instances, be considered a discriminatory practice. The language of the course offerings section is cited below. Do you find the same concern in it that I have?

"Course Offerings

4. Approve additional course options available only to students with disabilities to meet the standard credit requirements for the Standard Diploma.

7a. Augment the Personal Finance course (3120) to include the 21 Work Readiness Skills (WRS) for the Commonwealth. Allow this augmented course to meet the Economics and Personal Finance requirement if the student has earned at least 3 standard credits in history and social science. The economics strand in these courses would be deemed a credit accommodation.

Upon completion of the augmented Personal Finance course, the student may take the WRS assessment to earn the Board-approved Work Readiness Skills credential. This approach would satisfy the graduation requirements for economics and personal finance, history and social sciences, and the workplace credential.

b. Establish minimum content courses in the subject areas required for verified credits and provide flexibility in how the courses are delivered. Allow parts I and II of certain required courses to each earn a standard credit towards the total number required in the subject area. The student must successfully complete:

i. 4 standard credits in English and 1 verified credit each in Reading and Writing

ii. 3 standard credits in mathematics that include Algebra I and Geometry, and 1 verified credit in mathematics

iii. 3 standard credits in science that include Earth Science and Biology, and 1 verified credit in science

iv. 3 standard credits in history and social science that include Virginia and U.S. History and Virginia and U.S. Government, and 1 verified credit in history and social science."

The complete text of the emergency amendment is available here: http://www.doe.virginia.gov/boe/meetings/2013/03_mar/agenda_items/item_a.pdf. Be an informed parent and talk with your advocate about any concerns that you have!

Thursday, April 18, 2013

EPSDT - Virginia's Medicaid Program often Misconstrued as a Waiver!

I get asked questions all the time about how to get something covered under the EPSDT waiver. This post is meant to clarify some misconceptions about this program and how it works and how to use it.

First of all, EPSDT is NOT a waiver. It is a medicaid program. Virginia offers 5 waivers which can help with similar items to what EPSDT can cover, but EPSDT is not just for waiver recipients.

While waiver recipients can use the EPSDT program, it is available to children under the age of 21 who receive Medicaid or have a Medicaid Waiver, FAMIS children who are not enrolled with a Managed Care Organization (MCO), and children in foster care and some adopted children with disabilities are covered by EPSDT.

Unlike medicaid waiver programs, there is no long term care screening or health department/social service agency evaluation involved with the EPSDT program. The EPSDT program is initiated by your primary care physician who can make the determination during a well child check up as to whether your child would benefit from the EPSDT program and what it can offer you. Occasionally, you may find that your pediatrician does not know about the program. When that is the case, you can direct them to the DMAS website for more information: http://dmasva.dmas.virginia.gov/Content_pgs/mch-home.aspx They'll need to click on the link called "EPSDT - Early Periodic Screening and Diagnosis and Treatment Program" and provide their medicaid login information for the DMAS site to access the documentation. If for some reason they are not able to, you can refer them to the DMAS info booklet at http://dmasva.dmas.virginia.gov/Content_atchs/mch/mch-epsdt_fs.pdf and the EPSDT Fact Sheet which are also great parent resources that explain a lot of information as well.

EPSDT requires a form (found here: http://www.dbhds.virginia.gov/documents/ODS/ods-h-DMAS-355.pdf ) that is filled out by the child's treating physician based upon their observations of the child during a well child check up which can serve as the EPSDT Screening. Early Periodic Screening Diagnosis and Treatment (EPSDT) is a comprehensive and preventive healthcare program for children under the age of 21 who receive Medicaid. EPSDT provides medical, hearing, vision and dental checkups. EPSDT coverage includes: Hearing Aids, Assistive Technology, Personal Care, Private Duty Nursing, Medical Formula and Medical Nutritional Supplements, Therapies-such as Physical, Occupational, Behavioral or Speech, One-to-One Aides, and ABA Therapy.

If you have questions as to how to get something covered under EPSDT, you can contact your medicaid case worker who can give you important information on the documentation required and what physician or therapist will need to provide a Certificate or Letter of Medical Necessity.

If you have additional questions feel free to email me and I'll try to point you in the right direction!

Tuesday, February 19, 2013

IEP Frustration??? Join the Club! (Or IEP 101, How to Beat the Bureaucrats at their Own Game!)

