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Jacqueline Saa has a genetic condition that leaves her unable to stand and walk on her own or hold a job. Every weekday for four years, Saa, 43, has relied on a home health aide to help her cook, bathe and dress, go to the doctor, pick up medications, and accomplish other daily tasks.

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Have you or someone you know with disabilities unexpectedly lost Medicaid benefits since April 2023? Tell us about it here. contact us

She received coverage through Floridas Medicaid program until it abruptly stopped at the end of March, she said.

Every day the anxiety builds, said Saa, who lost her home health aide for 11 days, starting April 1, despite being eligible. The state has since restored Saas home health aide service, but during the gap she leaned on her mother and her 23- and 15-year-old daughters, while struggling to regain her Medicaid benefits.

Its just so much to worry about, she said. This is a health care system thats supposed to help.

Medicaids home and community-based services are designed to help people like Saa, who have disabilities and need help with everyday activities, stay out of a nursing facility. But people are losing benefits with little or no notice, getting bad advice when they call for information, and facing major disruptions in care while they wait for the issue to get sorted out, according to attorneys and advocates who are hearing from patients.

In Colorado, Texas, and Washington, D.C., the National Health Law Program, a nonprofit that advocates for low-income and underserved people, has filed civil rights complaints with two federal agencies alleging discrimination against people with disabilities. The group has not filed a lawsuit in Florida, though its attorneys say theyve heard of many of the same problems there.

Attorneys nationwide say the special needs of disabled people were not prioritized as states began to review eligibility for Medicaid enrollees after a pandemic-era mandate for coverage expired in March 2023. Email Sign-Up

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Instead of monitoring and ensuring that people with disabilities could make their way through the process, they sort of treated them like everyone else with Medicaid, said Elizabeth Edwards, a senior attorney for the National Health Law Program. Federal law puts an obligation on states to make sure people with disabilities dont get missed.

At least 21 million people nationwide have been disenrolled from Medicaid since states began eligibility redeterminations in spring 2023, according to a KFF analysis.

The unwinding, as its known, is an immense undertaking, Edwards said, and some states did not take extra steps to set up a special telephone line for those with disabilities, for example, so people could renew their coverage or contact a case manager.

As states prepared for the unwinding, the Centers for Medicare & Medicaid Services, the federal agency that regulates Medicaid, advised states that they must give people with disabilities the help they need to benefit from the program, including specialized communications for people who are deaf or blind.

The Florida Department of Children and Families, which verifies eligibility for the states Medicaid program, has a specialized team that processes applications for home health services, said Mallory McManus, the departments communications director.

People with disabilities disenrolled from Medicaid services were properly noticed and either did not respond timely or no longer met financial eligibility requirements, McManus said, noting that people would have been contacted by us up to 13 times via phone, mail, email, and text before processing their disenrollment.

Allison Pellegrin of Ormond Beach, Florida, who lives with her sister Rhea Whitaker, who is blind and cognitively disabled, said that never happened for her family. Rhea Whitakers home health aide care was cut for 12 days without her receiving any notice. Whitakers sister, Allison Pellegrin, took time off from work to take care of Whitaker, who was disabled by a severe brain injury in 2006.(Allison Pellegrin)

They just cut off the benefits without a call, without a letter or anything stating that the benefits would be terminating, Pellegrin said. Her sisters home health aide, whom she had used every day for nearly eight years, stopped service for 12 days. If I’m getting everything else in the mail, she said, it seems weird that after 13 times I wouldn’t have received one of them.

Pellegrin, 58, a sales manager who gets health insurance through her employer, took time off from work to care for Whitaker, 56, who was disabled by a severe brain injury in 2006.

Medicaid reviews have been complicated, in part, by the fact that eligibility works differently for home health services than for general coverage, based on federal regulations that give states more flexibility to determine financial eligibility. Income limits for home health services are higher, for instance, and assets are counted differently.

