{"id":7086,"date":"2012-03-16T16:36:35","date_gmt":"2012-03-16T20:36:35","guid":{"rendered":"http:\/\/stateimpact.npr.org\/new-hampshire\/?p=7086"},"modified":"2012-03-16T16:57:49","modified_gmt":"2012-03-16T20:57:49","slug":"how-state-budget-cuts-hit-nursing-for-sick-kids","status":"publish","type":"post","link":"https:\/\/stateimpact.npr.org\/new-hampshire\/2012\/03\/16\/how-state-budget-cuts-hit-nursing-for-sick-kids\/","title":{"rendered":"How State Budget Cuts Hit Nursing For Sick Kids"},"content":{"rendered":"
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Dan Gorenstein \/ NHPR<\/p>

The Fouts are among the New Hampshire families struggling with cuts to Medicaid hours<\/p><\/div>\n

Over the last year, dozens of families have lost state subsidized nursing support to care for their sick children.\u00a0 Some parents say the reductions have made it hard to juggle work and keep their kids healthy.<\/p>\n

New Hampshire hired a private company, Schaller Anderson<\/a> to manage these cases.<\/p>\n

Frustrated parents accuse the company of making decisions based on money, not the health of their children.<\/p>\n

There are about 150 families in the state of New Hampshire with children so ill most of them need medical care every day.\u00a0 Many of them can\u2019t walk or talk; some are fed through tubes, some have debilitating seizures.\u00a0 Historically this state has provided nurses to help these families care for their kids.<\/p>\n\n

In 2010, New Hampshire spent almost $10 million dollars sending nurses to children\u2019s homes. By 2011, it had been years since the Department of Health and Human Services<\/a> had taken a hard look at the program to make sure they were spending their money well.\u00a0 HHS\u2019s Lisa Britt Solsky says she was hearing stories, \u201cWe would have the most highly credentialed nurse in a home, overnight, where the patient was at all times stable sleeping through the night.\u201d<\/p>\n

Should your most qualified, most expensive nurses be on the clock when their patient is sound asleep?<\/p>\n

What are the consequences of taking that highly skilled nurse away when minutes could be the difference between life and death?<\/p>\n

Legitimate policy questions….particularly at a time when other programs are being gutted due to the budget crunch.\u00a0 But tricky, too.\u00a0 These are some of the state\u2019s most fragile and expensive Medicaid patients.<\/p>\n

Enter Schaller Anderson<\/h3>\n

The state asked its Medicaid contractor Schaller Anderson – a company with a 20 year track record that manages more than one million Medicaid patients across 11 states \u2013 to tackle this delicate project.<\/p>\n

\u201cThey were hired to bring a level of professionalism and resources…this is what they do.”<\/p>\n

Solsky explains Schaller\u2019s job was to basically check up on the 150 patients every 12 weeks to make sure skilled nurses did medical things, and the nurses with less<\/em> training did things like…watch patients while they slept.\u00a0 Solsky says if a family didn\u2019t like a cut made by Schaller, that family had options. \u201cSomebody who disagrees has the right to appeal.\u201d<\/p>\n

Schaller Anderson has reviewed 800 cases.\u00a0 In that time, they changed nursing service for about a third of the families.\u00a0 And families appealed just 5 percent of the decisions.\u00a0 But the appeals…man, are there some upset people.<\/p>\n

The Fouts’ Story<\/h3>\n

\u201cIt\u2019s convoluted. It doesn\u2019t make sense whatsoever.\u201d<\/p>\n

That\u2019s Elizabeth Fouts.<\/p>\n

NHPR has heard from half a dozen families who expressed everything from bewilderment to outrage with Schaller and the state.\u00a0 Fouts\u2019<\/em> odyssey began last May when Schaller reduced her son\u2019s nursing care from 40 hours a week to 32.\u00a0 \u201cWe had very few hours cut,” Fouts says.\u00a0 “But 32 hours is huge when it\u2019s the difference between being able to get to work on time and function.”<\/p>\n

From the get-go, Fouts questioned Schaller\u2019s methods.<\/p>\n

\u201cThe parents need to get a grip, their children are going to die.\u00a0 I have had that said to me.\u201d\u00a0 –Dawn Mrotek, Silver Touch Home Care<\/div>No one ever stopped by to meet her 17-year old son Adrian who has heart problems, micro feet, is deaf, legally blind, can\u2019t walk on his own, adores Fig Newtons and loves to cuddle.\u00a0 Instead, Schaller relied on their assessment of Adrian\u2019s medical records to determine how much nursing he needed.\u00a0 But Fouts says if anything, Adrian\u2019s needs kept growing…he sometimes suffered from eight- to 10-minute seizures.<\/p>\n

\u201cIf he has a seizure, he quits breathing…he is oxygen deprived, if we do not have the ability to give him medicine rectally that will stop the seizure, we call 9-1-1 because there is absolutely nothing we can do.\u201d\u00a0 As ridiculous as the cut seemed to her, Fouts knew she had to try and get those eight hours back.<\/p>\n

Easier said than done.<\/p>\n

\u201cThere really isn\u2019t a state office that can inform you who SA is, what they are doing,” Fouts says. “And frankly the person who called me the contact person, she\u2019s not forthcoming about what the decision was based on. What the criteria are for hours, all of that, all of the questions I asked went unanswered.\u201d<\/p>\n

HHS didn\u2019t make Schaller available for this story, nor did company officials return calls for comment.<\/p>\n

Even though Fouts appealed, she had to wait six months to get her hearing with Schaller.<\/p>\n

