DD Waiver Services Obtained For Needlessly Institutionalized Teenager

Ron T. was 19 years old when he required a brief stay at a psychiatric hospital unit. Although he needed only short-term care, he remained there for 10 months, and his condition began to deteriorate. Everyone agreed that a community placement was necessary and appropriate for him, that he needed the types of services available under the DD Waiver program, and that there was a DD Waiver provider ready and willing to take him, yet he remained locked away in the psychiatric hospital.

Why? Because his application for a crisis allocation to the DD Waiver was held up by a new, arbitrary Department of Health (DoH) rule.

Under the DoH rule, individuals under age 21 are deemed to be “eligible” for a special Medicaid services program for children called EPSDT or Early Periodic Screening, Diagnosis, and Treatment, and will not even be considered for DD Waiver crisis allocation. The only problem is, EPSDT services are not actually available for everyone under 21, and, in Ron’s case, extensive efforts to find EPSDT-covered services for him were unsuccessful. The state’s Adult Protective Services Division supported Waiver services for him. Nonetheless, the bureaucrats insisted that Ron could not be considered for a DD Waiver crisis allocation.

P&A staff intervened eventually threatening to file a lawsuit on Ron’s behalf to challenge the EPSDT “rule” and DoH’s procedures for processing DD Waiver crisis allocation applications. At the 11th hour, DoH relented, and agreed to provide Ron with a crisis allocation to the Waiver. The agency has also agreed to meet with staff from the Human Services Department—which runs Medicaid EPSDT services—to find a way to better coordinate Waiver and EPSDT services.