SMC LME state funded client: twin to 'Phil', mental health consumer of Raleigh N& O
December 12, 2007
Well, this client SMC LME # 040974, is getting to be kind of like the Raleigh News & Observer case study 'Phil', followed up by that paper's mental health writer, Lynn Bonner, I believe, for a number of years, revealing the problems w/ mental health reform.
This client is that client's twin. The Raleigh News & Observor's case study was a Medicaid/ Medicare client, I believe. This client is state funded.
Today, I had my 1.5 hr weekly session w/ the client. I receive no pay for this; I travel to the client's trailer which is 12 miles from the nearest city where I see other clients. Yesterday I spoke w/ Mr. Peterson in Heath Shuler's office in order to ask him to input into the process of this client's application for Medicaid.
SMC LME has refused any state funded clients Basic Level services. Leza Wainwright of Mike Moseley's office verified that the LME was within its right to do so. I severed my relationship w/ SMC LME soon after that.
The client took an overdose of pills last night which prompted the client's spouse to grab the bottle and put the client to bed. The client has a 'friend' who works at the Haywood County Hospital in the ER who passes to the client butterfly needled and plastic tubes which allows the client to fill up the containers with client's blood in order to write (in the future) poems w/ the blood. So, how many vials did you use, I asked? Client walked to the refridgerator, pulled a small one out, indicated there were others. Client is fascinated w/ death and has on laptop computer pictures of coffins.
There is no assurance that client can get Medicaid and I have never heard of a client who is unlinked to SSI or SSDI who gets Medicaid on a reliable basis. The best you ever get in terms of Medicaid w/o linkage to SSI or SSDI is Medicaid deductible for 6 mos/ at a time. The client could use my $3600 therapy bill, unpaid by SMC LME, in order to create the deduction. I cannot get paid if the client uses that bill in order to create a 6 mo Medicaid policy.
Client and spouse were excited last week as they believed they had uncovered, per the local health department, a way to get to Medicaid but then in checking on this, I discovered that 'Family Medicaid' only includes family planning services. No therapy; no medications; no dental coverage to fix the teeth damaged by bulemia.
This client will not be alive in 3 years, the amount of time now documented to be associated with obtaining SSI or SSDI (see NYT article below). Client cannot qualify for SSDI as not enough formal work time. Therefore, under SSI, which client could obtain after several years and the use of an attorney, client will never be able to formally work as client will not be able to earn more than about $200/ month or SSI will disappear, also endangering Medicaid.
This is the state funded client for which SMC LME refuses outpatient therapy.
This is the outpatient client which Leza Wainwright, the deputy under Mike Moseley of NC Mental Health, underlined, as per the LME, that the LME has a right to refuse Basic Level Services to state funded clients (in distinct contrast to WHN LME which does make available Basic Level Services).
This is the 'high cost' state funded client which I discussed today with The Commission's MH/DD/SA chairman Pender McElroy, in order to see if The Commission has the jurisdiction in order to consider whether my proposed suggestion that all LME's render to state funded clients Basic Level Services could come under their jurisdiction.
McElroy .state that it would necessitate combing thru the statutes to see if The Commission could consider the matter. McElroy indicated that much of the power re: mental health reform lays w/ the Secretary of DHHS, currently Dempsey Benton, appointed by the governor.
I am not willing, as the long-term provider of this client, to sit thru 20 hrs of CSS training, which I do not provide, in order to continue to revamp lengthy Person Centered Plans and call up the ACCESS manager at SMC LME in order to obtain month by month authorizations for seeing a client requiring intensive outpt therapy.
Mr. McElroy asked me if there were other providers who had experienced difficulties of this type re: other LME's. I advised him that my contacts w/ other psychologists are mostly within the Western Highlands LME network---where there are not these kinds of problems. .
***** Are there any providers on this listserv who can send me, back-channel, information re: other LME's refusing Basic Level Services for state funded clients?
