State Medicaid changes suspended as foster care providers struggle

Certain requirements of a Nevada Medicaid regulation enacted in January have been suspended, at least for 90 days, because of a financial crisis that Clark County foster care providers are facing and to prevent children from being displaced.

Effective Feb. 14 and retroactive to Jan. 10, the state’s Medicaid program implemented a policy permitting basic skills training for children and teens who recently have exhibited disruptive behavior and are in the custody of the juvenile justice system or a child welfare agency.

The services are to be provided without a medical review as they were under an old regulation that was changed on Jan. 10. The current requirements, which have been put on hold, require basic skills training recipients to go through a review and authorization process to determine whether there is a medical necessity for the services.

The suspension will allow state officials to evaluate the impact of the regulation change, according to a statement from Mary Woods, spokeswoman for the Nevada Department of Health and Human Services.

“We are in an emergency situation. We need to fix it immediately,” said Clark County Family Court Judge William Voy on Friday. “We got a Band-Aid in place and 90 days to find a solution.”

Basic skills training helps those who have mental, physical or behavioral impairments attain more functionality in society. Before the Jan. 10 regulation change, recipients automatically got two daily hours of basic skills training after submitting a request for services.

The regulation was changed to cut costs and reduce abuses in the system, which state officials have acknowledged may have included fraud. Costs for the program went up to $71.8 million in fiscal 2013 from $6.3 million in fiscal 2006.

Since the change went into effect on Jan. 10, many children in therapeutic foster homes have been denied services, which created financial hardship for foster home providers, forcing at least one to lay off 12 employees.

Some providers have said that if no short-term solution was identified, they were going to start returning children to Clark County’s Department of Juvenile Justice Services and the Department of Family Services.

Dave Doyle, Eagle Quest director of operations, said Voy and officials at the Juvenile Justice Services were “huge advocates” in helping obtain a quick resolution. His agency had to lay off staff. State and county officials also met to come up with a short-term fix.

Doyle said Mike Willden, director of the Nevada Department of Health and Human Services, understood that Medicaid reductions have affected specialized foster care providers.

“He too did not want any child to (lose placements) over a funding issue,” he said.

John “Jack” Martin, director of the county’s Department of Juvenile Justice Services, said on Tuesday that those his department oversees need the services, especially those facing charges related to sex offenses. Basic skills training includes anger management.

“Low-level sex offenders require treatment before they can be put back in the community,” he said. “Correctional care doesn’t provide for that special intervention.”

Therapeutic foster home do just that, he added. His department has about 66 youth placed in therapeutic homes, and about 50 percent of them are facing charges related to sex offenses.

Martin said he doesn’t know what a good long-term solution would be.

“This is a very complicated matter,” he said. “I wish there was an easy answer, an easy solution.”

Family Services officials won’t comment until they learn more about how the short-term solution will affect children in the agency’s care, according to Kristi Jourdan, Family Services spokeswoman.

Last year, county officials began to review basic skills training providers in the community because of fraud concerns, Voy said. The state’s Medicaid office hasn’t provided enough oversight.

“Medicaid is responsible for letting this (basic skills training) get out of control,” he said.

County officials will also step up its oversight efforts.

“There’s a need for it,” Voy said.

Doyle said that it’s “unfortunate that a few unethical providers often overshadow the work of honest and ethical providers.”

“No provider is perfect, but those who intentionally defraud and abuse Medicaid need to be dealt with swiftly and eliminated,” he said. “They simply should not have the privilege to work with children.”