BALTIMORE — Traveling from Glen Burnie to Towson for her community language program has been a struggle for 63-year-old veteran Alison Elinoff. A stroke 15 years ago left the right side of her body paralyzed.

She skipped class several times — often for a doctor’s appointment at the Veterans Administration hospital or because she was too tired. Her performance suffered.

“I really like virtual — virtual is great,” Elinoff, who struggles to speak clearly because she has aphasia, a condition developed after a stroke. She likes being in class in person, but it takes 45 minutes to get there, which she said is a hassle.

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The Snyder Center for Aphasia Life Enhancement (SCALE) went virtual at the start of the pandemic — but Elinoff will be forced to go back in person Sept. 30., part of a dispute over billing for virtual sessions versus in-person appointments between the VA and the League for People with Disabilities. Payments to the League for virtual sessions by the VA are reimbursed at a lower rate than in-person sessions.

Elinoff is not alone. Some people with disabilities say they’re hesitant about going back in person and want to keep virtual services that began during the pandemic. But the practicality of whether that’s possible remains uncertain, and other people with disabilities say they want to return to in-person activities.

Changes to telehealth, such as reimbursing at full price for virtual appointments, were possible when Maryland was under a state of emergency order. But Gov. Larry Hogan ended the state of emergency Aug. 15, meaning some COVID-19 telehealth options expired on that date, Maryland Department of Health spokesman David McCallister wrote in an email. Under the Preserve Telehealth Act of 2021, insurers, such as Medicaid, are required to provide coverage for telehealth services, regardless of the patients’ location, he also wrote.

But David Greenberg, president and CEO of the League for People with Disabilities, said organizations offering medical day care for people with disabilities will be required to serve them in person if they want to get reimbursed starting Sept. 30.

SCALE is part of the League for People with Disabilities. When asked for comment, the VA wrote in an email that it does not “provide any payments to organizations with which we have no contract or agreement. Billing requests by vendors and community partners failing to meet standards and failing to submit required documentation will be rejected.”

Gloria Padilla, who lives in the Northern Parkway area, said her son, Jeremy, is not ready to go back to in-person activities. Jeremy, 31, has autism. In the past, he volunteered at food pantries and took courses at Community College of Baltimore County. Padilla said while her son is vaccinated, she worries he may still catch the virus because he doesn’t know how to social distance.

She’d like for Jeremy to eventually give up virtual sessions to socialize in person, she said, but that should happen gradually.

Debbie Gnibus, of Middle River in Baltimore County, whose son, Ricky, also uses the League for People with Disabilities, shares the same worries as Padilla.

Ricky Gnibus, 41, has arthrogryposis, a muscle nerve disorder, and operates his wheelchair with his mouth or chin. He cannot operate the wheelchair with a mask on, she said.

Debbie Gnibus, 63, lives 40 minutes from the League for People with Disabilities and works full time. Before the pandemic, Ricky rode the bus to the League for People with Disabilities. Now he does virtual sessions.

“I’m concerned Ricky would be more susceptible to getting COVID. Even with the shot, people are still getting (the virus)” she said. “There are so many unknowns. You just don’t know what to do, and I’m trying to do the best that I can for my son.”

Jacqueline Jones, 53, of West Baltimore, has had four strokes. Jones, who uses a wheelchair and is partially blind in one eye, took part in the League for People with Disabilities’ virtual programs, which she said kept her busy. “This is a good place to be.”

While she’s comfortable going to the League for People with Disabilities’ office in person, she said she’d like others to have access to virtual learning as the state reopens.

“For me personally, I would come back to the League. I love the League, but there are some people out there that are still hesitant to come back because of the COVID-19 virus and the variant,” she said. “I was concerned, but after getting vaccinated, I feel better about coming back to the League.”

Changes to which virtual services are offered also impact local schools. People with disabilities are among those whose households have the lowest incomes, and many students lacked the technology and access to participate in virtual learning, according to the Maryland Developmental Disability Council. For example, a lack of closed captioning or interpreters continues to be a problem, and screens are not always useful for those with visual impairment.

But despite the challenges, “virtual life is generally positive for people who have mobility issues because it alleviates the stress that can come with traveling,” said Rachel London, executive director of the MDDC.

London said the organization raised $200,000 to provide technology for remote school access and other virtual services, but some spaces were still inaccessible.

She pointed to how the Maryland General Assembly embraced virtual meetings, which gave people with disabilities the ability to testify and attend public meetings from home instead of needing to find accessible transportation. The change led to an increase in meeting attendance among individuals that the MDDC works with and their families, she said.

As schools resume in person, parents have conflicting thoughts about what may be best for their kids. For those who suffer from anxiety, virtual classes allowed them to comfortably communicate and participate in class.

Rene Averitt-Sanzone, executive director of the Parents Place of Maryland, a special education nonprofit, said several schools also increased services, such as speech therapy and sign-language classes, to better accommodate students.

Younger students who spent little time in school before the pandemic have never had the opportunity to learn crucial social-emotional lessons. For students who received specialized help with one-on-one educators or assistive technology, more time out of the classroom meant even more learning lost.

Angie Auldridge, mother of an 8-year-old with autism and cognitive impairments, was faced with the challenge of juggling care for him, working from home and looking after her two other children with her husband.

Days were spent struggling to keep their son engaged with learning for hours in front of a screen, Auldridge said.

Some days, Auldridge had to physically restrain her son in front of the computer; nevertheless, he was not able to stay on the same academic track, she said.

In Auldridges’s family, virtual education was an obstacle to be overcome. One thing they would like to keep from the pandemic era is telehealth.

Maryland Health Care Commission’s 2019 decision to expand telehealth services and reimburse providers for them at the same rates as in-person visits made attending medical appointments more convenient.

For families like the Auldridges, they did not have to drive to Baltimore from their home in Western Maryland and their son was able to see a sought-after specialist in Kansas City.

“I was glad to hear about it because having telehealth access made my son’s appointments so much easier,” said Auldridge. “It was more convenient especially because his appointments are usually more of a conversation between the doctor and parents than a physical examination, so I hope we can continue to have that option.”

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