So its completely inevitable that anytime I have an IEP meeting it ends in more frustration than I had before I walked in the door. I've been an advocate for over 7 years for other families and worked as an ADA/Employment law paralegal for a decade before that, but there is nothing more frustrating than handling my own children's IEPs!

It doesn't help that I live in a "Red Headed Stepchild" district either... In other words, our district has a lot of problems dealing with the administrators for our special education department. If you can feel my frustration raise your hand! We're still fighting the stigma of autism around here, and even if they can talk the talk, our school district's administrators have not yet figured out how to walk the walk!

If this sounds like a familiar scenario to you, have no fear! SUPER PUZZLE WOMAN IS HERE! (Can you hear the theme music? ;)

IEP 101 time! When you have problems dealing with your school, go back and make sure you have basics in order. Or, if this is your first IEP, start the right way from the beginning!

IF YOU HAVE NO IDEA WHAT AN IEP IS OR WHAT I'M TALKING ABOUT GO HERE FIRST!

So since we're working on a very basic knowledge of IEPs now that you've read that link, let's start by getting organized! If you've never had an IEP for your child before you're going to want to get your documentation in order before you contact the school. First things first: contact your doctors and get letters that confirm the diagnosis, copies of any testing that they did to give your child their diagnosis, and any other pertinent documents or recommendations that they may have that will help build your case. Make sure you get the specialist's reports too, and any documentation from any therapists that see your child.

Next, go through your child's educational records. If you haven't kept any (shame shame, you know better! ;) then you need to do a FERPA request. FERPA is part of our wonderful educational laws that allow us to see EVERYTHING in our children's educational records and make copies! Here is a draft FERPA request letter you can use...

So once you've received those records, you'll need to start your binder.

Get a 3 inch binder. Trust me, you'll fill it up faster than you think. Get divider tabs and label these sections (and organize the sections chronologically, with the newest information in the front): 1. Diagnosis 2. Medical Testing & Assessments 3. Doctors Letters and Recommendations 4. Report Cards 5. Letters from the School 6. Letters to the School 7. School Testing & Evaluations 8. Prior Written Notices 9. Parent Concerns. Add other sections as relevant to your child and their needs, but these are the basics.

Now, draft up a list of all the concerns you have regarding your child and their education. Is Johnny falling behind in math? Does he have problems with handwriting? Can he tie his shoes yet? Does he have problems getting his homework home? Does he have problem behaviors in the classroom? Think about everything you've talked with the school about.

Now, armed with a copy of your child's diagnosis (if this is your first IEP) or a copy of their most recent progress report or report card and any other supporting documents, draft another letter (OK, here's a draft you can use... but if this is your first time requesting an IEP use this letter! ;) requesting an IEP meeting and enclose those documents that support your parent concerns. Include that parent concerns list that you wrote in the last step too.

I know... there's a LOT of letter writing involved with IEPs. Its very important to do it though, because those letters, prior written notices, and recordings of IEP meetings (OH YES, YOU SHOULD RECORD THEM!) are the only things that the Department of Education considers if there is ever a need to file a complaint!

So, once you're at your child's meeting, you'll need to make sure you record it! Also make sure that you notify the school in writing of your intent to record the meeting. (Another letter!) You can download a voice recorder through most Android or IPhones that will allow you to use your phone as the recording device, just make sure that you turn your ringer off when you go into the meeting so that it doesn't interrupt the recording.

During the meeting, you'll discuss your parent concerns. If there is anything that you don't agree with that the school proposes, or if the school refuses your requests, make sure you remind them to send you a Prior Written Notice explaining why.

The most important rule of IEP meetings is: DON'T SIGN THE IEP OR ANY OTHER DOCUMENT AT THE MEETING! Take it home, read it over, have a friend or an advocate look at it too. Make sure you agree with what you are signing, because if you don't, once you've signed it you are committed to it!

Hopefully this saves you a bit of frustration in the beginning... I know I would've benefited from having this information when I started with my oldest son's IEP back in 2004.

There will be a lot more posts with a lot more draft letters to come! Keep checking back or subscribe to the feed to get updates as soon as they happen. If you need more info in the meantime, don't hesitate to email me!

Wednesday, January 16, 2013

Mera's EDCD Waiver Tutorial

So, you have a child or loved one with a disability and feel completely overwhelmed? Do you need an extra set of hands or a break? You are not alone... And the State of Virginia fortunately realized how important it was for primary caregivers to have assistance of this kind because they created waiver programs specifically to help!

