Speakers blast managed care policy on disabled adults

HUDSON–Services for people with special needs dominated the Columbia County Community Services Board (CSB) meeting January 30. Dr. Nancy Hoag, a psychologist, expressed concern about what happens when managed care takes over Medicaid. And Toni-Marie Ciarfella, PhD, Dutchess County’s deputy commissioner for special needs, offered an overview of programs and challenges.

“Regular” Medicaid pays for IQ tests and various services for adults who have an intellectual or developmental disability after the age of 26, Dr. Hoag said. But Medicaid programs are all converting to managed care. And except in cases of autism and traumatic brain injury, managed care insurance companies in general will not pay for these items. They call them “educational” rather than “medical” issues.

“It’s wrong,” Dr. Hoag of the lost coverage, a sentiment echoed by Ms. Ciarfella.

“Intellectual and developmental disabilities alone should be sufficient for coverage,” said Dr. Hoag.

The state Office for Persons with Developmental Disabilities provides some services, but only to people with results of IQ tests taken in adulthood, and managed care will not pay for the tests. In order to qualify a person with such a disability for insurance coverage, the application writer often says the applicant has a mental health issue, a situation one advocate at the meeting said was “forcing you to put down something that isn’t true.”

Michael Cole, Columbia County director of human services, reported calling the situation to the attention of other authorities.

In an example of the tendency to equate intellectual and developmental disabilities with mental health, Ms. Ciarfella reported attending a conference billed as including those disabilities where all the talk was about mental health and suicide.

Ms. Ciarfella’s presentation touched on education, transportation, jobs, and housing. Many special needs students who live in Dutchess County travel daily to programs elsewhere. This adds to the school districts’ expenses and the students’ travel time. So one challenge Ms. Ciarfella has posed is how can officials in her county create the programs the children currently must travel to receive.

Columbia County has similar situations. The Hudson City School Board, for example, regularly approves financing associated with sending special needs children out of the district, often to sites outside county.

On a related topic, individuals who qualify can attend a two-year “jobs readiness and skills development” program called Think Ahead. The program is offered at Dutchess Community College, and participants get student IDs and the same perks as other students at that college students. Those who have completed the program have obtained internships.

Ms. Ciarfella also spoke of the need for public transportation, saying that “lots of group homes are in the eastern part of the county,” which has little public transportation.

Ms. Ciarfella’s work is part of Dutchess County’s ThinkDIFFERENTLY program, whose purpose, a brochure says, is “to promote an inclusive environment for residents with special needs.” In the brochure Dutchess County Executive Marcus Molinaro described ThinkDIFFERENTLY as focusing on “the inherent potential of every individual, regardless of ability…. We hear the real impact of ThinkDIFFERENTLY in the voices of those too often overlooked, and we see it in the growing number of people willing to open their hearts and minds to neighbors of all abilities.” He goes on to challenge employers to create employment opportunities for those with a different ability.

Also at the meeting:

• Beth Schuster, chair of the CSB and executive director of Twin County Recovery Services reported that Twin County will provide services for youth with substance abuse issues from Berkshire Farm, a child welfare agency in Canaan

• Ms. Ciarfella called for volunteers for this year’s Special Olympics, which will take place June 14 through 16 at the Vassar College campus.

The next meeting of the Columbia County CSB is Wednesday, February 27, at noon, at 325 Columbia Street, Hudson.

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