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Family Story of Implementation of Medicaid Managed Care Step One

Posted: October 4, 2013

October 4, 2013

Here is a story about a father of three children with disabilities and his experience in trying to sign up for Medicaid Managed Care Step 1.  At CSNI we are asking for other stories to be submitted to dtriesner@csni.org . We are looking for both success stories and challenges.

Attached you will find a scan of a provider listing for the Doherty family that Gateways Community Services serves. Dad, Bill Doherty, has three children (Rob, Bonnie, and Jon) on the autism spectrum; with one being up for voluntary enrollment and two being mandatory.  It is of interest that Bill welcomed Commissioner Toumpas last month (August — Bill showed the Commissioner information on Bonnie and Medicaid cost of care that is still mixed up.) at his home to give him a better feel for what his family’s life is like and how Medicaid supports for medical, behavioral, and long term care make a positive impact on his family’s well-being.

We asked Bill to write down all the providers, in addition to Gateways, involved in caring for his children.  You will see the document titled Medical, Mental Health & Related Providers.  Bill does his absolute best to keep all three children with as few providers, or common providers, to ensure continuity in care and relationship building when it comes to appointments, follow up, and understanding for family medical history and considerations.  It also just makes life easier to work with as few, competent providers as possible for positive outcomes for the three children.

In NH EASY, we have learned that the PCP for all three children is with Meridian, the pediatric neurologist is with BMC Wellsense and NH Healthy Families, the child/adolescent psychiatry specialist is with BMC is Massachusetts, but will not commit to signing up for patients in NH, and that the OB/GYN (for Bonnie) is with Meridian.  We found no listings for the licensed psychologist, ear, nose, throat specialist, or optometrist.  We contacted Meridian directly to determine if the specialists will be signed up with Meridian moving forward and are waiting to hear back from Meridian.  Bill is clarifying if any of the specialists could be referrals through Meridian, since they are Medicaid now, so as to ensure continuity in care.

Bill will opt out for Jon.  For Rob and Bonnie, he is concerned that there is no one MCO to meet the kids’ entire care spectrum needs.  He is contacting the CallCenter for the other two MCOs to determine if consults and out of network referrals will be possible.  When I asked Bill to prioritize the medical caregivers for Rob, and pick which caregiver should at all cost not be interrupted for Rob, he responded:

“All of them are important.  You take one away, everything is thrown off! I just don’t know what I am going to do.  The most important people are Nick Carson, MD and Teresa Bolick, Ph.D and they aren’t even signed up with any of them. If I knew what the reimbursement rate is that would even help. This is brutal — they have been seeing Dr. Bolick since 1996 — we’ll never find someone who knows the kids as well as Teresa.  She has hooked us up for clinical studies, trials and with Dr. Carson.  Without her, our kids would have significantly more behavioral issues. The kids have done well because of our insistence that all medical information be exchanged between all the providers.  We’ve essentially created our own medical home making sure each provider gets the results or notes from the others. I also have copies on file and in my computer. This is gonna be a full time job on top of everything else we are doing with the kids. Thank God we come from a medical background or else we’d be screwed — we are the coordinators and we’ve built a system that works — I follow up on reports, referrals, and everything. They even work with Atech to write an order for a device.  This is going to be like pulling teeth.”

“Jon turns 17 on September 30th, so a year from now we can go through this again.”

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