There are 5 waiver programs in the State of Virginia, but this tutorial is going to focus on the only one that doesn't have a waitlist, (and let's face it, you probably need help NOW, right?); the Elderly and Disabled with Consumer Direction waiver, or EDCD Waiver.

I get a lot of questions from parents about how to apply for the waiver and what they look at, what happens once you get the waiver, etc. This is a brief tutorial on what to expect once you're ready to apply for the EDCD waiver.

So first, you have to apply. You've probably called Social Services and asked about the Medicaid waivers and they have probably told you that they have no idea what you're talking about. There is a lot of confusion when it comes to figuring out how and where to apply for the EDCD waiver. So here's what you'll do and what will happen step by step:

1. Call the Health Department in your area and ask for a Long Term Care screening. They may ask you for information as to what the disability is, etc.

2. The health department will schedule a time to come out and do their assessment. The assessment is a document called a UAI (Uniform Assessment Instrument).

3. On the day of your assessment, a public health nurse from the health department and a social worker from the long term care division will come to your home to do the screening. The first thing that they will verify is the disabled individual's income and resources. The current income limit for the program is $1171 per month. If there are other health or life insurance policies, trust accounts, personal property, real property, etc. in the disabled person's name then they will need that information as well. Then they are going to ask you and the disabled family member questions about what he/she is able to do for themselves and record the information on the UAI. This waiver is based on Personal Care needs also known as Activities of Daily Living and Independent Activities of Daily Living. Here are the areas that they are going to ask you about:

  • Mobility - Does the individual applying for waiver services require assistance either through human help (hand holding, supervision for movement or elopement, help up and down stairs, etc.) or mechanical assistance (cane, walker, braces, wheelchair, etc.) to move around their environment safely.
  • Transferring - Does the individual applying for waiver services require assistance to get in and out of a chair, car, onto a toilet, etc., through either human help or mechanical assistance?
  • Eating - Does the individual applying for waiver services require assistance with preparing meals and feeding themselves either through someone else performing the task for them or through supervision for safe chewing and swallowing? This is a big one for kids with autism and PICA. If your child has Pica you will want to make sure that your assessor knows that, as Pica can be very dangerous if not monitored 24/7.
  • Bathing - Does the individual applying for waiver services require assistance when bathing, either through human help or mechanical help like a shower chair?
  • Toileting - Does the individual applying for waiver services require assistance with toileting? Do they have bowel or bladder accidents and what is the frequency? Make sure your assessor knows whether or not your child is potty trained, uses pull-ups or diapers, etc. Additionally, if you have to supervise them in the bathroom for proper hygiene or wipe them or wash hands for them you should make sure your assessor knows this as well.
  • Dressing - Does the individual applying for waiver services require assistance taking clothes off or putting them on either through human help or mechanical help? Does he/she undress themselves without provocation or in social situations?
  • Behavior - Is the person's behavior appropriate or do they have problems with meltdowns, aggression, extreme passivity (under-responsive to stimuli), easily over-stimulated, problems with elopement (running or walking away, becoming distracted, etc.)? Describe what you go through daily to maintain safety and ensure that the individual is able to be calm.
  • Transportation - How does the individual get to and from doctor's appointments, get their medications, groceries, do laundry, etc.? These are all considered Independent Activities of Daily Living. If they are performed by someone else most of the time, make sure that your assessor knows that as well.
  • Medications - Be sure to have a full list of the medications that the person applying for the waiver is currently on with the accurate dosages and medication times.
  • Doctors & Therapies - Be sure to have a full list of doctors that treat the person applying for the waiver and a list of the therapies that they receive with the therapists contact information.
  • Who will care for the disabled individual if the primary caregiver is unable? - This is the most important question for family members who are looking for assistance with their children. Medicaid wants to know whether or not there is a surrogate who can stand in for you if something were to happen or if the individual applying for the waiver would end up being cared for by the state; either through foster care or nursing home/residential facility.

So, once you've thought about all of these questions and formed the answers specific to your family member in your head, there's something you need to remember: If you do not tell the assessor everything, they cannot make an informed decision. They will want to know how often your child melts down, so gather some data before they come out so that you can tell them whether its 3 times a week, 3 times a day, or hourly! When they ask about the nature of the behaviors, we as parents naturally want to make sure that little Johnny or Sally doesn't seem like a raving monster (and thusly, like we are awful parents!), so we tend to give them "watered-down" details. DON'T DO THAT! You asked for a waiver screening for a reason... Give them the truth of the situation, no matter how good or bad.

