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OFFICE OF HANDICAPPED CONCERNS
WILL'S CORNER, OKLAHOMA
(Serving the Disability Community of Oklahoma)
Volume 6, Issue 4
October, 2005
MEDICARE PRESCRIPTION DRUG BENEFITS
Health and Human Services Secretary Michael Leavitt visited
Oklahoma City August 24 in a whirlwind of media interviews and
questions from elderly and disabled Oklahomans. Secretary
Leavitt brings good news to Oklahomans and indeed all Americans
who are eligible for Medicare benefits. Medicare will be
offering prescription drug benefits beginning January 1, 2006.
Let’s look at what you have to do in order to initiate these
benefits.
First you will have to actually sign up for this prescription
drug benefit. It will not automatically come to you because you
are receiving other Medicare benefits such as hospitalization or
medical. Secondly, you will have a specific time to enroll for
the program, and that is from November 15, 2005 through May 15,
2006. If you currently are receiving some Medicare benefits, you
will be receiving the little booklet Medicare & You in the mail
sometime during the month of October. This little booklet will
list different plans for prescription drug coverage available to
you. You will have to choose the plan which is best for you and
sign up during the enrollment period to finalize your benefits.
The new prescription drug coverage does not come free of charge
to the Medicare recipient. There will be monthly premiums to the
organization offering the prescription drug coverage plan which
you choose. There will be co-pays on each prescription you fill
under the plan, and there will be a deductible. The drug plans
should cover about 75% of your first $2000 cost of prescription
drugs during a one-year period. If your annual drug bill is more
than $2250, Medicare will pay nothing from $2250 until your
annual bill reaches what is considered “catastrophic” levels at
$5100. At the catastrophic level and above, Medicare will pay
about 95% of prescription drug costs.
In his visit to Oklahoma City, Secretary Leavitt said, “In the
past we (Medicare) may pay $100,000 for a heart operation but
nothing for the drugs to manage the heart problem. Medicare must
concentrate more on prevention.” This makes sense both for the
citizen and the government. Secretary Leavitt continues,
“Ninety-five percent of the $300 billion spent by Medicare in a
given year is spent after a person has had a bad medical
problem. We need to get ahead of the problem instead of reacting
to a problem already manifest.”
According to Secretary Leavitt, costs of Medicare continue to
rise. He told the group in Oklahoma City that in the presidency
of President Truman in the late 1940’s that the United States
spent 5.1% of the gross national product on health care. Today
we spend 15.5% of our entire economy on health care alone.
Making people healthier is a goal of expanding Medicare to
include coverage of prescription drugs.
Secretary Leavitt also underscores that he feels the various
drug plans offered will create competition in providing
prescription medications which will have the long term effect of
driving the cost of medications down. Some people criticize the
government for not allowing Medicare to negotiate directly with
drug companies to lower the cost of medications. The
Congressional legislation authorizing the expansion of Medicare
to include prescription drugs specifically denies Medicare this
power of negotiating directly with the drug manufacturers.
Secretary Leavitt reminds us, however, that prescription drug
coverage is the biggest expansion of Medicare since the program
was born forty years ago. “This drug coverage doesn’t cover
everything for everybody, but it’s a start.”
Even if you do not take a lot of prescription drugs now, it’s
still good to consider joining. As we age, most people need
prescription drugs to stay healthy. Enrolling during the
enrollment period of November 15, 2005 through May 15, 2006
means you pay a lower monthly premium than if you join after the
open enrollment period ends on May 15.
Medicare prescription drug coverage is insurance. Private
companies provide the coverage. You choose the drug plan which
meets your needs and pay the monthly premium. When you join a
plan, Medicare helps pay the bill. As with any insurance
program, you have options. In October you will receive
information on what your drug plan options are. Although each of
these plans will meet Medicare’s stringent requirements, they
may differ in terms of costs and coverage.
Study each plan offered to see which is best for you. If you
need more information about the new Medicare prescription drug
benefit, call 800-633-4227 twenty-four hours per day seven days
per week. If you have capacity to go online, visit
www.medicare.gov. Information is available to answer all your
questions. Some people will find the costs of premiums, co-pays,
and deductibles in the new prescription drug coverage
prohibitive because of low incomes. If you fall among these
people, ask how Medicare may assist you in overcoming these
barriers.
