State officials are defending recent changes to Medicaid regulations that went into effect on Thursday, responding to critics who argue that the tighter rules create unnecessary burdens for families. The new regulations, they argue, are essential for preventing fraud and ensuring that taxpayer dollars are spent appropriately, specifically on services that directly benefit people with disabilities.
These new rules stem from adjustments made by the Developmental Disabilities Administration (DDA), which administers Medicaid waivers for individuals with disabilities. Under the revised guidelines, some families will now be required to submit more comprehensive documentation to verify that the various services they receive—such as health care, transportation, and care services—are being used to support their disabled family members.
The regulations were implemented just days after a group of patients and family members gathered outside the State House to protest, expressing their concerns that the changes were rushed and developed without meaningful input from those who would be directly affected.
Health Secretary Dr. Laura Herrera Scott, however, insists that the additional documentation requirements are necessary to detect and prevent fraud. She argues that the changes will help ensure Medicaid dollars are being used for their intended purpose, rather than being spent on nonessential items, such as high-priced appliances or luxury purchases. “In the current model, beneficiaries just had to attest to certain things without any supporting documentation, and now we are requiring specific documentation to make decisions,” she explained. “We have to look at some of these very high requests as potentially inappropriate or also fraudulent. And we certainly have expectations with the federal government … Without adequate documentation, the state has limited ability to identify fraud, waste, and abuse.”
Advocates for individuals with disabilities support efforts to curtail misuse of Medicaid funds, but they argue that the new regulations have left families feeling unjustly scrutinized. Many believe that the additional paperwork is burdensome and stigmatizing. “We hear a lot of these stories that paint families of people with disabilities in a very poor light, and we’re just not sure that’s true,” said Patti Saylor, a volunteer with the Self-Directed Advocacy Network of Maryland, whose son with Down syndrome died in 2013.
Saylor emphasized that no one wants to waste taxpayer dollars. “No one wants to waste taxpayer’s dollars, that would be ludicrous,” she stated. “If there are a few bad apples, as there are in all programs, have the state deal with those specific individuals.”
Maryland provides Medicaid waivers for people with disabilities to assist them with various services, including day care, transportation, and live-in caregivers. Around 16,800 families use the waiver for traditional care, which is provided through established programs. However, about 3,600 people with disabilities receive self-directed care, where they or their families are responsible for hiring and managing their support staff. This flexibility is especially important for individuals who require personalized assistance that might not be available through a more traditional, structured program.
However, the introduction of additional documentation requirements has raised concerns among some families. On Tuesday, around 40 to 50 people gathered at the State House in Annapolis to protest the new rules. They argued that the changes were rushed, failed to adequately consider the perspectives of families using the Medicaid waiver, and posed a threat to the availability of current services.
In response to these concerns, Dr. Herrera Scott reassured the public that the changes were not designed to restrict services but rather to ensure better accountability in the way the funds are used. “Where the changes are is in how and what information is collected and how applications are processed,” she said. “And this addresses findings that – actually repeat findings, quite frankly – in legislative audits that DDA did not take proper action with significant numbers of improper or unsupported payments.”
Audits have revealed several instances of improper or unsupported uses of Medicaid funds, including the purchase of commercial appliances—such as industrial washers and dryers—that cost significantly more than their household counterparts, as well as the buying of vehicles for family members and the payment for services already covered by other insurance. Other misuse examples include the purchasing of tickets to sporting events, including season tickets, for individuals other than the Medicaid recipient, and home maintenance services unrelated to the individual’s disability needs.
Dr. Herrera Scott also pointed out that some individuals in the self-directed care program were receiving significantly higher wages than those working for traditional care providers. She explained that these discrepancies were problematic and that the new rules aim to address these wage disparities.
“This is a tough life, and they’re throwing a lot of administrative red tape and paperwork. It starts off being hard and this makes it harder,” said Alicia Wopat, president of the Self-Directed Advocacy Network of Maryland. Wopat, whose son has autism, expressed concern about the additional paperwork and the lack of transparency surrounding the implementation of the changes.
Wopat further emphasized the need for collaboration and transparency in policymaking. “It all comes back to collaboration and transparency and actual meaningful dialogue that gets to solutions that work for the people using the program,” she said.
Dr. Herrera Scott emphasized that the goal of these changes is to improve the efficiency and fairness of the program, ensuring that Medicaid funds are used properly. She stated that the new rules would expedite payments, enhance independence for beneficiaries, and support families in a way that fosters greater equity. “Almost every single week, there is a meeting with the DDA community that at any point, a beneficiary or their parent or their provider can join in to weigh in,” she said, emphasizing that the department is still open to feedback on how the new system works in practice. “There’s still lots of opportunity to provide feedback on the documentation that’s now needed. We want to make sure their beneficiary, their loved ones, receive the services that meet their needs and we will continue to work with them, and the additional documentation does not compromise the current services they’re getting,” she concluded.
The changes to Medicaid waivers are part of ongoing efforts to prevent fraud and waste while ensuring that taxpayer dollars are used efficiently to provide services to people with disabilities. While these changes may pose challenges for families navigating the new documentation requirements, they are aimed at safeguarding the integrity of the Medicaid program and ensuring that funds are spent in a way that truly benefits the individuals who rely on these essential services. Families who rely on Medicaid, especially those utilizing the Medicaid disability waiver for self-directed care, will need to adjust to the new documentation requirements, but advocates and state officials agree that the goal is ultimately to create a more transparent and equitable system.
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