The Department of Health and Mental Hygiene’s (DHMH) Rare and Expensive Case Management (REM) Program was designed to provide specialized health care services to low-income individuals with rare and expensive-to-treat illnesses, who qualify for Medicaid. However, under current DHMH regulations, Maryland residents who qualify medically and financially for REM benefits—and for Medicare—are being denied those benefits if they receive Medicare benefits.
Medicare does not cover the kind of health care services REM is designed to provide. As a result, these seriously disabled Marylanders are without the critical assistance the REM program is intended to give them, a situation that gravely threatens their well-being and their family’s financial security.
Dustin who is critically ill (ventilator dependent), qualifies both medically and financially for REM but has been denied benefits because of “Medicare conflicts.” In essence, because he worked, earned wages, and paid Medicare and Social Security taxes, he is ineligible for the one government program that can provide the in-home nursing care he requires. Instead, his mother faces the very real prospect of having to quit her job to care for him, which would cause significant hardship for the family.
We are asking the State of Maryland to:
1) immediately provide REM benefits to individuals who qualify both medically and financially for them but have been denied benefits because of the “Medicare conflicts”;
2) strengthen coordination and communication among Maryland’s health care agencies so that patients and families have full and convenient access to information about assistance programs and the regulations governing them; and
3) review and modify, as appropriate, Maryland programs such as the Living at Home Waiver, the Medicaid Institutional Requirement, and the Developmental Disability Waiver to make them more accessible and useful to those in need of home health services.