Christin Bates, the Dallas Theological Seminary doctoral candidate/muscular dystrophy patient whose struggles with Texas' health bureaucracy we chronicled here a week ago, won't be stuck in a nursing home after all.
Bates, 31, had spent the previous eight months futilely battling an alphabet soup of state health agencies in an attempt to secure full-time, in-home care. Her condition, spinal muscular atrophy, has left her confined to a wheelchair and unable to perform most daily functions (e.g., going to the bathroom, preparing meals and taking medication) unassisted. For the first three decades of her life, her parents provided the needed care with nominal help from the state while she was pursuing her master's degree in Houston, but they recently moved back to Florida; besides, no self-respecting 31-year-old wants to be eternally dependent on their parents. If the state would pay for in-home care while she pursued her degree -- as she contends federal law obligates it to do -- she would be able to achieve her goal of becoming a theology professor, which would allow her to cover her own health-care expenses.
But Superior Health Plan, Bates' state-contracted Medicaid provider, offered a maximum of 47 hours of care per week. That's a tad less than seven hours per day, which, for someone in Bates' condition, is scarcely better than nothing. And that was after the nine-hour boost that came after Bates got U.S. Senator John Cornyn's office to inquire about the case. The state would, however, pay full freight at a nursing home.
This week, something miraculous happened. Superior tripled the amount of care it was offering Bates. "So, less than a week after your story posted I signed a plan from Superior today providing me with 140 hrs of PCA services," Bates wrote in an email yesterday. "I'm obviously really pleased to have a resolution after all of this time, but it's frustrating to know that if I'd reached out to the media eight months ago I could've saved a ton of time and stress."
Which is great, both for Bates, who gets the care she needs, and for Eric Nicholson, who gets to include self-congratulatory quotes in his story. But why did it take eight months and an unflattering news story for Bates to get her hours? And what about the justifications the the state gave me for limiting the hours -- basically that federal Medicaid rules are very strict and don't permit the state to pay for in-home care when a nursing home is cheaper?
Stephanie Goodman, a Texas Health and Human Services Commission spokeswoman, says this morning that she'll check on the specifics of Bates' case but, in the interim, offered the following:
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Ms. Bates, like most Medicaid clients in Texas, is covered by a Medicaid managed care program. Under managed care, the state pays the client's Medicaid health plan a set fee each month to provide that person's care. So the state's costs are locked in. The health plan must agree to provide at least the same level of service that Medicaid would have covered under the traditional fee-for-service program, but the health plan can choose to cover additional services.
In other words, Superior, the contractor, is just eating the extra cost. Whatever the mechanism, Bates is happy for the help, even if she would have preferred a broader policy change making it easier for patients in her situation -- physically disabled but otherwise able to function independently -- to live independently rather than be stuck in a nursing home. Then again, Texas has never really been keen on expanding low-income health benefits.
Update at 2:57 p.m.: Goodman adds, "Ms. Bates' Medicaid health plan was able to work out a service plan with her that increased her hours for attendant care and decreased her hours of nursing care to better meet her needs and still stay under the cost cap. A recent increase in the cost limit (those are reviewed periodically) also helped make that possible."
Send your story tips to the author, Eric Nicholson.