4. Once the screening is over then the assessors will leave and take their respective sections of the UAI with them. The social worker will make an eligibility determination based on the income and resources of the person applying for the waiver. The public health nurse submits her report to the reviewing physician at the health department who then makes a determination as to whether the disability and limitations qualify for waiver services. If you are denied due to income/resources you can opt to do a "spend down" and then reapply - there's more on that later. If you are denied due to the nature of the disability and limitations and you do not feel that you should have been, read on, there's information on how to appeal below as well.

5. If you are approved, you will receive a letter in the mail with your approval and a list of Service Facilitators. Look it over carefully and do your research online and with other waiver recipients (if you know any) or go to one of the support groups online (like the Living Puzzle Group and ask around for referrals. Service Facilitators will meet with you once a month to complete a report on your condition for medicaid and they are in charge of keeping you in compliance with Medicaid's regulations so you want to make sure you choose a good, stable, reliable Service Facilitator. Once you've chosen a Service Facilitator they will schedule an appointment with you to "open" your case. This process may take a few days depending on how long it takes your local Social Services department to get your Service Facilitator the UAI. Once you've met with your Service Facilitator and gone over all the documentation and signed dozens of forms you'll be given a date that your PCA (Personal Care Attendant) can start working their hours with you, and they'll determine how many attendant hours and respite hours (if any) you qualify for. There's more on hiring attendants and what the two different types of hours are for below.

6. Go to your local Social Services agency and apply for Medicaid. Take your approval letter with you. Once you are approved for the waiver you qualify for long term medicaid. Usually within a month you will get your Medicaid approval letter and card in the mail.

7. Start looking for a PCA (Personal Care Attendant)! If you have a friend or family member that you trust to help you, they can be your worker so long as they do not fall into one of these categories:

  • A parent working for a minor child;
  • A minor child working for a parent;
  • A spouse;
  • Another person living inside your home;
  • Prohibited due to one of Virginia's barrier crimes;
  • Unable to pass the CPS registry check;

Many people automatically start searching Craiglist and Care.com for PCAs, but I STRONGLY recommend against it because of the problems that have occurred (some of which have gotten national attention, just Google it) with people hired as caregivers through those sites. Visit the Living Puzzle - Finding Caregivers page before you go to crazy trying to find someone.

8. You will receive a very large packet with lots of yellow sticky tabs that say "Sign Here" from an agency called Public Partnerships, LLC within 6 weeks of meeting with your Service Facilitator. This is your Employer Packet. You have to fill out all of the information and sign everywhere they request accurately or it will delay getting your account set up with them. Until they have you registered as an employer, they will not register your attendant and so YOUR ATTENDANT WILL HAVE A DELAY IN GETTING THEIR PAYCHECK.

9. In the Employer Packet you should also receive at least one (sometimes two or three) Employee Packets. You can have your attendant fill out the Employee Packet but make sure that they have the Criminal Background Check (SP-167) Form and the CPS Registry Check Form NOTARIZED before you send them in. You can include it with your Employer Packet when you mail that in if you'd like to make the process a little faster.

10. Go to the Public Partnerships E-Timesheet website and create an account for yourself and for your attendant once your attendant has been issued their Attendant ID number. It is much faster to submit the timesheets online, but if you'd like you can still fax them in. Be aware, faxing does sometimes cause delays in processing payroll because the machine that they use to process them is very finicky about how the data is written on the sheet and it causes rejections that have to then be hand-entered all the time! Payroll is disbursed every other Friday based on the payroll schedule. The payweeks run from Thursday to Wednesday in bi-weekly increments, so every other Thursday you will submit the time to be paid out on the following Friday.

That's it! Step by step, the process to getting set up on the waiver! Now... Dealing with Public Partnerships and tracking your payroll is a completely different topic. Literally... I'm writing it tomorrow. ;)

As for denials: If you were denied for the waiver due to income/resources and you feel like you are able to "spend down" those resources then you can do that and reapply for the waiver. Keep in mind, the monthly income of the disabled individual can't be above $1171 a month to qualify without a co-pay. If your income is over that then you may still qualify and pay a co-pay, or they may deny you completely if your income is too high. If you were denied due to nature of disability or limitations, or if you are applying for an infant and denied due to the child's age, then APPEAL. There are some districts that do not feel that infants with genetic disorders or medical disabilities should qualify, however, they have been overturned on appeal before. There will be information for your district in your denial letter that will instruct you on how to appeal your denial. If you need help understanding it you can contact the health department, contact State Medicaid's Long Term Care division, or email me and I'll try to help explain.