When the date finally<\/em> arrived, Fouts was sure to bring Adrian, wanting Schaller to actually meet her boy.\u00a0 She wanted to overwhelm Schaller with evidence that they had screwed up.\u00a0 When given the chance, she grilled the company\u2019s doctor.\u00a0 \u201cI said to Dr. Robinson…do you feel now that you\u2019ve met Adrian, you\u2019ve seen the medical reports, that he\u2019s represented?….and he said, no. \u2018Clearly, a mistake has been made. And I am prepared to reverse this decision right now.’\u201d<\/p>\n

Good news for Fouts and her son.<\/p>\n

\u201cWe sort of went home feeling, the pediatrician, the nursing agency, good sense prevailed…and 10 weeks to the day, I got a phone call saying your hours have been cut.\u201d<\/p>\n

Cut back down to 32 hours, for a second time.<\/p>\n

It was as if the first appeal hadn\u2019t even happened.<\/p>\n

\u201cIf I could go back to Dr. Robinson and say we went through this.\u00a0 We wasted your time. you wasted our time. but we came to a decision. Why would we do that again?\u201d\u00a0 But Fouts says neither Schaller nor the state ever made Dr. Robinson available….so she appealed….again.<\/p>\n

Appeals Process Under Fire<\/h3>\n

Families and nursing agencies also say Schaller Anderson staff has made heartless comments.<\/p>\n

Dawn Mrotek runs Silver Touch Home Healthcare<\/a>, one of the nursing agencies that has lost money from the Schaller cuts.\u00a0 \u201cThe parents need to get a grip, their children are going to die.\u00a0 I have had that said to me.\u201d<\/p>\n

The comments and Kafkaesque process has convinced people like Disabilities Rights Center attorney Rebecca Whitley that Schaller is motivated by money.\u00a0 \u201cHow is it efficient, both time and money, to do these 12 week reviews, continue to do appeal after appeal? How is that efficient? For these children whose conditions do not change. It doesn\u2019t make sense.\u201d<\/p>\n

“Some of these situations…don\u2019t seem to make a lot of sense, and don\u2019t seem consistent with what our goal was when we undertook this review a little over a year ago.\u201d–Lisa Britt Solsky, HHS<\/div> If the state is really interested in savings, Whitley suggests HHS invest in a better way to review cases…one that doesn\u2019t involve repeated nursing cuts for people who have successfully appealed.\u00a0 That\u2019s where critics believe the state has really fallen short, there\u2019s no oversight.\u00a0 Nobody at the Department is willing to override Schaller, exercise some discretion, or say \u2018I\u2019m sorry.\u2019<\/p>\n

HHS\u2019s Lisa Britt Solsky says in no uncertain terms Schaller doesn\u2019t profit from making more cuts than necessary.\u00a0 But she admits in some moments the state should have done better by their clients.\u00a0 She says concerned families should call the Office of Medicaid Business and Policy.<\/p>\n

\u201cIf we had the opportunity to work directly with the families, we could iron out some of the anomalies. Some of these situations that don\u2019t seem to make a lot of sense, and don\u2019t seem consistent with what our goal was when we undertook this review a little over a year ago.\u201d<\/p>\n

That said, Solsky believes the project has been worthwhile.<\/p>\n

She believes this project helps the state as the Department inches towards outsourcing their entire Medicaid program this summer.\u00a0 The bulk of Medicaid patients \u2013 kids and mothers \u2013 are relatively healthy and not terribly expensive.\u00a0 The opportunity for savings in Medicaid, says Solsky, is in controlling the costs of the elderly and disabled.<\/p>\n

Reviewing all 150 severely disabled kids helps the state hit the ground running.<\/p>\n

\u201cNow that we know more about their day to day needs, we are in a much better position to make those assessments. And we are in a better position to make the transition as we move into managed care,” Solsky says.<\/p>\n

Impacts Beyond Disabled Kids?<\/h3>\n

The Department is currently negotiating contracts with three managed care companies.\u00a0 HHS will make the names public in about two weeks.\u00a0 In a little more than 3 months, HHS will be enrolling most of its 120,000 Medicaid patients into one of several private managed programs.<\/p>\n

That\u2019s about 10 percent of the state\u2019s population.<\/p>\n

Some advocates predict this trouble with Schaller is just a preview of how the state will handle managed care writ large \u2013 where, they say savings trumps care.<\/p>\n

Steve Norton with the New Hampshire Center for Public Policy Studies<\/a> says managing Medicaid means being more aggressive, cutting services.\u00a0 \u201cYou create cliffs, and those cliffs create pain for a small group of people who fall over that cliff into a place where they no longer receive the same services.\u201d<\/p>\n

But Norton says there\u2019s nothing about managed care that requires<\/em> HHS to abandon its duty to its patients.\u00a0 There\u2019s nothing that prevents the state from building some safety valves to help people when they hit brick walls with the private Medicaid companies.\u00a0 That, he says, is well within HHS\u2019s power.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Over the last year, dozens of families have lost state subsidized nursing support to care for their sick children.\u00a0 Some parents say the reductions have made it hard to juggle work and keep their kids healthy. New Hampshire hired a private company, Schaller Anderson to manage these cases. Frustrated parents accuse the company of making […]<\/p>\n","protected":false},"author":69,"featured_media":7107,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[53],"tags":[556,529,564,494],"acf":[],"_links":{"self":[{"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/posts\/7086"}],"collection":[{"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/users\/69"}],"replies":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/comments?post=7086"}],"version-history":[{"count":28,"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/posts\/7086\/revisions"}],"predecessor-version":[{"id":7116,"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/posts\/7086\/revisions\/7116"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/media\/7107"}],"wp:attachment":[{"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/media?parent=7086"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/categories?post=7086"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/new-hampshire\/wp-json\/wp\/v2\/tags?post=7086"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}