Secretary Leavitt says there are three good reasons to sign up
with a prescription drug benefit plan. “Affording your
prescription drugs will allow you to keep your health. It will
also save you money, and finally it will give you some peace of
mind that you will not have to choose between affording your
prescription medications and providing for other necessities.”
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OHC web site:
www.ohc.state.ok.us
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LOVE CONQUERS ALL
Two women in Agra, Oklahoma have found out first hand that the
love of a foster family makes life worth living. Life would have
been difficult at best without foster family Nancy and Jerry
Durbin. It would have been a life of impersonal institutions
with a revolving door of staff working for minimum wage who
might themselves have had some kind of physical or mental
disability. It would have been the life of a throw-away from
society who nobody else wanted and was left to slowly atrophy
without the care and concern of a natural family. Both women
have severe developmental disabilities. One of the women was
abandoned by her mother and father as an infant at the doors of
Children’s Hospital in Oklahoma City.
Both women who are now young adults were warmly welcomed into
the Durbin home many years ago when they were still young
children. They were accepted into a home which looked beyond
their disabilities and saw two beautiful little girls who needed
the opportunity to be everything they could be.
Lynn was born without disabilities and was progressing through
normal developmental milestones until developing autism so
severe that she lost some of the skills she had already learned.
She could no longer talk. She developed a cognitive disorder.
The Child Welfare worker begged Nancy to take Lynn. If she could
not find a foster home for Lynn, she would have to look at her
going to one of the state schools at Pauls Valley or Enid. Nancy
promised to talk to her husband, Jerry, about it and Lynn has
been with them ever since. That was nineteen years ago. What
would her life have been?
Dawn was the infant abandoned by her parents at the doorsteps of
Children’s Hospital. What I didn’t tell you was that Dawn had
been shaken so severely that she suffered a brain injury and
subsequent severe mental retardation. She had seven surgeries in
six weeks to remove fluid from her brain. They said she wouldn’t
survive. The doctors didn’t know the power of love. They didn’t
have any idea that there was a family out there who wanted Dawn
and who were intent that Dawn was going to have a chance in this
life in spite of her disabilities.
I spoke to Nancy Durbin on the telephone to get the story about
Lynn and Dawn. I have never met Nancy Durbin in person although
I would certainly like to shake her hand. I have met Jerry
Durbin at professional conferences and know him as an advocate
for children with disabilities. Last quarter we did an article
about Nancy Durbin and her efforts to get a golf cart ordinance
passed in her city. Her advocacy was successful. Talking to her
on the phone several months ago peaked my interest in her. When
I heard that Nancy had two foster children who are now adults
and still living with her, I had to inquire further. I quickly
saw that the Durbin’s were advocates for people with
disabilities in much more than getting a golf cart ordinance.
They had raised two girls in the local public schools. Both
girls had special needs, and there would be many struggles with
school administrators on educational priorities.
The Durbin’s lived in a town so small that it did not have its
own special education program. Instead, it bused the children
with special needs to a nearby school system to provide their
education. The problem was the bus itself. The bus picked up not
only Lynn and Dawn but ten other students with disabilities and
transported them over rough, rural roads in hot and cold weather
without air conditioning. Some of the students were blind, and
there was no aid on the bus to assist with entry and exit. The
bus driver had no radio to ask for help in an emergency, and
more than once the bus broke down with all the difficulties that
you can imagine in that circumstance.
Nancy saw that she had a job to do. She wanted a dependable,
safe, air conditioned bus not only for her children but all the
children with disabilities in her community. Nancy Durbin was
going to talk to the school board about the needs of children
with disabilities. She had to do what she could do to let the
people who had the authority know about the needs of those whom
they served.
One school board meeting was not enough. Nancy came prepared to
attend each meeting as long as it took. She made it a point to
get on the agenda for the meeting and she learned how to say
what she had to say within the three minutes allowed her to
speak.
Nancy pointed out that the school system had recently bought a
$95,000 activity bus to drive athletes to out-of-town games.