I hope this information is useful! If you have questions, just let me know and I'll try to help! :)

Shooting the Spectrum one day at a time... ~Mera~

Sunday, November 4, 2012

The Healthcare Puzzle - Is "Obamacare" a good thing?

The Key Changes to Our Healthcare System under the ACA -
AKA Why OBAMACARE Rocks!!!

As autism is a complex neurological disorder which has puzzled doctors over its cause and best treatments, it seems only appropriate to begin with healthcare.

For those who have not had time to read through or research the Affordable Care Act that our President, Barack Obama, signed into law on March 23, 2010, I will outline the key points of the law below. The full context of the law is here: http://www.healthcare.gov/law/index.html.

  • Summary of Benefits and Coverages:

    As of September 23, 2012, Health Insurance Issuers and Group Health Care Plans must provide anyone enrolled with a short, easy to read and understand summary of the benefits that you, as a participant, have. They must also send you a glossary of the healthcare terms that they use in that summary to ensure that you understand everything that they do, and more importantly, do not cover. It must also show how the insurance that you have purchased will cover you in the event that you have a baby or if you were diagnosed with a long term chronic illness like Type 2 Diabetes.

  • Consumer Assistance Programs:

    The ACA created grants to state governments to create or improve existing CAPs, which help consumers understand their health insurance programs and advocate for themselves whenever services are denied by the insurer. These CAPs are very helpful for families with autistic children, as ABA therapy and other types of therapies and sensory equipment which has been labeled "experiemental" or "unproven" by insurance companies was previously very easily denied to those insured. Your local CAP can assist you in filing appeals and complaints against your insurance provider, educate you on your coverages, and assist in finding the best coverage for your family.

  • Appealing Health Plan Decisions:

    The ACA guarantees American consumers the ability to appeal any healthcare decision or denial! This is a VERY important step in ensuring that our spectrum angels receive the best care available to them. For any policy enacted after July 1, 2011, if your plan denies a claim they MUST inform you of the reason in writing, as well as provide the information required to file an internal appeal with the insurance company and an external review if the internal appeal is not successful! They also have to give you information on your local CAP program. This information has to be provided in the native language of the enrollee after January 1, 2012. Internal appeals for emergency claims must be done within 72 hours, and for non-urgent claims within 30 days. And, if the external reviewer overturns the internal appeal, the insurance company must pay the claim or give you the requested services.

  • Preventative Care:

    Preventative Care is one of the biggest changes under the ACA. Health insurance companies must now cover the list of preventative care found here: http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html without any additional cost, co-pay, or deductible. That means that your insurance company can't charge you for birth control, flu shots, children's vaccines, pre-natal testing, and much much more!

  • Patient's Bill of Rights:

    The ACA now guarantees that consumers are the ONLY ones in charge of their healthcare decisions. The Bill of Rights guarantees that children can be on their parents insurance until their 26th birthday, does away with pre-existing condition clauses for adults and CHILDREN, allows consumers to choose their own doctors from the insurance companies "in-plan" list, ends lifetime limits and caps and restricts dollar amount caps, reviews premium increases to ensure that your insurance costs don't skyrocket unnecessarily, ensures that your money is being spent on healthcare and not administrators, ends arbitrary cancellations of policies, and removes barriers to emergency services. In short, in guarantees that parents are the ones that can make decisions on their children's health care or their own. It stops insurance companies from deeming autism as a pre-existing condition and refusing coverage.

  • Small Employer Tax Credits:

    To help reduce the cost to small businesses, the ACA also gives a 35% tax credit to companies that provide health insurance for their employees, and non-profits can receive a 25% tax credit as well.

  • Early Retiree Reinsurance Program:

    Under the ACA, this program gives financial assistance to companies to allow them to insure their early retirees.

