Effingham mother promised in-home care denied service - WTOC-TV: Savannah, Beaufort, SC, News, Weather & Sports

Effingham mother promised in-home care denied service

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EFFINGHAM CO., GA (WTOC) -

An Effingham County mother said her daughter was promised in-home care through Medicaid, but was then later denied service.

Shanna Parrish said her daughter has had in-home care her whole life through a Medicaid program called the Georgia Pediatric Program, but recent cuts in service had them looking at other Medicaid programs with more coverage.

That's when things fell apart.

"Who wants to know that their baby can't get care," said Parrish.

It's been an emotional roller coaster for Parrish and her family. She said her daughter, Kali, was accepted into the Comprehensive Supports Waiver Program, also known as COMP. It's a Medicaid program that provides in-home care.

"She has cerebral palsy and epilepsy, she's wheelchair bound. She has a trake," said Parrish.

Parrish said her daughter needs extensive care with extensive coverage, so she had to apply for what they call an exceptional rate.

The Georgia Dept. of of Behavorial Health & Developmental Disabilities set her up to receive local in-home care through Coastal Home Care. Officials there told Parrish her daughter had been approved to receive that type of optimum care service.

"I was very hesitant for the certain fact of, what if they came back and denied?" she said.

Parrish had a gut feeling that something wasn't quite right because she never received a letter in the mail, only verbal reassurance.

"They kept reassuring us, ‘you were approved,'" Parrish said.

On August 1, nurses began coming to care for Kali, but less than a week later, that all changed when they got a call from Coastal Home Care Officials.

"Saying Kali got denied off the exceptional rate and they were pulling all nurses off of our case," Parrish said.  

Parrish was given no notice and no time to find other care. What's even more shocking, she's yet to receive any type of explanation from the state or Coastal Home Care about why Kali was denied in the first place, especially after they told her she was accepted.

"I think Region 5 dropped the ball," Parrish Said. "I think Coastal dropped the ball in contacting us appropriately."

Luckily, Kali was able to jump right back into her old Medicaid program. Parrish said some care is better than no care at all.

Coastal Home Care released this statement to WTOC:

Coastal Home Care is deeply disappointed with the outcomes on the Parrish case, and we sympathize with the family.  

We began services for this family at the request of the regional office of the state department of behavioral health services with the understanding that the state would approve the program. Before the Atlanta office provided written authorization we responded to a request by the family and the Savannah regional office to send nurses to care for this child beginning on August 1. Regional representatives assured our company that the case would go forward. It turned out that they had no authority to do so. The state office chose to not approve the program for the family, and Coastal was left with no options but to discontinue service. We are a private company with no authority to serve individuals in these programs unless we are authorized to do so.

We understand that the family continues to have access to services through another program (known as the GAPP waiver) specifically for children with disabilities.

The Department of Behavorial Health & Developmental Disabilities released this statement of facts to WTOC:

  1. Region 5 has a letter of agreement with Coastal Home Care.
  2. Coastal Home Care is an enrolled Medicaid Waiver provider in several home and community based programs in Georgia; the waiver programs for people with developmental and intellectual disabilities are included in the programs under which the agency provides services.
  3. A thorough clinical evaluation is conducted to determine if individuals who require exceptional support may be eligible for an exceptional  rate.
  4. Individuals accepted into the Comprehensive Supports Waiver Program (COMP) receive notification of eligibility and admission through the regional office closest to their home or current location.  The exceptional rate determination is a process between the provider, the regional office and the DBHDD central office since it involves dialogue with an identified provider about what additional support may be required to safely and effectively serve a particular individual.  The rate will be determined based on proposed staffing by the provider and validated through clinical evaluations of specific needs.
  5. Any  provider who has a relationship with a Medicaid member may and should engage in conversations with the member.  As a matter of course and good practice, the department requests that such conversations take place in collaboration with the department using factual information.
  6. Exceptional rates are directly determined by evaluating the clinical need.  Because of the direct correlation between the clinical assessment and the exceptional supports funded through the rate, additional clinical information may be submitted if the provider disagrees with the rate.  The rate, however, does not impact the individual's ability to receive service

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