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August 2006
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Buffalo News Many disabled New Yorkers have been denied necessary medical equipment, state report says The state has systematically deprived many poor, severely disabled New Yorkers of wheelchairs and other medically necessary equipment, violating state and federal regulations in its pursuit of the bottom line, according to a report released by the State Assembly. "Department of Health uses and misuses legal and bureaucratic means to unfairly prevent people with severe disabilities from getting equipment they should have," the report states. The 48-page document examines the state's processing of Medicaid claims for medical equipment, which includes everything from wheelchairs and beds to lifts and breathing apparatus. Through personal anecdotes and data analysis, the report catalogs how the department frustrated and discouraged Medicaid recipients and their physicians by: • Denying requests "deemed medically necessary by physicians and treating practitioners." • Delaying responses for months by demanding redundant, unnecessary or unreasonable information. Karen Makowski of Cheektowaga, who broke her leg falling off a porch four years ago, has since suffered several bone injuries, undergone "countless" surgeries and has developed carpal tunnel syndrome in both wrists from crutch use. She now uses a wheelchair, and only with the help of her boyfriend or her 80-year-old father can she safely navigate the stairs in front of her home. "I feel like a prisoner," Makowski said in a phone interview. "I have no way to get out of the house." In September of last year, after spending five weeks in the hospital recovering from a shoulder injury suffered while trying to go down stairs, Makowski requested a portable ramp from the state. "I want to be independent, so that . . . I don't have to rely on everybody," she said. Yet despite documents from her health care team and the equipment vendor attesting to the ramp's medical necessity and cost effectiveness, her request was denied - first by the Health Department and twice in court. " New York State has a responsibility to care for its neediest citizens," said Assemblyman Sam Hoyt, D-Buffalo, who helped put out the report. "They're getting the runaround. . . . Clearly, the DOH regulations aren't being followed, and it's taking too long to provide what these people need to survive." The state Assistive Technology Advocacy Project, based in Buffalo, provides free legal assistance to disabled individuals. Since its inception in 1995, the group has taken on hundreds of cases each year and boasts a success rate of more than 80 percent. "It is not uncommon in Western New York to talk about the big joke - the 18-month application," said Marge Gustas, a paralegal who has worked with the project from its beginning. "All that time, somebody is doing without some piece of medical equipment that was medically necessary." The project has taken on Makowski's case and remains optimistic about winning the court appeal. "The timely delivery of durable medical equipment can make the difference between them moving on with their lives or that self-fulfilling prophecy of spending a life in dependence," said Jim Sheldon, supervising attorney for the Assistive Technology Advocacy Project. "I have hope, but it's very discouraging," Makowski said. "No matter which angle you go at, you get shot down." The Department of Health recognizes the "critical importance" of performing its responsibilities in a timely and efficient manner, said department spokesman Rob Kenny. "We will take their findings and recommendations into consideration," he said, though he declined to speculate what actions the department might take. Jamie Lembeck, a local advocate for the disabled, bemoaned the complexity of the current health care bureaucracy. In order to obtain the durable medical equipment and prescription medications he needs, Lembeck, a quadriplegic who uses a specialized wheelchair, utilizes a combination of coverage from BlueCross BlueShield, Medicare and Medicaid. "It can be so convoluted sometimes," he said. "It's tough to tell which way to go." A former chairman of the mayor's Advisory Committee on Disabilities, Lembeck has taken notice of the state's foot-dragging. " Western New York is the slowest when it comes to reimbursement for durable medical goods," he said. Adds Sheldon: "Our concern is that this whole process of delays is wearing people down." In fact, signs of disenchantment among applicants may be growing. The number of requests for fair hearings on modified or denied requests dropped by about 50 percent in the past three years. "The volume of need has not gone down . . . and the speed of approvals has not gone up," said Assemblyman Richard Gottfried, D-Manhattan, who also worked on the report. Inconsistencies and inaccuracies in Health Department correspondence have only further worried members of the Assistive Technology Advocacy Project staff. One letter argued against giving a claimant the equipment he requested since he had survived without it for 19 years. Another denied a new wheelchair request on the grounds that the applicant, a 13-year-old boy, failed to specify how much it would cost to repair the eight-year-old wheelchair he had outgrown. "His current wheelchair fits him like a roller skate," Gustas said. Kevin Horrigan, director of public affairs for People Inc., understands the dilemma facing the cash-strapped department but disagrees with the current solution. "The cost of Medicaid has to be contained; it just can't be put on the backs of the poor and disabled," he said. "It is costing the state more than the state saves in the long run. We need them to abandon a short-sighted, misguided focus on short-term savings," Gottfried said. e-mail: ohearey@buffnews.com |
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