Maryland Health Secretary Dr. Laura Herrera Scott. File photo by Bryan P. Sears.
State officials pushed back against critics of new Medicaid regulations that took effect Thursday, saying the tighter rules are needed to stop fraud and ensure that taxpayer dollars go to services that assist people with disabilities.
At issue are recent rule changes from the Developmental Disabilities Administration that will require some families to submit additional documentation to prove that the various health, care and transportation services granted under state Medicaid waivers go to services that help a disabled family member.
Those changes took effect Thursday, days after patients and family members rallied outside the State House over regulations they said were burdensome and developed without their input.
But Health Secretary Laura Herrera Scott says the additional paperwork will help catch fraud and ensure that Medicaid dollars go to services that help people with disabilities, instead of going to things like high-cost appliances and season tickets to games. She said audits have uncovered “significant numbers of improper or unsupported payments” for beneficiaries, which is why increased documentation is needed.
“In the current model, beneficiaries just had to attest to certain things without any supporting documentation, and now we are requiring specific documentation to make decisions,” she said. “We have to look at some of these very high requests as potentially inappropriate or also fraudulent. And we certainly have expectations with the federal government … Without adequate documentation, the state has limited ability to identify fraud, waste and abuse.”
Advocates say they support stopping abuse of the system, but the changes have left families “feeling hurt and judged and accused.”
Disability advocates say new state policies will burden caregivers with paperwork
“We hear a lot of these stories that paid families of people with disabilities in a very poor light, and we’re just not sure that’s true,” said Patti Saylor, who had a son with Down syndrome who died in 2013 after an altercation with an off-duty police officer. She is a volunteer with Self-Directed Advocacy Network of Maryland.
“No one wants to waste taxpayer’s dollars, that would be ludicrous,” she said. “If there are a few bad apples, as there are in all programs, have the state deal with those specific individuals.”
Maryland offers Medicaid waivers to people with disabilities to help them and their families afford various services, such as day care, transportation needs and live-in caregiver support. About 16,800 families use the waiver for “traditional” care through an established program. But 3,600 people with disabilities receive “self-directed” care — meaning they or their families are responsible for hiring and paying support staff.
About 40 to 50 people gathered at the State House in Annapolis Tuesday to protest the new rules, saying that the changes were rushed, did not consider the voices of families who use the Medicaid waiver and could put access to current services at risk.
But Herrera Scott said there have been “no major changes to the policy and the types of services that DDA provides.”
“Where the changes are is in how and what information is collected and how applications are processed,” she said. “And this addresses findings that – actually repeat findings, quite frankly – in legislative audits that DDA did not take proper action with significant numbers of improper or unsupported payments.”
Herrera Scott said findings of improper uses of Medicaid funds have included:
- Commercial appliances, such as commercial microwaves, washers and dryers, that are three times the price of household appliances;
- Purchase and repair of vehicles and vehicles for family members;
- Medical and dental services that are already covered under the participant’s insurance;
- Sporting event tickets, including season tickets for individuals other than the participant;
- and home maintenance.
She also said that some self-directed service providers are collecting higher wages than those who work for a traditional provider doing similar work, and the rule changes will reduce that wage disparity.
This is a tough life, and they’re throwing a lot of administrative red tape and paperwork. It starts off being hard and this makes it harder.
– Alicia Wopat, president, Self-Directed Advocacy Network of Maryland
“Their wages are set at a level that’s significantly higher than market norms for similar type of employment,” she said. “So, it’s not an equitable system of care, even within the Disabilities Administration, because under traditional services, those workers make significantly less than some of the exceptions that are allowed under self-directed services.
“We have employees under the self-directed model that are greater than the 90th percentile of wages for similar work in the state of Maryland,” Herrera Scott said. “And the most extreme example, for instance, is support brokers are being paid at about 155% more, or about $60 an hour, than the Bureau of Labor Statistics’ 75th percentile of about $24 an hour.”
Saylor, who is a nurse who works with people on self-directed Medicaid waivers, said that rates for self-directed providers and traditional are providers are the same, but that self-directed providers have fewer overhead costs.
“They (traditional providers) have to cut their pie in lots of different pieces — because they have to pay for the building they have to pay for the HR department, they have to pay for their vans. Over in self-direction, you don’t have all of those costs,” Saylor said.
“So, you have more money, more part of your pie that you don’t have to put into wages … but the rates are the same,” she said. “The rates in self-direction and the rates in traditional providers are the same. There’s less overhead, so it shows up in a higher wage to the employee.”
Alicia Wopat, president of SDAN who has a son with autism, said that employees under the self-directed model do not get the same benefits that a traditional provider may offer.
“A larger company offers more benefit packages that you can’t do as a company of one,” Wopat said.
For Wopat, the larger issue is the burden of paperwork and lack of transparency on how the rules were rolled out.
“This is a tough life, and they’re throwing a lot of administrative red tape and paperwork. It starts off being hard and this makes it harder,” she said.
“It all comes back to collaboration and transparency and actual meaningful dialogue that gets to solutions that work for the people using the program,” Wopat said.
Herrera Scott said the change is designed to expedite payments and “enhances independence and increases flexibility, supports families and creates equity … in a fiscally responsible way.” While the rules are already in effect, Herrera Scott said that the department will continue to take feedback on how the new documentation system works as families use it.
“Almost every single week, there is a meeting with the DDA community that at any point, a beneficiary or their parent or their provider can join in to weigh in,” Herrera Scott said. “There’s still lots of opportunity to provide feedback on the documentation that’s now needed.
“We want to make sure their beneficiary, their loved ones, receive the services that meet their needs and we will continue to work with them, and the additional documentation does not compromise the current services they’re getting,” she said.