Tough Decisions: Oregon's Limited Paid Parent Caregiver Program
Tough Decisions: Oregon's Limited Paid Parent Caregiver Program
Plus: Lawsuit says insurance fraud was responsible for Indiana's $1B budget deficit, not parent caregivers; and a 24-hour nursing service in Florida charged thousands while 7-year-old starved to death
How many stories does it take to make a “media frenzy”? Is two stories enough?
Probably not. But in last couple weeks there have been not one but two in-depth stories published on Oregon’s paid parent caregiver movement! (See last week’s issue for the one from KATU.)
This latest one is from Kaylee Tornay from Investigate West — a ProPublica-type outlet for Oregon and Washington. Tournay did a great job of synthesizing this issue for her readers, so I urge you to check it out. Leah Nash, the photographer, came and did photos at my family’s house but I liked Paige Hall’s quotes the best. Paige is also a member of our parent group Advocates for Disability Supports, which focuses on childhood disability services policy change in Oregon. (Join our email list and follow our Facebook page for updates.)
Here’s an excerpt from the story:
As a single parent, Paige Hall has primary custody of her son James, 12, who has drug-resistant epilepsy and nonverbal autism. She spends hours each day keeping him healthy and safe.
As is the case for many families whose children experience disabilities, that work is varied and complex. Paige works with him on self-regulation, using an adaptive communication device and training with his service dog. Sometimes, they’ve had support from outside certified workers that James was comfortable with. But many other workers have not shown up when they’re scheduled or haven’t been a good fit for James. Paige is the one who knows him best and is best equipped to care for him, she said.
She was laid off from her part-time job during the pandemic. Since then, she’s worked mostly odd jobs, including as a paid part-time caregiver for another child with disabilities. James’ Social Security benefits and food stamps help ensure they have a roof over their head and enough to eat.
Being paid for his care during the pandemic took a huge weight off her mind, she said.
“That was life-altering,” she said. “For the first time in my child’s life, I wasn’t just completely stressed out about if his needs were being met, if he was being taken care of appropriately, if I could afford to feed him or myself.”
James was healthier, too, she said. While he had previously been hospitalized at least once a month, during the two years his mother was paid for caring for him, he had only one unscheduled hospitalization, she said.
“I didn’t realize how bad it was until I got put into a place where we felt secure and we felt safe and where we could really evaluate what was working and what wasn’t working,” she said. “That should always be the bare minimum.”
In an ironic twist, however, Paige is unsure whether she would participate in the Children’s Extraordinary Needs program if given the option.
That’s because she has estimated that the money would raise their income enough to make them ineligible for food stamps. But 20 hours a week at $20-$22 an hour wouldn’t be enough to replace what food assistance provides for them.
Paige said the 20-hour cap feels like “a slap in the face.”
“That’s not replacing the full-time job that people are giving up” to care for their children, she said.
Read the full story — including our proposed solution — on Investigate West’s website.
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Medical Motherhood’s news round up
Snippets of news and opinion from outlets around the world. Click the links for the full story.
• From 13 News (Indiana): “Whistleblowers file federal lawsuit against several big-name insurance and hospital companies”
13News has new information about what might have led to a massive Medicaid budget shortfall last year and how it may have been prevented in the first place.
A federal whistleblower lawsuit was just unsealed that provides insight into the Family and Social Service Administration's announcement last December of a nearly $1 billion projected budget deficit.
That deficit meant cutting services to some of the most vulnerable Hoosiers.
The lawsuit is hundreds of pages long and details the allegations. It basically claims that several insurance companies and hospital systems defrauded Indiana's Medicaid program by improperly billing them for patient care and walked away with more than $700 million.
According to the lawsuit, the alleged fraud sometimes involved duplicate claims, some of them made months and years after a patient had died.
The whistleblowers named in the lawsuit are two former state employees. According to court documents, they filed their lawsuit in 2021.
[…] According to the lawsuit, that former employee says in 2017, state Medicaid officials told him and his team to "significantly curtail its efforts" to use information from the contractor to "recoup improper Medicaid overpayments."
The lawsuit accuses those Medicaid officials of "bowing to political pressure exerted by the health insurers' and the hospitals' lobby."
All this comes about a year after the state announced a nearly $1 billion projected Medicaid budget shortfall.
The state blamed how families of medically complex children got reimbursed for care as part of the reason for that budget deficit.[…]
• From the Miami Herald: “Deonte's Death: How did Florida, two healthcare agency nurses let a 7-year-old starve?”
TW: Child death due to neglect and starvation. This is very tough story to read. Please take care of your mental health if you decide to continue or click through to the full story.
[…]Deonte had been under the care of Children’s Medical Services. His participation in the health care plan entitled him and his family to receive a host of services that, combined, were designed to ensure he received all necessary medical care. They included 24-hour home health care, medical daycare, physical, speech and occupational therapy, medical equipment, formula and supplies, respiratory therapists “to conduct monthly equipment assessments” and transportation to medical appointments.
Deonte’s family also should have had “a care coordinator to help navigate the health system [and] primary and back-up case managers to provide [the] family ongoing educational and monthly case management conferences,” the pleading said.
The court pleading doesn’t specify if all, or any, of those services actually were provided. But the professionals listed in the pleading would be legally required to report suspected maltreatment to the state’s child abuse hotline, so it is difficult, if not impossible, to imagine they worked with, or even saw, a child dying of starvation without reporting it.
The last documentation of Deonte’s weight came from a non-specified medical record in May of 2022, the pleading said, with the boy weighing 46 pounds. Nineteen months – and zero weight listings – later, Deonte weighed seven pounds at the morgue.
Despite what he was entitled to receive from the state, the court record suggests Samaritan Home Health is all that stood between life and death for Deonte.
The agency was being paid by Florida Medicaid to supply 24-hour nursing care to Deonte, seven days-per week. Between September 2023 and January 2024 – the month after Deonte died – Samaritan “submitted falsified claims” or “fraudulent billing for services” that were “not rendered to the victim,” the court record said, totaling between $10,000 and $50,000.
[…]“Records and call logs show that [Moltimer] expressly denied any issues in providing 24/7 nursing care, she stated that there were no gaps in any of the shifts and that there were no issues or concerns with the victim.” Moltimer also wrote reports to Deonte’s primary-care pediatrician every 60 days “detailing all of the nursing services” delivered to the family, “despite having actual or constructive knowledge that services were not being provided,” the court record said.
Records generated by the investigation, the court pleading said, show Moltimer “engaged in a widespread scheme to defraud Medicaid and continues to have access to significant financial assets.” […]
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