Medicaid Equipment Pleas Go Unanswered

By RICHARD PÉREZ-PEÑA

Published: January 12, 2005

New York State has all but halted Medicaid payments for equipment used by severely disabled poor people in the metropolitan area, leaving thousands without devices like wheelchairs and walkers, according to the health professionals who treat them.

To cut costs, the State Health Department eliminated the Medicaid office in Manhattan that handled equipment orders for the downstate region, an office that had approved the great majority of requests within a few weeks.

Since the office closed on Nov. 1, the requests have gone through an office in Albany that has delayed and rejected nearly all of them, according to doctors, therapists and equipment vendors.

The department said those people have not adequately justified their equipment orders to Medicaid, the government health plan for the poor, but the professionals dispute that position.

"We've sent well over a hundred requests since late October, and we've gotten just one approval," which came last week, said Dr. Dara Richardson-Heron, chief medical officer of United Cerebral Palsy of New York City. In interviews last week, several other people who treat severely disabled people said that all or nearly all of their requests were being denied.

A spokesman for the Health Department, William Van Slyke, said the doctors and therapists were exaggerating the extent of the problem, though he said he could not supply any figures. "We are seeing a higher number of rejections out of the metropolitan area, but we would dispute that it's virtually all of the requests," he said.

"The most common problem is the lack of documentation citing that the product is medically necessary," he said. "We found that the New York City office deviated from established protocols, and we're trying to apply the rules and regulations uniformly to every part of the state."

People who work with the disabled said that since the downstate office closed, the state's requests for more information have been vague, excessive or duplicative. And, they said, they have found it nearly impossible to communicate with the Health Department about their requests.

Mr. Van Slyke said he did not have enough information to respond to such complaints, and the department would not make any official directly involved in the program available for an interview.

The items in question fall in the category of durable medical equipment, including shower chairs, special beds, crutches and wheelchairs, but most requests are for replacement parts or repairs for those devices.

Doctors said the Manhattan Medicaid office processed tens of thousands of equipment orders monthly, so the number of requests turned back since Nov. 1 must be in the thousands. They cannot cite more precise figures, but they said some patients had been left unable to leave their homes for school, work or medical treatment, while many more were using ill-fitting or broken equipment.

Dr. Meg A. Krilov, who treats disabled patients at several clinics in New York City, said she had not had a single equipment request approved in months. She told of a patient who is homebound because he cannot get a new battery approved for his power wheelchair, one who cannot replace a broken belt to hold her in her chair, and one who can control her wheelchair only by moving her chin and cannot get a device that would let an attendant control the chair.

Cerebral palsy has left Howard Stone, 44, with little use of his arms or legs, he suffers from scoliosis, and he is moderately retarded, said his mother, Dorothy. His wheelchair tilts forward or back - movements he cannot make on his own - but after years of hard use, it is broken. He has been trying for two months to get it repaired, so far without success.

"At the doctor's office, the chair froze in the horizontal position, so it took four of us to get him in position to give him a shot, and we weren't sure we would be able to get him home," said Mrs. Stone, who, like her son, lives in the Bronx.

http://www.nytimes.com/2005/01/12/nyregion/12wheelchairs.html?ex=1106549791&ei=1&en=8da95bdd6b8708a9