$25,000 would purchase the new bus they needed for the children
with disabilities. The standard response was that we don’t have
the money. Nancy then asked the board how they could afford the
new ball field lights. They weren’t used to dealing with a
person who would not accept “no” for an answer. One school board
meeting Nancy brought home made cookies and candy to the
meeting. It became harder and harder to resist her compelling
arguments. The school superintendent said it was time to do
something. In the fall of 2001, the school district had a new,
air-conditioned bus to transport children with disabilities to
the adjoining district.
How was she successful in her advocacy for children with
disabilities? Nancy Durbin says, “Once you start something, you
gotta see it through.” Nancy kept going to those school board
meetings for two and a half years. Sometimes she spoke to the
board and sometimes not. Her presence alone spoke a lot. Board
members knew who Nancy was and what she wanted. Nancy came home
from that last board meeting ecstatic. “We’re getting a new bus.
We’re getting a new bus.” Lynn and Dawn didn’t fully understand
what their foster mother was saying at the time, but later when
they began riding in that air conditioned new bus, they knew all
over again. Mom loves us, and this is just another way she has
of showing it. Love really does conquer all.
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State of Oklahoma
www.ok.gov
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MEDICAID REFORM
The latest figures show that about 545,000 Oklahomans receive
Medicaid benefits. Medicaid is a broad range of benefits to
children and adults many of whom may have a disability. Medicaid
funds long-term care for eligible Oklahomans as well as Medicaid
waivered services which directly benefit people with
disabilities. There are a wide variety of eligibility
requirements in the various Medicaid programs in Oklahoma but
most programs insist that the qualified individual have a low
income and limited resources to meet their needs.
The Medicaid program began forty years ago under President
Lyndon Johnson. It is a federal program but requires state
matching funds. The program has continued to grow in scope over
the years. In many states Medicaid is now the single largest
item in the state budget surpassing education which has
traditionally held that place. A number of different groups are
looking at Medicaid right now both nationally and within the
state to consider changes in the way we currently operate the
program.
In August, 2005 the Bush Administration made its proposals. In
the same month the federal Commission to study Medicaid also
reported their findings and recommendations. The National
Governors Association has addressed the subject in its August 29
report. The Legislative Task Force on Medicaid Reform chaired by
Representative Kris Steele of Pottawatomie County is meeting
twice per month beginning in August, 2005 through December 7,
2005. Thus Medicaid is under scrutiny both on a federal and a
state level.
If you or a member of your family is a beneficiary of some type
of Medicaid service, it is worth your time to consider how the
program is currently operated and some of the ways that various
groups are proposing to change it. It appears to me that cost
containment is a primary factor in the attention Medicaid is
receiving on the federal and state level. Let’s look at a few of
the proposals to change Medicaid.
Reduce the price that Medicaid pays for medications. Setting a
cap on what Medicaid will pay for a given medication sounds very
reasonable but it could have direct fallout on the consumer who
is going to fill that Medicaid prescription. Some pharmacies may
not agree with the cap and may choose not to serve Medicaid
customers on the particular prescription with which they
disagree. They may agree to fill prescription X where they feel
they are satisfactorily reimbursed through Medicaid and not fill
prescription Y where they feel otherwise.
Currently applicants for Medicaid are asked if they have
transferred any of their assets in the last three years. If they
have transferred an asset, that asset may be added to their
total assets in determining their eligibility for Medicaid.
Today Medicaid looks back three years on the transfer of assets.
The proposal is to increase that look back period to five years.
The effect this would have is to make it more difficult to
satisfy the resource eligibility requirements of the Medicaid
program.
Another proposed change in the Medicaid program would narrow the
definition of a particular service which Medicaid reimburses and
thus make it more difficult to meet the criteria for that
service. The National Governors Association has recommended
states should be given the ability to implement common-sense,
enforceable cost-sharing throughout the Medicaid program to
increase the responsibility of Medicaid beneficiaries for the
cost of their health care. Consumer cost sharing is a
disincentive to overuse, but it may also be an impediment to
getting the real medical services one needs.