In Texas, a parent in a household of three would be limited to earning no more than $344 a month to qualify for Medicaid. And most adults with a disability can qualify without a dependent child and be eligible for Medicaid home health services with an income of up to $2,800 a month.

The state was not taking that into consideration, said Terry Anstee, a supervising attorney for community integration at Disability Rights Texas, a nonprofit advocacy group.

Even a brief lapse in Medicaid home health services can fracture relationships that took years to build.

It may be very difficult for that person who lost that attendant to find another attendant, Anstee said, because of workforce shortages for attendants and nurses and high demand.

Nearly all states have a waiting list for home health services. About 700,000 people were on waiting lists in 2023, most of them with intellectual and developmental disabilities, according to KFF data.

Daniel Tsai, a deputy administrator at CMS, said the agency is committed to ensuring that people with disabilities receiving home health services can renew their Medicaid coverage with as little red tape as possible.

CMS finalized a rule this year for states to monitor Medicaid home health services. For example, CMS will now track how long it takes for people who need home health care to receive the services and will require states to track how long people are on waitlists.

Staff turnover and vacancies at local Medicaid agencies have contributed to backlogs, according to complaints filed with two federal agencies focused on civil rights.

The District of Columbias Medicaid agency requires that case managers help people with disabilities complete renewals. However, a complaint says, case managers are the only ones who can help enrollees complete eligibility reviews and, sometimes, they dont do their jobs.

Advocates for Medicaid enrollees have also complained to the Federal Trade Commission about faulty eligibility systems developed by Deloitte, a global consulting firm that contracts with about two dozen states to design, implement, or operate automated benefits systems.

KFF Health News found that multiple audits of Colorados eligibility system, managed by Deloitte, uncovered errors in notices sent to enrollees. A 2023 review by the Colorado Office of the State Auditor found that 90% of sampled notices contained problems, some of which violate the states Medicaid rules. The audit blamed flaws in system design for populating notices with incorrect dates.

Deloitte declined to comment on specific state issues.

In March, Colorado officials paused disenrollment for people on Medicaid who received home health services, which includes people with disabilities, after a system update led to wrongful terminations in February.

Another common problem is people being told to reapply, which immediately cuts off their benfits, instead of appealing the cancellation, which would ensure their coverage while the claim is investigated, said attorney Miriam Harmatz, founder of the Florida Health Justice Project.

What theyre being advised to do is not appropriate. The best way to protect their legal rights, Harmatz said, is to file an appeal.

But some disabled people are worried about having to repay the cost of their care.

Saa, who lives in Davie, Florida, received a letter shortly before her benefits were cut that said she may be responsible to repay any benefits if she lost her appeal.

The state should presume such people are still eligible and preserve their coverage, Harmatz said, because income and assets for most beneficiaries are not going to increase significantly and their conditions are not likely to improve.

The Florida Department of Children and Families would not say how many people with disabilities had lost Medicaid home health services.

But in Miami-Dade, Floridas most populous county, the Alliance for Aging, a nonprofit that helps older and disabled people apply for Medicaid, saw requests for help jump from 58 in March to 146 in April, said Lisa Mele, the organizations director of its Aging and Disability Resources Center.

So many people are calling us, she said.

States are not tracking the numbers, so the impact is not clear, Edwards said. It’s a really complicated struggle.

Saa filed an appeal March 29 after learning from her social worker that her benefits would expire at the end of the month. She went to the agency but couldnt stand in a line that was 100 people deep. Calls to the states Medicaid eligibility review agency were fruitless, she said.

When they finally connected me to a customer service representative, she was literally just reading the same explanation letter that Ive read, Saa said. I did everything in my power.

Saa canceled her home health aide. She lives on limited Social Security disability income and said she could not afford to pay for the care.

On April 10, she received a letter from the state saying her Medicaid had been reinstated, but she later learned that her plan did not cover home health care.

The following day, Saa said, advocates put her in touch with a point person at Floridas Medicaid agency who restored her benefits. A home health aide showed up April 12. Saa said shes thankful but feels anxious about the future.

