New Medicaid regulations just recently went into effect that will make a huge difference in the lives of many. These are the personal care attendant (PCA) service regulations under Medicaid EPSDT that will impact children and youth with disabilities who need help with reminders, cuing, prompting, or what is officially called "cognitive assistance".
This medical service will not only serve young people with traumatic brain injury and developmental disabilities who may have thought process difficulties, but youth with severe mental illness, who usually are stricken with devastating disorders such as schizophrenia and bipolar disorder in their teenage years.
For the past few years, New Mexico provided this critical personal care attendant service to people in New Mexico over age 21 through adult Medicaid. At first only people with physical impairments were able to access the program, but soon several people with mental illness were able to get assistance because of the inclusion of the phrase "cognitive assistance"
In one family, the daughter who has schizophrenia is over 21. The young woman was brilliant in high school. In her teenage years she began to deteriorate. Her family took her to doctors across the country, but none of the medications have worked. She needs constant supervisory care, as she will jump on tables, put her fingers in door jams, and is incapable of even providing self-hygiene without assistance. Her family has had to give up working because of her intense mental health needs. Without her family she would probably die or be placed in a facility without the love and care of her family. Now, because of the personal care attendant program, her father and sister provide the attendant care she needs and they are reimbursed by the Medicaid PCA program at approximately $9/hour.
This kind of program was NOT being provided for youth under 21 until this new regulation went into effect. Many of these severely impaired youth could benefit from support with cognitive assistance.
Many families have youth (under age 21) who have developmental disabilities. Some have applied for the Medicaid DD Waiver, but the waiting list is several years long. Some do not meet the strict criteria for developmental disability, and yet they cannot survive without additional support. If that youth is on Medicaid and needs cognitive assistance in order to live in the community, this new program for younger people could be a major support.
Personal care attendants may be used for:
· assistance with traveling to the doctor to receive blood draws (often necessary for certain types of anti-psychotic medications on a weekly basis);
· cueing during psycho-social activities to help stay on track while taking a bus, doing the laundry, cooking meals, and other activities that, without the assistance, the patient may be too fearful, forgetful, or lack motivation to complete;
· reminders to take medications on time
In order to qualify for this service, people who are under 21 and on Medicaid must contact their case managers in their Salud! Managed care system (Cimarron, Presbyterian, or Lovelace). Those people who are over 21 must go through the Medicaid PCO office in Santa Fe with Crystal Matta (505-827-3100).
The PCO program for people over 21 has been cutting back on the number of hours NM Medicaid is willing to provide, as noted in the front page article.