Thanks for your help.
marsha hammond, phd
******************************
references:
Disability Cases Last Longer as Backlog Rises
Jeremy M. Lange for The New York Times
Richard and Vicki Wild of Hillsborough, N.C., said they were mystified when their son Mark’s disability claim was rejected. “We had 10 years’ worth of hospital records,” Mr. Wild said.
By ERIK ECKHOLM
Published: December 10, 2007
RALEIGH, N.C. — Steadily lengthening delays in the resolution of Social Security disability claims have left hundreds of thousands of people in a kind of purgatory, now waiting as long as three years for a decision....
“We had 10 years’ worth of hospital records and unanimous opinions from the doctors,” said Richard Wild, 62, who until recently was a computer analyst. But his son’s initial application was turned down in 2003.
The family had sunk into debt because of medical bills, nearly losing their house of 30 years, but found a lawyer to file an appeal. The son, by then in his mid-30s, had to wait two more years to get a hearing scheduled, with no income and little life outside his parents’ home and the hospital.
As his hearing date in October 2006 approached, Mark Wild told his parents that he feared another rejection. “It was his last chance at any dignity, and he said if they turned him down it would be too much to take,” recalled Mrs. Wild, a nurse.
On Tuesday, Oct. 17, 2006, just a few days before the hearing, Mrs. Wild woke up to find her son gone. On his desk lay his watch, his ring and a bullet.
On that Thursday, Mrs. Wild, 55, got a call at work from their lawyer. “I just wanted to give you the good news,” she said he told her. “Somehow the judge has already approved the disability, it’s a done deal, Mark’s got it.”
Two hours later, a deputy sheriff and a chaplain arrived to say that hunters had found Mark Wild’s body in the woods, dead of a self-inflicted gunshot wound.
“No one can say for sure, but we’re convinced that his despondency and fear about the disability decision contributed to his death,” said Mrs. Wild, who wears a pinch of her son’s ashes in a small tube on a necklace. ..."
http://www.nytimes.com/2007/12/10/us/10disability.html?_r=1&pagewanted=2&ref=us&oref=slogin
Well, this client SMC LME # 040974, is getting to be kind of like the Raleigh News & Observer case study 'Phil', followed up by that paper's mental health writer, Lynn Bonner, I believe, for a number of years, revealing the problems w/ mental health reform.
This client is that client's twin. The Raleigh News & Observor's case study was a Medicaid/ Medicare client, I believe. This client is state funded.
Today, I had my 1.5 hr weekly session w/ the client. I receive no pay for this; I travel to the client's trailer which is 12 miles from the nearest city where I see other clients. Yesterday I spoke w/ Mr. Peterson in Heath Shuler's office in order to ask him to input into the process of this client's application for Medicaid.
SMC LME has refused any state funded clients Basic Level services. Leza Wainwright of Mike Moseley's office verified that the LME was within its right to do so. I severed my relationship w/ SMC LME soon after that.
The client took an overdose of pills last night which prompted the client's spouse to grab the bottle and put the client to bed. The client has a 'friend' who works at the Haywood County Hospital in the ER who passes to the client butterfly needled and plastic tubes which allows the client to fill up the containers with client's blood in order to write (in the future) poems w/ the blood. So, how many vials did you use, I asked? Client walked to the refridgerator, pulled a small one out, indicated there were others. Client is fascinated w/ death and has on laptop computer pictures of coffins.
There is no assurance that client can get Medicaid and I have never heard of a client who is unlinked to SSI or SSDI who gets Medicaid on a reliable basis. The best you ever get in terms of Medicaid w/o linkage to SSI or SSDI is Medicaid deductible for 6 mos/ at a time. The client could use my $3600 therapy bill, unpaid by SMC LME, in order to create the deduction. I cannot get paid if the client uses that bill in order to create a 6 mo Medicaid policy.
Client and spouse were excited last week as they believed they had uncovered, per the local health department, a way to get to Medicaid but then in checking on this, I discovered that 'Family Medicaid' only includes family planning services. No therapy; no medications; no dental coverage to fix the teeth damaged by bulemia.
