Health and Welfare announces policy revision

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Staff Writer

Public outcry regarding Medicaid coverage of incontinence supplies for eligible adults has led officials at the Idaho Department of Health and Welfare to rethink their strategy.

"Input from providers and participants prompted IDHW to reconsider the entire policy and update it to better serve Medicaid participants," IDHW public information officer Chris Smith told The Press on Tuesday.

On Monday, the department announced the revision of this policy, listed under in the Idaho Maintenance Management Information System Provider Handbook.

In late February, families and caregivers of disabled individuals ages 21 and older were distraught because of the department's recent enforcement of a code that had been in place for years, but had not been regarded because of an error in the coding system. The error allowed Medicaid coverage of protective pull-up underwear for those adults, even though the pull-ups were never supposed to be included in the coverage.

Following the discovery and correction of the error, IDHW's Medicaid Division included a reminder of the policy in the January 2018 MedicAide newsletter, which goes out to Idaho Medicaid providers. Red flags were raised when the providers subsequently relayed the news to their clients. This was reported in a Feb. 17 Press article.

"I had friends and family that wrote to the governor," said Coeur d'Alene mom Kathy Gray, whose adult son is severely autistic. "They actually got responses back from the department of Medicaid."

Concerned parties argued that the pull-ups allow for much more dignity than adult diapers, the cumbersome alternative that have always been covered under this policy.

"The impact of the coding correction did prompt discussion and re-consideration by our Medicaid policy team," Smith said. "Plus, we received input from participants, providers and legislators who emphasized the importance of protecting this vulnerable population and preserving their dignity on a very personal issue.

"Pull-ups are now covered for a Medicaid participant over 4 when certain conditions are met, and a 'toileting transitioning' plan is no longer required for those between 4 and 21," Smith explained. "We are asking providers to keep a statement on file from the participant’s medical provider or non-physician practitioner that the pull-ups are a necessity for the individual. For new participants, that statement of necessity is not required until July 1, and this new policy is retroactive to Feb. 1, 2018."

The swift turnaround of this policy snafu is being celebrated by the loved ones and caregivers of the affected individuals, which include mobile young adults, middle-aged workers and seniors in nursing facilities.

"I have to give them kudos for acting on it so fast. Usually things like this don’t change that quickly," Gray said. "They really pulled through. I was amazed.

"This is awesome news and it’s all because the advocates for people with special needs spoke out."

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