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                                                      July 25, 2008
DHHR, Advocates Spar Over
Brain Injury Waivers

 

By Kellen Henry
Staff Writer
 
 
  CHARLESTON, W.Va. - The state Department of Health and Human Resources wants a Kanawha County judge to reconsider an order that advocates say would help injured soldiers and others with traumatic brain injuries find treatment.
 
In May, Kanawha Circuit Judge Duke Bloom ordered the DHHR to develop a plan for funding and providing services to West Virginians with traumatic brain injury.
 
The department was instructed to meet with Gov. Joe Manchin, Senate President Earl Ray Tomblin and House Speaker Rick Thompson within 60 days, before reporting back on July 17.
 

 

 

 

 

 

To my knowledge it has not been done," said David Sudbeck, ombudsman for behavioral health for the DHHR.

The Brain Injury Association of West Virginia said the state should apply for a federal Medicaid waiver for citizens with TBI. This waiver would allow the state to forgo certain Medicaid requirements to cover a broader array of services for people with brain injuries, as an alternative to being institutionalized.

Michael Davis, founder and president of the Brain Injury Association of West Virginia, said waivers would provide flexibility to patients for the kinds of medical support they need. Twenty-two states have waivers for TBI, allowing individuals to receive flexible coverage that could include living skills, crisis management, family counseling and rehabilitation.

"A lot of folks can't hold down a job, but don't qualify for unemployment. They're the walking wounded," Davis said. "There are hundreds of West Virginians not being served."

About 3,800 brain injuries are estimated to occur in the state every year, with 600 resulting in death. But Davis said it is impossible to estimate how many people actually suffer because of a fall, vehicle accident or domestic violence, and don't realize a brain injury is responsible for their pain, behavioral change or inability to function.

With a waiver program, the state would be responsible for a third of the medical expenses, with the federal government paying the rest. Davis said his association has suggested using a percentage of money generated by video lottery machines to cover the cost of care.

The DHHR has filed a motion, which has been sealed by the court, asking the judge to reconsider the order. The motion addresses whether the judge has overstepped his authority. It will be taken up at an Aug. 28 hearing.

"I think that [DHHR] thinks, more or less, that it is out of his jurisdiction," Sudbeck said.

The DHHR said there are alternative solutions to receiving a state Medicaid waiver for brain injuries.

"There are other ideas that could be utilized to fund a program for TBI. There are other federal waivers available," Sudbeck said.

West Virginia has several types of waivers that can be used to aid those with brain injuries, including the Aged and Disabled waiver and the MR/DD waiver, which will provide comprehensive coverage for people who received their injuries before the age of 22.

The Brain Injury Association is concerned about adults who sustain brain injury after they pass the age limit. Some do not qualify for other care, but are still unable to hold a job or function normally because of their injuries.

And the problem could escalate as soldiers return from war zones with brain injuries, Davis said. High profile sufferers, such as journalist Bob Woodruff who was severely injured by a roadside bomb in Iraq, have drawn attention to TBI.

However, many West Virginians who suffer head injuries cannot afford expensive treatment and may not have a support system of friends and family to help with recovery, Davis said.

After people are released from acute care in the hospital, many of the injured have no money to pay for rehabilitation. Some recover with family or in nursing homes, but others land on the streets or in jail, unable to cope with the behavioral changes.

"They have difficulty with judgment and making proper decisions. They can be impulsive or say things that get them into trouble," said Jennifer Rhule, a board member who suffered a brain injury during a car crash that left her with vision problems that required several brain surgeries.

The state will end up paying the costs, if it does not leverage federal dollars, the Brain Injury Association said. They believe a waiver program would save the state money on treating brain injuries and be the right thing for those with injuries.

"If we had a waiver, we'd get care providers and specialists. There aren't that many available in the state," Rhule said. "We serve every other disability, but brain injuries are, many times, invisible."

Reach Kellen Henry at khe...@wvgazette.com or 348-5179.

