Thursday, May 20, 2010

Colorado Medicaid denies woman with muscular dystrophy new wheelchair because she lives in nursing home

From The Coloradoan:

Crystal Rader (pictured) loves to travel, enjoys the nightlife in Old Town Fort Collins and visits her family in Windsor, but she's not your average 26-year-old.

Born with muscular dystrophy, Rader has lived in a long-term health-care facility since she was 3 and requires a motorized wheelchair to get around.

But her current wheelchair is on its last legs. Rader bought it for $35,000 with the assistance of Medicaid six years ago while living in New Jersey, but today, she said, it could break down anytime.

Confident that Colorado's Medicaid program would come through for her just as New Jersey's Medicaid did, she applied for assistance for a new wheelchair.

But Medicaid denied her request, claiming in its rejection letter that the wheelchair is unavailable to her under the state's Durable Medical Equipment Program because she lives at the Fort Collins Health Care Center, a nursing home.

The center, the letter said, should pay for the chair itself.

"It's $35,000," Rader said. "I don't think this facility is able to do that."

She's preparing to fight Medicaid, whose staff, she said, doesn't understand that she's not a typical nursing home patient.

"I want to fight Medicaid just to get them to realize that if I don't have this, I lose my independence," Rader said. "My wheels are my legs. That's how I get around."

She also fears that when her current chair stops working, she wouldn't be able to get financial assistance for new parts because she's so active.

"Medicaid won't pay for new parts on such an old chair," she said.

But Rader's pleas to the state Department of Health Care Policy and Financing, which administers Medicaid in Colorado, might not get very far.

"If they live in a long-term care or nursing facility, we do not pay for durable medical equipment unless that person is within 14 days of discharge," department spokeswoman Joanne Lindsey said.

The state pays the Fort Collins Health Care Center $107.48 per patient per day for medical and equipment costs, Lindsey said.

Rader said she isn't confident the Fort Collins Health Care Center, which is owned by Atlanta-based Sava Senior Care, will help her get a new chair.

"They're pretty much putting it all on me," she said.

Sava spokeswoman Nan Impink said the company is looking into the matter.

Rader said if she can't get the new wheelchair, the prospects for her future are frightening.

"For a 26-year-old to be stuck in bed is horrible," she said. "It scares me. I lose all my activities I like to do."