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Brain injury waiver program enrollment falls far below target

The state Department of Health and Human Resources is paying $1.5 million a year to oversee a brain injury program that so far has benefited just three people.

The 9-month-old Traumatic Brain Injury Waiver Program is meant to keep Medicaid-eligible West Virginians with brain injuries in their homes and out of institutions.

The state planned for 75 people to use the program in its first year, according to documents submitted to the federal government. Enrollment opened Feb. 1.

But so far only 28 people have applied for the program and only three have received services.

In the meantime, the state is paying New York-based APS Healthcare $1.5 million a year to administer the program. Most of that is federal Medicaid money spent by DHHR. The state's annual share is $375,000.

The state awarded a contract to APS to oversee the program in fall 2011. It's worth up to $4.7 million over three years.

"It was intended to build the program," DHHR spokeswoman Marsha Dadisman said Tuesday.

The state told the U.S. Centers for Medicare & Medicaid Services that each person in the program would cost about $36,000 to care for. If that's true, the state is on track to spend $1.5 million to oversee a program that is currently spending a little more than $100,000 to care for West Virginians with brain injuries.

The program was supposed to provide up to $27 million a year in benefit to patients. So the $1.5 million overhead isn't that much - except that less than a handful of West Virginians are actually benefiting from it now.

Kanawha Circuit Judge Duke Bloom heard an update on the program last week. Bloom was getting a number of updates on the so-called Hartley Case, a 1981 case that remains open and centers on the treatment of mental health patients in the state.

DHHR fought the brain injury program for at least a decade.

The department had promised the circuit court it would seek federal approval for the program in 2001 and again in 2007. DHHR failed to follow through both times. Finally, in 2011, the state Supreme Court ordered the department to actually do what it had promised.

Michael Davis is head of the Brain Injury Alliance of West Virginia, a nonprofit advocate for brain injury survivors and their families. He didn't attend the hearing last week but has previously expressed concern that the brain injury program's requirements were too stringent.

"There's no reason they shouldn't fill this program up within a month of announcement," Davis said in a telephone interview after the hearing.

Davis blamed DHHR, which he said was "like the black hole in space," for not doing enough to make the program available to West Virginians.

"They are not friends of people with disability in this state," Davis said of the agency. "They just don't do what they are supposed to do. They are supposed to be compassionate, caring people."

To qualify, a person must have a traumatic brain injury that requires a "nursing home level of care" and a low income. A traumatic brain injury is one that occurs because of an external force, such as a car accident or combat. Brain injury patients also must be in an institution when they or a representative apply for the program.

During the hearing, a state Medicaid official told Bloom some veterans might have severe enough injuries, but they might not qualify because of military pay they continue to receive. Some people who are medically but not financially eligible may get into the program once they begin to run out of money.

The state thought it could receive, at most, 2,000 applications a year for the waiver. So far, the number of patients or their legal guardians seeking help has been far lower.

APS said it received 28 applications from Feb. 1 to Oct. 15.

Six patients weren't correctly referred to the program or had applications withdrawn on their behalf. The remaining 22 were tested to see if they were medically eligible. Of those, six didn't qualify because their condition wasn't severe enough, 11 aren't yet financially eligible, one had his or her application withdrawn, three were accepted and one died.

APS' staff has "conducted statewide outreach efforts" to get people to enroll in the program, according to a report prepared by the company and submitted as evidence in Bloom's courtroom. Among those efforts, the consultant sent 300 emails, made 133 phone calls, had 159 face-to-face conversations and gave 10 presentations.

Contact writer Ry Rivard at ry.rivard@dailymail.com or 304-348-1796. Follow him at www.twitter.com/ryrivard.

 


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