Post a Comment

Posted By: P Jackson (2 minutes ago)

As a professional in the field for over 25 years and more recently as a family member as well, a waiver program, which has been successful in so many other states, seems like it should be a 'no brainer'!! If you consider that there are 36,000 West Virginians who have experienced a brain injury, just think about the actual total of those effected by the trauma when you include their families and loved ones. Wouldn't it have to be well over 100,000.......perhaps 200,000? Personally, now more than ever, I believe one's perspective can change greatly when impacted on a personal level and that in itself is unfortunate. It all boils down to quality of life issues for those who have suffered the injury......AND their loved ones. Traumatic Brain Injury is not for the faint of heart, for the weak, the poor or otherwise underprivileged. It is an equal opportunity event for which everyone may qualify with NO application required.

Posted By: Susan H. Connors (18 hours ago)

The Brain Injury Association of America strongly supports upholding the court order to establish a Medicaid Waiver for West Virginian's with brain injury. Such a waiver would allow DHHR to provide healthcare services to meet the specific needs of brain injury patients. The cost would be equal to or less than institutional care and would be shared by the federal government.

Nearly half of the states in this country use Medicaid waivers to provide care for patients with brain injury thereby minimizing disability, enhancing prospects for return to work and previous social roles, and preventing homelessness, incarceration, and inappropriate placement in nursing homes and/or psychiatric institutions. In the long-term, use of a Medicaid waiver will reduce future burdens on the state and therefore the tax-payers. Frankly, this is a "no-brainer" and DHHR should jump on it.

Posted By: sickandtired (11:41am 07-27-2008)

 I agree with Stacy. Medicaid Waiver Programs, where family members and paid to take care of family members is a "cash cow" for some. I know of one case where a lady in Boone county was pulling in approx $5,000 pr month taking for her two adult "mentally challenged" adult children. Plus, they were receiving free care provider(s) help. She was reimbursed by the state every time she even ran family errands. Why is it some qualify for this type of help and others cannot get help (such as Medicaid for chronic illness or rehabilitation for substance abuse?

Posted By: Stacy (4:25pm 07-25-2008)

As long as the DHHR doesn't consider paying family members to provide care, I'm on board. Paying family members to take care of their family members just opens a Pandora's Box that is in large part disastrous.

Posted By: jda...@core-env.com (1:38pm 07-25-2008)

The CDC estimates that at least 5.3 million Americans, approximately 2% of the U.S. population, currently have a long-term or lifelong need for help to perform activities of daily living as a result of TBI. ( www.cdc.gov) The population of WV is currently over 1.8 million. Two percent of that is 36,000 West Virginians with a long-term or lifelong need for help to perform activities of daily living as a result of TBI. That is probably a very low estimate given the higher than average elderly population (falls) and higher incidence of ATV accidents in our state. This estimate also neglects the higher proportion of troops from WV that see combat. The Rand Corporation just released a study that estimates that up to 20% of our military men and women returning from the Middle East have sustained a TBI. It doesnít take a genius or a psychic to predict what is going to happen when our troops come home to a state that canít or wonít provide needed services to current TBI survivors.

Posted By: bkerr (11:15am 07-25-2008)

 There are too many benefits associated with a state based waiver program for adults with TBI for this to not be considered / move forward. No one would have to reinvent the wheel here. Neighboring states already have successful waiver programs. A state based waiver program would allow these individuals to access appropriate care in setting that not only understand TBI but specialize in it!

Posted By: jtblakemore.com (10:51am 07-25-2008)

Brain injury can be a lifelong injury. Medicaid waivers have been used in other states to effectively offer services that keep people with brain injury out of jails, nursing homes, and psychiatric hospitals. Why would a state be willing to let people with brain injury end up in those types of places? As someone who works in the field of brain injury, it is a story we hear too often. State agencies that don't understand the injury think if a person with a brain injury ends up in jail or a psychiatric hospital that must be where they belong. It is sad commentary that the courts have to step in to make an agency develop a plan for citizens they should already be serving!

Posted By: Carolyn Rocchio (10:32am 07-25-2008)

As a Charleston native and Founder of the Brain Injury Assn. of FL I strongly support the Medicaid waiver proposed by the Brain Injury Assn. of WV. Medicaid recipients between the ages of 22 and 59 are underserved and pose a severe financial burden for the State of WV. Their care would be more cost effectively managed with the waiver. Florida's TBI waiver program annually serves large numbers of uninsured or underinsured persons with traumatic brain injuries who might otherwise live out their lives in nursing homes or on the streets as homeless