Making The Most Of Medicaid
By Michelle Diament
Medicaid services are a lifeline for many people with developmental disabilities. But getting the government services can be an uphill battle and your odds of being successful often depend on what state you live in.
When United Cerebral Palsy (UCP) ranked the 50 states last month, Vermont came out on top for providing the highest quality Medicaid services to individuals with intellectual and developmental disabilities. (Find out where your state stands >>)
But behind that ranking are years of hard work, dedication and planning. So, what can you do to make sure that Vermont cedes its title to your state next year? Tarren Bragdon, an independent health and Medicaid policy researcher who crunched the numbers for UCP, tells you how.
Get out in the community
First and foremost, the single biggest predictor of the quality of Medicaid services a state provides to individuals with intellectual and developmental disabilities is how many individuals are living in community-based settings, Bragdon says.
In the UCP ranking, this alone accounted for half of each state’s score. So, most of the states at the top of the list boast limited institutionalization, if any at all.
In Vermont, for example, all Medicaid funding goes toward community-based housing and everyone lives in homes with fewer than seven people.
“That’s phenomenal. That really sets them apart,” Bragdon says.
Yet even in states where total deinstitutionalization isn’t a reality yet, there are major possibilities for success. Take supported employment, for example. It encourages meaningful activity for people with disabilities and it’s also an easy sell to politicians since it’s low-cost and has a clear monetary return. (Oklahoma and Washington take the cake in that arena.)
Another key indicator of a successful state is the number of families receiving support. (New Mexico and New Hampshire are tops here.)
How do you get there?
Help end institutionalization in your state by demystifying life in an institution for the people in charge, Bragdon says. Take your legislators to an institution to see what it’s really like and to ask questions. Then, ask if they would want their loved one living in an institutional setting.
Also, look at your state’s structure. Most successful states focus on individuals. Michigan (ranked #6), for example, has a very strong county system, Bragdon says. So instead of every resident looking to a state department for assistance, there is a locally based office to turn to with staff who are more likely to know you and your unique needs.
Persistence Pays Off
The top performing states in 2009 represented some of the biggest and smallest states. They were rich and poor states with varying tax structures. And, while some states spent a lot on each individual with a developmental disability, some did not.
What made the different, however, was persistence.
“For those states that were most successful they were never states that got one great policy change and then went home,” Bragdon says. “They were always pushing.”
Copyright © 2009 Disability Scoop, LLC. All Rights Reserved. For reprints and permissions click here.
What do You mean, – making the Best of the Medicaid Joke??!! – We live in Ohio, and Medicaid Is almost worthless to so Many poor here!! We Live in “poverty’” – on SSDI!! – And We can never access Medicaid,- period!! We have to make a Laughable “Spend-Down”!!! This is criminal! Living in “poverty”- Then how does anyone meet a “spend-down??!! We are always $2-300 a month short,- so where does a spend-down come from? We can’t print $Money like the Criminal Federal Reserve!! – The people on SSI,- or Supplemental Security Income have it made!! We on SSDI whom still Live in poverty get no Medicaid!!! We worked & paid Taxes for Many Years, and are now left out!!! Our so-called Congress could care less!! – Congress Should be Ashamed!! – Past Hard-Working tax payers can not get the $Help that SSI Welfare People get!! – Discrimination to the max!!! We on SSDI were forced to pay into SSDI, – and now we get screwed again!!! Where is the so-called Supreme Court while this Blatant discrimination by Congress goes on??!! – jward52
Jward52 is right. I was approved for SSDI and promptly cut off of Medicaid which I got while I was appealing because I raised so much cain when I got unnecessary infection after a mastectomy at the public hospital that they knew they needed to stay away from there. Now I can’t get Medicare until next July! I have no health care and part of my disability involves respiratory issues—-issues caused by our dear Republican FEMA putting me in a poisonous RV after Katrina (I was a fully productive school teacher until then) and that caused me to be on a respirator last January. Health and Hospitals department said I could “buy-in” to Medicaid if I got a part time job. But I am worried about swine flu and am not strong enough.
This is why it is time for universal health care with a government option. But you know what? The conservative anti-health care Republicans even shout over people with disabilities and their families in their greed to prevent us from getting services. All disabled people who function above the severely retarded level need to register to vote and write or call their congresspeople in support of health care. Their families need to come off any conservative values they have and support it also. No more excuses. America needs health care.
Oh, and two of the states listed as having the worst Medicaid, also have the highest death rates from cancer—Louisiana and Mississippi!
IN CA those with developmental delay connected with regional centers get better help and have more medicaid coverages than those multi or severely disabled without those lobbyists.
If anyone knows of any legal or other resources to help the rest of us – let me know.
Sadly, Independent living centers, advocates who are not legally or medically trained and due to special funding streams by group vs need, and local gov’t funding that creates political footballs out of the clients, also seem to help create the divide in services and representation.
Discrimination due to types of disability, including ,misdiagnoses for the systems needs, is pervasive through all the systems.
There no legal representatives to do individual ADA/504 cases in appeals or in court.
No legal reps who do ADA/504 in VOCN Rehab services .
That is the voice and access we many are missing.
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