Tag Archives: new york

NY State needs and deserves its TBI Waiver

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If you take a Rolls Royce, arguably the best made car on the planet, and put a lousy driver behind the wheel, the car is going to have mishaps, accidents, and probably have a tough time staying on the road. This does not mean you get rid of the Rolls Royce, it means you get a better driver. And so it is with New York State’s Traumatic Brain Injury Waiver. The TBI Waiver is an extraordinary presence in the state and, as one recent person commented on this blog accurately pointed out: “Without the comprehensive services (of the waiver and its) dedicated staff …survivors (of brain injuries) will be forced to live in nursing homes and out of state facilities. These folks will never have the opportunity to live – albeit with supports – as independently as possible in the community, rebuild friendships and relationships, and enjoy life as any other person would.”

The problem is not the waiver. The problem is the insular and dysfunctional staff at the New York State Department of Health who are dangerously mismanaging the waiver, along with a disturbing public silence in support of the waiver from groups like the state’s Traumatic Brain Injury Services Coordinating Council (TBISCC) and Brain Injury Association (BIANYS). I would urge both groups to publicly support the waiver and do so soon.

The TBI Medicaid Waiver came to New York in 1995 so brain-injured New Yorkers living in nursing homes oftentimes in Massachusetts yet paid for by New York dollars, could come back to New York and live in the community. The waiver also helped and continues to help brain-injured New Yorkers at risk for nursing home placement remain in the community.  It is worth noting too that it is less expensive for someone to be on the waiver than in a nursing home.

Time is very much  of the essence. The current behavior of the DOH (along with a well-fed rumor mill that says the state is looking to dump the waiver) is putting the lives of those on the waiver at risk; at real risk. Let’s not forget that a federal court had to step in and protect the life of waiver participant Francine Taishoff from the DOH. Let us not forget that the DOH was seeking to dump Ms. Taishoff from the waiver, charge her $24,000 in back housing subsidies, knowing full well that their actions would’ve probably rendered Ms. Taishoff, who is a senior with a brain injury, homeless, which may well have ended her life. Slashing housing subsidies with little if any explanation, holding off on signing service plans (waiver lingo for treatment plans) for inexcusably long periods of time, blocking waiver staff from supporting their clients at Medicaid Fair Hearings when their services or homes are being threatened, all adds up to a hostile, dangerous, and life-threatening environment.

It was worrisome when,  after publicly warning the TBISCC during their September 12 meeting that lives were at risk,  council chair Michael Kaplen immediately responded by adjourning the meeting, never mind the threat to people’s lives  and never mind that Mr. Kaplen’s term on the council, we later learned, ended in 2004.

None of us want to wake up one morning and learn that someone has died because of the behavior of the DOH; but it is the DOH, not the waiver that is the problem. If the waiver is not protected and better “drivers” placed at the helm, tragedy awaits. It’s inevitable.

This country was founded on the belief that individual freedom is an unalienable right. Freedom includes independence, and all people, with or without disabilities, deserve the maximum independence possible. To dismantle or abbreviate the waiver, rather than supporting it, building it, and giving it better “drivers,” would be the denial of freedom and independence which is, when all is said an done, about as un-American as it gets.

 

The Problem With Secrets

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The problem with secrets is most people can’t keep them.

Despite the New York State Department of Health’s refusal to confirm the directive for this writer, employees in several RRDCs (Regional Resource Development Centers) around New York State confirm the DOH has directed that waiver provider staff are not permitted to  advocate or testify for their clients in a Medicaid Fair Hearing. In fact, if they attend the Fair hearing, they must support the DOH’s position and not their clients.

Several sources say this directive was shared with RRDCs during a conference call with DOH official Beth Gnozzio.

Sources say they have been given two reasons for this. One is based on the slippery-slope notion that since providers are approved by the state to provide services, they are under contract with the state and to disagree with the state would be a conflict of interest (I suddenly feel like I’m writing about the Soviet Union). The second reason would be funny were it not so sleazy: This reason says since providers are paid to provide services to their clients, supporting their clients request for continued services would be self-serving and again, a conflict of interest. 

It seems to me that this is one of those occasions where facts and reason have little effect, at least not on the decision making of the DOH. The notion that being approved by the state precludes providers from supporting their clients would, I suppose, mean that doctors, psychologists and social workers, all licensed by the state, would be precluded from supporting their clients and patients.

Using the fact providers are paid for their work as a reason to stop them from supporting their clients would, I again suppose, mean that a doctor recommending treatment for his or her patient should not support the patient when an insurance company seeks to deny treatment because the doctor is getting paid for his or her work.

It seems to me we are witnessing institutional corruption.

You can be sure of one thing, more people will talk, more facts will come out into the light of day and, when they do, they will find their way to the pages of this blog.

The DOH and others would be well advised to pay close attention to Launcelot’s words in Shakespeare’s Merchant of Venice when he said, “but at length the truth will out.”

And it will.