Across the State of Kentucky, the disabled, and families of the disabled acting on their behalf, apply for the Michelle P. Waiver to receive essential supports and services that are desperately needed. Upon approval, recipients can receive up to forty hours a week of personal care, supported employment, attendant care, behavioral supports, community living supports, speech, occupational, and physical therapies. Qualifying applicants possess a diagnosis of mental retardation or developmental disability, as determined by doctors, psychologists, and specialists, whose area of expertise is relevant to the specific diagnosis given. An evaluation performed by a local community health center must then be reviewed by a separately contracted agency, to determine if the applicant qualifies for the waiver. Currently, the agency contracted by the State of Kentucky to provide this service is SHPS, or Carewise Health. SHPS/Carewise is a privately owned, for profit, health care and human resources service company, that in addition to providing services to the State of Kentucky Medicaid program, provides services to health plans and insurance companies, pharmacy benefit managers, third party administrators, health and benefits brokers and hospitals. They act as a middle man for the people that need services, and the organizations that provide services. In Kentucky, they employ doctors with no definitive expertise in mental retardation or developmental disability to review the evaluations provided by the local community health centers, and determine the applicant's level of care requirement. This is bad policy that is negatively affecting many families across the state, as disabled citizens that clearly meet all provided guidelines as defined in the Michelle P. Waiver legislation, are being denied supports and services by SHPS. It is insulting and inappropriate for a general practitioner, with only cursory knowledge of the diagnosis' they are reviewing, to assert a determination contradictory to that of a doctor or specialist, who is specifically trained and adept in the relevant field. SHPS' inability to understand and appreciate the subtle complexities of the evaluations they are reviewing is undermining the effectiveness of the Michelle P. Waiver, resulting in an alarmingly high number of denials for children diagnosed with disabilities ranging from Downs Syndrome to Autism Spectrum Disorder. It is time the Cabinet for Health and Family Services finds a new process for reviewing Michelle P. Waiver applications that relieves SHPS of their role, that includes assessors, evaluators, and doctors, knowledgeable in mental retardation and developmental disabilities. To continue delegating this task to incapable, under qualified, profiteering corporations sends a message to disabled citizens across the state, that they are second class and insignificant.
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