  • Medicaid and Medicare:

    Alot of our kids are on Medicaid or Medicare because autism is a life-long disability. Even if they don't qualify right now, it is very likely that they will at some point in their lifetime. Medicaid has been expanded to include millions of people that wouldn't have qualified before. The majority of the changes to Medicaid will go into effect by January of 2014. It will make it easier for our children to get and continue coverage throughout their lives which will be important for consistency of care. You can view the full list of changes here: http://www.medicaid.gov/AffordableCareAct/Affordable-Care-Act.html. Medicare recipients will also benefit from many of the changes that the ACA puts into place, like expanded choices for prescription drug benefits and more expansive coverages with lower out of pocket costs. You can view the full list of changes for Medicare here: http://www.cms.gov/apps/files/ACA-savings-report-2012.pdf.

    So... with all of these positive things that help millions of Americans, why are so many against "OBAMACARE"?

    In a USA Today/Gallup poll on June 28, 2012, (http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/07/01/poll-most-americans-want-to-keep-obamacare-in-some-form/) and pictured below, only 31% of Americans wanted to repeal the law entirely. So it is a GOP myth that the majority of Americans want to repeal "Obamacare".

    I think this article from the New Yorker sums up the Republican contempt with the healthcare law quite simply: (view the full text at http://www.newyorker.com/online/blogs/newsdesk/2012/06/was-the-health-care-decision-good-for-republicans.html)

    The list of the problems with the health-care market is long, but the two that are most important and most relevant to the debate over Obamacare are that insurance is, for most Americans, tied to employment, and that people with preëxisting conditions find it very difficult (and sometimes impossible) to buy insurance on the individual market.
    The fact that most people get insurance through their employers is bad from an economic perspective, because it discourages job mobility: people often need to keep their jobs in order to stay insured. This makes the labor market less efficient. And it’s a poor fit with the contemporary workplace, where job tenures are getting shorter, and where self-employment is increasingly important. As a result, any sensible health-insurance system going forward needs to sever Americans’ ability to get insurance from job status—people need to be able to quit their jobs, start new businesses, and so on, and still know that they won’t go bankrupt if they get sick.
    In order to do this, though, you need to make sure that people with preëxisting conditions—by the insurance companies’ definition of “preëxisting conditions,” this includes many, if not most, Americans—will be able to buy insurance at a reasonable price. In other words, you need guaranteed-issue (anyone who applies can get insurance) and community rating (prices will be the same for everyone, subject to a few broad qualifications, like age and whether or not you smoke). And the only way to do that without driving premiums sky-high or insurance companies into bankruptcy is to have the vast majority of people buy insurance. There are a variety of ways you can try to do this—the A.C.A. did it via the mandate—but the principle is what’s key: if you want everyone, regardless of whether not they have preëxisting conditions, to be able to buy insurance, you need just about everyone, including those who are young and healthy, to be participating in the market.

    Now, this seems counter-intuitive to me, as I was taught that you grow up, go to college, and then look for a long term job with good benefits to support you so that you can have a family, buy a house, grow old, retire, and then die peacefully, but I suppose I can see where the Republican party would like to ensure that millions on young Americans in every generation are unstable in their employment based on this argument. It ensures that their healthcare continues, while the young Americans they rely on suffer. This sounds suspiciously like that old saying... "The rich get richer while the poor get poorer..."

    Many of the talking heads and political pundits on every major news network have also perpetrated the myth that "Obamacare" is simply too expensive! Apparently they've never tried going without any form of health insurance like the rest of us have had to endure.

    The reality is, that yes, having health insurance costs money. In a survey conducted by Towers-Watson in August (http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/08/28/zero-out-of-512-employers-plan-to-drop-health-insurance-survey-says/) 512 companies were surveyed and all 512 stated that they did not plan to drop their health insurance coverages for employees after the Affordable Care Act was implemented. The average cost per employee (and family) from those companies was $15,073. The penalty that the company would pay under the ACA for lack of coverage is $2,000 per employee. So they would actually save quite a bit of money if they did drop their health insurance coverage for employees, but instead are choosing to keep it, despite the cost. That's because they know, without a doubt, that it is more expensive for an employee to get sick and miss work than it is to provide them with health insurance.

    The Republicans also scream that the ACA will add trillions to the deficit, but according to the Congressional Budget Office, that is just another fallacy... A falsehood that sounded good in a stump speech. According to FactCheck.org:

    Factoring in the effects of both the costs of the health care law -- including federal subsidies for lower-income individuals to help them purchase insurance, expansion of Medicaid eligibility and tax credits for small businesses that provide coverage -- as well as revenues it would produce -- including a reduction in the growth in Medicare spending and various taxes -- CBO has estimated that the law would reduce the federal deficit by $210 billion over the 2012-2021 period.