2005 is not the first time that Medicaid has been seriously
considered for changes. Neither will it be the last time which
policymakers scrutinize the program. Certainly skyrocketing
costs of medical services and prescription drugs is a factor in
current consideration. You may feel helpless wondering what you
can do as an individual in such a thing that has Congressional
and Oklahoma Legislative interest.
First I would suggest that you become aware what services you
are currently receiving which are reimbursed through Medicaid.
Many people are unaware that the prescriptions which they
receive are ultimately paid for by Medicaid. Many people are not
aware that the case management services they receive for their
child with disabilities are also paid for through Medicaid. Know
how the program impacts you personally. This is the first step.
Many of the services funded through the Department of Human
Services in Oklahoma are Medicaid services. Talk with your DHS
case worker or case worker supervisor about what changes may be
coming down the pike. The Oklahoma Health Care Authority is the
federally-authorized Medicaid authority in Oklahoma. You may
call their customer relations number at 800-522-0310 asking
about potential policy changes which may affect you directly in
the services you receive. If you are involved with an
organization which serves people with disabilities like one of
the independent living centers in Oklahoma or perhaps an
organization tailored to your specific disability, quiz the
director about potential changes to Medicaid. Disability
organizations are often more aware of this kind of information
than the average consumer of services.
Ultimately the decisions on Medicaid will be political
decisions. The U.S. Congress has authority to change the program
on a federal level. The Oklahoma Legislature has the authority
to change the program on the state level. If you are not yet
familiar with your federal and state representatives, you may
want to find out who your representatives are from your local
County Election Board. Call, email, or set up a face-to-face
appointment with your legislator. Always identify yourself as a
constituent who lives within their district before you share
your concerns.
Medicaid is a big program which impacts hundreds of thousands of
Oklahomans. Even small policy changes have the potential to
affect your life, especially if you depend totally on those
services to meet your needs. Changes in Medicaid are being
considered both on the national and the state level now. No one
knows how these various proposals from different groups will
finally come together in real policies which affect the
day-to-day lives of beneficiaries. Now is the best time to find
out about the proposals and to tell people in authority how you
feel about the issues.
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We can’t change the fact that things happen, but we can change
how we let them affect us.
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ADAPTIVE EQUIPMENT, UNITED CEREBRALPALSY
Do you need a shower seat at your home while you recover from a
hospital stay? What about a manual wheelchair for your family
member who was just released from rehab. Do you have insurance
to cover the cost of that special piece of adaptive equipment
that has been recommended? The latest statistics say that
Oklahoma has the third highest rate of uninsured people in the
nation. That fact with the high cost of adaptive equipment
presents families with some real challenges during an already
stressful circumstance.
Adaptive equipment is a wide variety of equipment that helps
people with disabilities function more easily. We are all
familiar with the wheelchair which allows people with mobility
challenges to get from point A to point B. We may have had an
older family member who used a walker to allow them to walk more
steadily and safely. But what about a prone stander for a child
who is not able to support their body weight and needs to be
upright part of the day? What about a communication device which
allows a person with little or no speech to communicate their
basic needs? We may be less familiar with these things although
they do the same thing as a wheelchair for a person with a
different kind of disability.
Adaptive equipment is a wonderful thing. It restores function to
a person who has temporarily or permanently lost it. I continue
to be amazed at the equipment which has been manufactured to
help people with disabilities. There are devices which flash at
the front door when the doorbell is rung for a person who is
hearing impaired. Books on tape are an adaptation of printed
material which makes the printed word available to people with
visual impairments. United Cerebral Palsy maintains a loan
closet of adaptive equipment in the Norman office to help people
just like you.
Michelle Jackson is in the Norman office of UCP at 1167 E. Main,
suite #2 in the Community Building. She tells me that they
maintain a loan closet of adaptive equipment to meet the needs
of Oklahomans with disabilities. United Cerebral Palsy is a
private, non-profit social service agency which serves people
across the state. They have an office in Oklahoma City and
Tulsa, but the bulk of their adaptive equipment is in the Norman
office.
Of course my first question to Michelle regarding their loaning
adaptive equipment is if a person has to have cerebral palsy to
check out equipment. The answer to that question is a resounding
“no”. Then I begin thinking about eligibility requirements the
agency has to loan equipment. What do you have to do to check
out a piece of equipment. To my surprise, I find out that you
just have to identify yourself as a person with a disability.