This client will not be alive in 3 years, the amount of time now documented to be associated with obtaining SSI or SSDI (see NYT article below). Client cannot qualify for SSDI as not enough formal work time. Therefore, under SSI, which client could obtain after several years and the use of an attorney, client will never be able to formally work as client will not be able to earn more than about $200/ month or SSI will disappear, also endangering Medicaid.
This is the state funded client for which SMC LME refuses outpatient therapy.
This is the outpatient client which Leza Wainwright, the deputy under Mike Moseley of NC Mental Health, underlined, as per the LME, that the LME has a right to refuse Basic Level Services to state funded clients (in distinct contrast to WHN LME which does make available Basic Level Services).
This is the 'high cost' state funded client which I discussed today with The Commission's MH/DD/SA chairman Pender McElroy, in order to see if The Commission has the jurisdiction in order to consider whether my proposed suggestion that all LME's render to state funded clients Basic Level Services could come under their jurisdiction.
McElroy .state that it would necessitate combing thru the statutes to see if The Commission could consider the matter. McElroy indicated that much of the power re: mental health reform lays w/ the Secretary of DHHS, currently Dempsey Benton, appointed by the governor.
I am not willing, as the long-term provider of this client, to sit thru 20 hrs of CSS training, which I do not provide, in order to continue to revamp lengthy Person Centered Plans and call up the ACCESS manager at SMC LME in order to obtain month by month authorizations for seeing a client requiring intensive outpt therapy.
Mr. McElroy asked me if there were other providers who had experienced difficulties of this type re: other LME's. I advised him that my contacts w/ other psychologists are mostly within the Western Highlands LME network---where there are not these kinds of problems. .
***** Are there any providers on this listserv who can send me, back-channel, information re: other LME's refusing Basic Level Services for state funded clients?
Thanks for your help.
marsha hammond, phd
******************************
references:
Disability Cases Last Longer as Backlog Rises
Jeremy M. Lange for The New York Times
Richard and Vicki Wild of Hillsborough, N.C., said they were mystified when their son Mark’s disability claim was rejected. “We had 10 years’ worth of hospital records,” Mr. Wild said.
By ERIK ECKHOLM
Published: December 10, 2007
RALEIGH, N.C. — Steadily lengthening delays in the resolution of Social Security disability claims have left hundreds of thousands of people in a kind of purgatory, now waiting as long as three years for a decision....
“We had 10 years’ worth of hospital records and unanimous opinions from the doctors,” said Richard Wild, 62, who until recently was a computer analyst. But his son’s initial application was turned down in 2003.
The family had sunk into debt because of medical bills, nearly losing their house of 30 years, but found a lawyer to file an appeal. The son, by then in his mid-30s, had to wait two more years to get a hearing scheduled, with no income and little life outside his parents’ home and the hospital.
As his hearing date in October 2006 approached, Mark Wild told his parents that he feared another rejection. “It was his last chance at any dignity, and he said if they turned him down it would be too much to take,” recalled Mrs. Wild, a nurse.
On Tuesday, Oct. 17, 2006, just a few days before the hearing, Mrs. Wild woke up to find her son gone. On his desk lay his watch, his ring and a bullet.
On that Thursday, Mrs. Wild, 55, got a call at work from their lawyer. “I just wanted to give you the good news,” she said he told her. “Somehow the judge has already approved the disability, it’s a done deal, Mark’s got it.”
Two hours later, a deputy sheriff and a chaplain arrived to say that hunters had found Mark Wild’s body in the woods, dead of a self-inflicted gunshot wound.
“No one can say for sure, but we’re convinced that his despondency and fear about the disability decision contributed to his death,” said Mrs. Wild, who wears a pinch of her son’s ashes in a small tube on a necklace. ..."
http://www.nytimes.com/2007/12/10/us/10disability.html?_r=1&pagewanted=2&ref=us&oref=slogin
posted by Marsha V. Hammond, PhD at 2:21 AM
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