User:Woozle/blog/2009-06-10 0640 No relief in sight

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No relief in sight
2009-06-10 0640

I don't really have the focus to write a proper blog post about this (except to note that the first sign of trouble came near the end of the day on Friday in the form of a phone call and that we waited all weekend and Monday with no news), but I should at least post this "team update" email which more or less explains what has happened.

  • What: Josh Smith services status update 6/9 pm: foster care no-go
  • When: 2009-06-09 18:42

Hi All,

This is just a general status update for those involved with Josh's services, since Sandy got the notification verbally from Yolanda.

Value Options turned down the request for Therapeutic Foster Care for Josh this afternoon. It's not clear to us on what basis they are doing so, since we have no less than three Ph.D.s saying he needs to be out of the house and two Ph.D.s saying specifically that he needs to be in a group home.

According to what Sandy understood from Yolanda, Health Choice would not cover the Residential Services because DDS does not cover these services (or something like that)... but in the Health Choice manual, Residential Services are clearly listed as being covered. We aren't clear on the details.

As we understand it, Yolanda is following up on this and trying to get more information.

Yolanda: we need Value Options to state, in writing, the exact reason why the services were denied, and under what circumstances they would be approved.

There was a lead on a group home opening in Charlotte about two (?) weeks ago, which we rejected in favor of the foster care home because the latter was much closer and we knew absolutely nothing about the group home (they did not ever return Yolanda's call, as far as I know); it is remotely possible that this opening is still available, and I believe Yolanda is checking into that as well, but this is a long-shot. (It's also not clear whether Health Choice would cover this.)

That aside, we are now in a bit of a pickle. We have absolutely nothing for Josh to do outside the house, beginning Wednesday afternoon. We expect his behavior will deteriorate quickly, though we don't know how quickly; lately he seems to have found some things in the house which are keeping him entertained... for now.

We (Sandy, Yolanda, and I) all agree that they had absolutely no business switching him from Medicaid to Health Choice, if that is what made the difference in the approval; that's another line that needs looking into:

  • For the Medicaid people: what was the reason for the switch? What do we need to do in order to get Josh switched back to Medicaid?
  • For Value Options: did that change affect their decision? Would they approve a group home, or are they claiming that such services are simply not supported by Health Choice? Under what circumstances would a group home be supported, if it currently is not? Under what circumstances would therapeutic foster care be supported?

We are trying to remain optimistic about this, but this is a very big let-down and we will soon be in a very bad situation if we can't quickly get a new regular worker for Josh and/or somehow reverse the decision. It is also a big mess and we are seriously short on information at this point.

I guess that's all for now.