You do not have to have some kind of a doctor’s prescription
although many people bring their physical therapist or other
therapist with them to select the piece of equipment which more
nearly meets their needs.
This is not to say that you are going to find exactly what you
need in the UCP loan closet. They have about 500 plus items
available now not including the many switch toys for children
with developmental disabilities, but the number and variety of
items varies depending on donations and loans. Equipment can be
loaned out across Oklahoma but UCP does not make deliveries
except in very unusual circumstances. There is a one-page intake
sheet which Michelle says is mostly contact information. There
are no hoops to go through establishing some kind of financial
eligibility. UCP believes in keeping it simple.
Many people need adaptive equipment only temporarily, but United
Cerebral Palsy also loans equipment on the long term. UCP does
not recommend equipment to people and does not take
responsibility if a person selects something which does not
really benefit them. If you are in doubt if a piece of adaptive
equipment could benefit you, ask a professional. Occasionally on
very popular items such as shower benches, there may be a
waiting list.
The agency does not maintain a listing of their equipment which
a person can browse through like a shopping list. People need to
specifically identify their disability and the particular item
which would help them. It is suggested that those interested
call United Cerebral Palsy and make an appointment to visit the
loan closet. In central Oklahoma they can call 405-701-2095 or
800-827-2289 toll free statewide.
UCP also gives away some written information which may be of
interest. They have a listing of parent and caregiver support
groups across Oklahoma. They have information about joining the
Oklahoma Parent Network for families of children and adults with
disabilities. Ask about written information they may have of
interest to you when you visit.
Michelle tells me that they accept donations of useable
equipment as well. For donations they provide a non-cash receipt
of donation. They do not provide a specific cash value for the
donation. Ask your tax preparer how to claim the donation on
your tax forms. If you wish to donate a piece of adaptive
equipment but do not have a way to get the equipment to Norman,
call the office at the number listed above. They may be aware of
an individual or agency in your part of the state which could
use the equipment. Donated equipment should be in a reasonable
state of repair. UCP does have access to a provider of minor
repairs for wheelchairs in Oklahoma City.
Occasionally United Cerebral Palsy will loan equipment to an
organization other than an individual. They may loan a
wheelchair to a particular nursing home. They may loan a switch
toy to a local school. There is no charge to either individuals
or organizations. The emphasis is on meeting the adaptive
equipment needs of people with disabilities in Oklahoma.
Michelle actually took me back into their loan closet to view
the equipment available now. I was surprised to see one power
wheelchair available. I was also surprised to see several boxes
of adult and children’s disposable briefs. There were lots of
manual wheelchairs and walkers, but the most unusual item I saw
was something called a Roll Aid which Michelle tells me can
convert a manual wheelchair to a power wheelchair. There was a
pair of lady’s diabetic shoes as well as several canisters to
hold oxygen. Come by the office to see for yourself or call to
ask for the specific item you need. Remember, you may contact
the UCP loan closet office in Norman at 405-701-2095 or
800-827-2289 statewide. What a wonderful resource we have which
many people do not know about.
CALENDAR OF EVENTS
October, 2005 All Medicare recipients will be receiving the
pamphlet Medicare & You listing different plans for prescription
drug benefits available to you.
October 24, 2005 There will be a demonstration of new voting
equipment for people with disabilities from 1-4:30 pm. at the
Oklahoma County Election Board, 4201 N. Lincoln Blvd. in
Oklahoma City. (The south entrance is accessible.)
November 10, 2005 Emergency Summit on Mental Illness, Substance
Abuse, and Criminal Justice sponsored by NAMI-Oklahoma. St.
Luke’s Methodist Church in Oklahoma City. For more information
call 405-230-1900.
December 8, 2005 Oklahoma Turning Point state conference at
Metro-Tech Springlake Campus in Oklahoma City. Call Karen at
Oklahoma State Department of Health for more information
405-271-6127.
If you have an event coming up relating to disability, let us
know at 800-522-8224 and we’ll help you publicize.
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