    So its not more expensive for companies, who would save $13000 by dropping their healthcare coverages. Its not more expensive and doesn't add to the deficit, in fact it decreases it by $210 billion over the next 10 years. In fact, here's how much it will save: http://www.cms.gov/apps/files/ACA-savings-report-2012.pdf. So what else could people possibly hate about the Affordable Care Act?

    It takes away their freedom to choose. This is the other argument that I have heard ad nauseum. The same people who don't believe a woman should have the right to choose to have an abortion are complaining that the ACA takes away their right to choose whether to have or not have health insurance. I just don't even know where to begin on this one. Healthcare isn't a privilege that some should be able to choose while others have no hope of even making that choice... Its a right afforded in the constitution, right along with the right to "life, liberty, and the pursuit of happiness". Expanding healthcare to every US citizen no matter what their income level was just the right thing to do.

    And still there are those that believe that this is "redistribution of wealth" or "socialism". Even though they aren't, let's look at these statements really quickly. Taxes paid to the government are used for government programs. That's the way the country has worked since its inception... so how is that redistribution of wealth? No one is asking the 1% multi-billionaires to hand over millions of dollars to the poor and middle class or face some form of penalty or punishment. As for socialism...

    This isn't going to be a popular statement, but we are all socialists, in a manner of speaking. The reality is that the United States is very similar to a socialist democracy... Kinda like Europe. Why, you may ask? Well, we don't let people die on the streets. Social Security is paid into for until retirement, and then we collect benefits after we retire. Medicare is government health care for the disabled and the retired. While they are programs that many believe need reform, no one is trying to dismantle them completely yet... (Although that may change if Romney gets into office, with the advent of this "voucher" program.) But even still, vouchers or in its current state, it is a socialist concept and one of many in our country. The Affordable Care Act seeks to rectify a long term inadequacy in our healthcare system that stopped millions of Americans from being able to engage in their own right to live, have liberty, and be happy.

    So... long and short... or extremely long at this point... The ACA is not the big bad that the Republican party would like you to believe that it is. And just for the record, Romneycare - the health plan enacted in Massachuessets when Romney was governor, has been so successful that 98.1% of the state's residents are covered on some form of health plan and it has only cost the state 1.5% more than their previous healthcare system. It was the basis for the Affordable Care Act, although many provisions were expanded nationally to cover those below the poverty level. So, if Obama is a socialist, then so is Mitt Romney. See the full benefits/drawbacks of the Romney plan at http://mittromneycentral.com/resources/romneycare.

    Just sayin'...

  • Politics - The Puzzle becomes more Puzzling

    In a world that is already difficult to understand at times, where nothing is ever truly as it seems...

    Sounds like the beginning of a book or movie, right? In fact, I think I've seen it in fiction many times. Unfortunately, this is not the beginning of fiction; it is the end of the most grueling, confusing, frustrating, and at times disturbing political campaign season that our country has endured. When I talk with other parents about the political scene of the last year the most common comment is "Thank God its almost over!"

    Moreso now than at any other time in our history, the political landscape has become a twisting road with enough bumps to throw any rider from their horse, and more recently to stop any driver from finding gas in an adequate amount for a reasonable price. Both campaigns seem to be in the thrall of the media's spell; trading sound bytes for actual policy and bantering barbs at each other instead of actually debating issues.

    Its confusing for those of us who are "neurotypical", and nigh impossible to keep track of everything amongst the schedules that parents and caretakers of our angels on the spectrum must adhere to. So, here is my attempt at making sense of the issues that affect us "Puzzlers" the most and the stance (or lack of) that each candidate has made (or avoided) to date.

    In this series of posts over the next few days I will attempt to explore as many of these issues as time (and doctor's appointments, IEP meetings, therapy sessions, behaviors, meltdowns, household chores, and work, of course) permits.

    I welcome your comments, but of course must keep these to reasonable on-topic comments. This is meant to be informative and spark a healthy discourse for any who would like to be involved, however, rules of civility must be respected. This is a moderated blog for that reason, and I will not allow comments of an inflammatory, disrespectful, or distasteful nature. Of course, since this is my blog, it is my discretion which determines what will be allowed.

    First up: Healthcare!