Sunday, November 15, 2009

Effect of 9c Cuts on Massachusetts Residents

Governor Deval Patrick announced the latest cuts for Mass Health that affect persons with disabilities and elders as reported by My comments are inserted in bold for some of the cuts:

1) Reducing day habilitation services by 5 hours per week, per recipient
2)Rolling back day habilitation rates to pre-February 2008 rates

3)Reducing Adult Dental Care, eliminating restorative care; allowing only emergency, preventative and x-rays


This cut is ridiculous. If people can't get dentures paid for Mass Health, how will they eat solid foods? Elders and persons with severe disabilities are in danger of starving to death. Why should they have to resort to having their foods pureed if they can't afford dentures to eat solid foods? Not a sound healthcare policy by the Governor. There will be an increase in emergency room visits due to people getting infections in their teeth for poor dental care. A big cost to taxpayers.

4)Eliminating podiatry for all but diabetics

As mentioned above, not a sound healthcare policy. There will be an increase in ER visits due to Mass Health not paying for preventive foot care.

5)Eliminating PCA supports for severely disabled people needing less than 14 hours of service per week

Unfortunately, individuals who had less than 14 hours a month for PCA care are in danger of going to a nursing home due to cuts in homecare. Families will now have to do more to help their loved ones stay out of nursing homes and/or going to the ER for lack of personal care. More stress on the family and caregivers will result in potential neglect and physical abuse on these clients.

6)Reducing Adult Foster Care rates

I have mixed feelings due to one for profit entity making a 20% profit after operational costs are covered. Why can't these entities be non-profit and put the profit back into needed services for those clients to remain living at home?

7)In addition, there will be co-pays for some office visits and on presecription medications.

Hooray! Finally, these residents will have to pay something for their services. I am aware that some of them will not pay due to poor money management strategies. These individuals needs better skills in money management to pay for their co-pays for services. I have no sympathy for some individuals who blow their money on lottery tickets and on other foolish ways on the public dole.

In summary,these changes will be implemented over the course of the five months through April 2010. Some will require regulatory changes that include public hearing. Others may require legislative changes but let's be real - the legislature is not about to dirty it's hands in any way other than passing quickly on whatever the Governor proposes

Final Comment:I am aware that Mass Health will reduce their rates to providers who have to ask for co-pays from their clients. Potential layoffs can occur if providers are not able to provide the bare bone services they are currently providing for this population

What do you think?

Robbin Miller, LMHC

Wednesday, November 4, 2009

Promoting Disabilities as a Cultural Competence Part II.

Below I copied and pasted a Mass Health Provider (I did not put the actual name down) for Mental Health Services in Massachusetts on their policy for Cultural Competence:

What is Cultural Competence?

Cultural competence is the ability to work effectively with people from different ethnic,
cultural, political, economic, and religious backgrounds. This Mass Health Provider for mental health is committed to cultural competency and aims to improve the
access and quality of care received by our diverse group of Members.

This Mass Health Provider trains staff and providers so they are able to provide services with sensitivity, understanding, and respect for the Member's culture.

This Mass Health Provider is committed to a culturally competent program and aims to
establish services that reflect:
• Staff knowledgeable in the primary languages and cultural backgrounds represented
by Members;
• Sensitivity of staff members toward the cultural differences of Members;
• Programs that respect and reflect community values and are created by the
participation of community groups; and
• Involvement of Members in decision-making of policies and procedures.


The above does not address Disability Sensitivity as a cultural competence. Why not? How would the proposal to use "unique physical characteristics" as suggested as a possible use for all individuals with these characteristics fit in as a cultural competence?

Please comment.

Thank you,

Robbin Miller, LMHC

Sunday, November 1, 2009

House passes Healthcare Reform: What do you think?

On November 7th at 11:15, the House of Representatives by a slim victory of 220 to 215 votes passed the bill for Healthcare Reform our country. The bill now goes to the Senate for a fierce battle over what stays and goes to improve healthcare reform for our citizens. I was appalled by the lack of disrespect both sides of the aisle had for each other in voicing their disagreements with each other. What happened to civility?

I watched part of the debate on Saturday night and learned how the liberal Democrats chose to forego the abortion issue of using federal funds to pay for it so they can get the votes from their fellow conserative Democrats. Despite the conversary to get the bill passed, it had to be done to move it forward to the Senate in a timely manner.

I agree with some of the concerns the Republican Minority Whip raised during this debate regarding the following issues:

1) Increase in taxes to pay for it.
2) Another layer of government beaurcracy to manage it
3) Seniors losing their choice for enrolling in medicare advantage programs
4) Malpractice insurance and liability for doctors have not been discussed yet

I also agree with the benefits put forth by the Democrats with some reservations:

1) The donute hole for seniors enrolled in the medicare program would be eliminated and discounts of medications would be available. However, are the discounted drugs generic or brand medications?
2) Americans can keep their current health plans. However, will employers find a way to force people to go on the government's plan to decrease their costs to run their businesses?
3) Medical errors in hospitals still need to be addressed. Yes, I agree with the the Democrats that increase errors can lead to increase malpractice and liability claims for doctors and hospitals.
4) The End of Life counseling by doctors is voluntary and not mandatory. This issue needs further clarification.

What bothers me the most is the issue regarding mental health care. How will healthcare reform impact this care? Is the new mental health parity starting in January 2010, the answer to resolving all the concerns and issues that will no longer need to be addressed in healthcare reform?

What do you think? Regarding abortions, I would like healthcare reform promote more adoptions as an alternative and a viable choice for women.

Robbin Miller, LMHC