ADVOCATING FOR CHILDREN Muhammed WITH SPECIAL HEALTHCARE NEEDS - - PowerPoint PPT Presentation

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Apr 03, 2023 646 likes •707 views

3/6/2014 ADVOCATING FOR CHILDREN Muhammed WITH SPECIAL HEALTHCARE NEEDS Feda Almaliti LLE M a r c h 6 , 2 0 1 4 We all wear many hats A Positive Message Parent of a child with special health care needs Appointee to the State

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3/6/2014 1

ADVOCATING FOR CHILDREN WITH SPECIAL HEALTHCARE NEEDS Feda Almaliti LLE

M a r c h 6 , 2 0 1 4

Muhammed A Positive Message We all wear many hats…

Parent of a child with special health care needs Appointee to the State Council on Developmental

Disabilities

Appointee to Advisory

Commission on Special Education

Parent of a TEENAGER! Advocate

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3/6/2014 2 What is an Advocate?

Merriam-Webster Dictionary advocate (n.)

1. One who pleads another’s cause
2. One who argues or pleads for a cause or proposal

American Heritage Dictionary 2000 advocate (v.)

1. The Art of pleading or arguing in favor of something, such as a cause,

idea or policy; active support.

Real World Definition: Why should you be an Advocate?

It is every healthcare providers duty It’s a very natural part of your job and you do it all

the time i.e. in the form of treatment decision

You bring credibility to the issues No one else may be advocating Everyone needs an advocate

What is the biggest change in this country in the last 50 years…

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3/6/2014 3 Patient Protection & Affordable Care Act

The Exchange

Ambulatory patient services Emergency services Hospitalization 50% coverage of DME Maternity and newborn care Mental health and substance use

disorder services, including behavioral health treatment

Prescription drugs Rehabilitative and habilitative

services and devices

Laboratory services Preventive and wellness services and

chronic disease management

Pediatric services, including oral and

vision care

“A ROSE BY ANY OTHER NAME”

The word “habilitative” has been at the heart of

health insurance coverage denials for children

Health insurers typically claim to cover

“rehabilitative” and not cover “habilitative”

Habilitative definition - Health care services that

help a person keep, learn or improve skills and functioning for daily living

Common Denials

Not a covered benefit Experimental Not medically necessary

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3/6/2014 4 Continued Barriers to Care

Parents of CSHCN’s are under extreme pressure.
Therapies/treatments for CSHCN is a financial hot potato.
Insurance companies have traditionally refused to pay for it.
Social services agencies play hide-the-pea with confused parents until their children age out of

eligibility.

School districts expertly pick up where the agencies leave off,
The “system” is not fair.
The “system” is confusing.
Parents of CSHCN are exhausted (mentally, financially and emotionally)
Getting treatment for CSHCN will always be a challenge.
It is and will never be easy to get coverage for expensive treatments/therapies

Leading the country Primum non nocere Cue the sappy music…

Everyone is entitled to medical care. DD patients are entitled to have their quality of life

maximized.

Families are your partners. Do NOT be shamed into giving up. Only 10% of denials appeal. Do not take NO for an answer.