The toughest part of that period is knowing that that can happen at any time, she said, and not because of anything I did wrong.

Have you or someone you know with disabilities unexpectedly lost Medicaid benefits since April 2023? Tell KFF Health News about it here.

KFF Health News correspondents Samantha Liss and Rachana Pradhan contributed to this report.

Daniel Chang: dchang@kff.org, @dchangmiami Related Topics Insurance Medicaid States Colorado Disabilities Disparities District Of Columbia Florida Texas Contact Us Submit a Story Tip

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Sports

If college football’s playoff system ain’t broke, why fix it?

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If college football's playoff system ain't broke, why fix it?

During college football’s Bowl Championship Series era, the sport’s opposition to an expanded, let alone expansive, playoff could be summarized in one colorful quote by then-Ohio State president E. Gordon Gee.

“They will wrench a playoff system out of my cold, dead hands,” Gee said in 2007.

We are happy to report that while college football does, indeed, have a playoff, Gee is still very much alive. The 81-year-old retired just this week after a second stint leading West Virginia University.

What is dead and buried, though, is college football’s staunch resistance to extending its postseason field. After decades of ignoring complaints and the promise of additional revenue to claim that just two teams was more than enough, plans to move from 12 participants to 16 were underway before last season’s inaugural 12-teamer even took place.

A once-static sport now moves at light speed, future implications be damned.

Fire. Ready. Aim.

So maybe the best bit of current news is that college football’s two ruling parties — the SEC and Big Ten — can’t agree on how the new 16-team field would be selected. It has led to a pause on playoff expansion.

Maybe, just maybe, it means no expansion will occur by 2026, as first planned, and college football can let the 12-team model cook a little to accurately assess what changes — if any — are even needed.

“We have a 12-team playoff, five conference champions,” SEC commissioner Greg Sankey said this week. “That could stay if we can’t agree.”

Good. After all, what’s the rush?

The 2025 season will play out with a 12-team format featuring automatic bids for five conference champions and seven at-large spots. Gone is last year’s clunky requirement that the top four seeds could go only to conference champs — elevating Boise State and Arizona State and unbalancing the field.

That alone was progress built on real-world experience. It should be instructive.

The SEC wants a 16-team model but with, as is currently the case, automatic bids going to the champions in the ACC, Big 12, Big Ten, SEC and the best of the so-called Group of 6. The rest of the field would be at-large selections.

The Big Ten says it will not back such a proposal until the SEC agrees to play nine conference games (up from its current eight). Instead, it wants a 16-team system that gives four automatic bids apiece to the Big Ten and SEC, two each to the ACC and Big 12, one to the Group of 6 and then three at-large spots.

It’s been dubbed the “4-4-2-2-1-3” because college athletic leaders love ridiculous parlances almost as much as they love money.

While the ACC, Big 12 and others have offered opinions — mostly siding with the SEC — legislatively, the decision rests with the sport’s two big-dog conferences.

Right now, neither side is budging. A compromise might still be made, of course. The supposed deadline to set the 2026 system is Nov. 30. And Sankey actually says he prefers the nine-game SEC schedule, even if his coaches oppose it.

However, the possibility of the status quo standing for a bit longer remains.

What the Big Ten has proposed is a dramatic shift for a sport that has been bombarded with dramatic shifts — conference realignment, the transfer portal, NIL, revenue sharing, etc.

The league wants to stage multiple “play-in” games on conference championship weekend. The top two teams in the league would meet for the league title (as is currently the case), but the third- and fourth-place teams would play the fifth- and sixth-place teams to determine the other automatic bids.

Extend this out among all the conferences and you have up to a 26-team College Football Playoff (with 22 teams in a play-in situation). This would dramatically change the way the sport works — devaluing the stakes for nonconference games, for example. And some mediocre teams would essentially get a playoff bid — in the Big Ten’s case, the sixth seed last year was an Iowa team that finished 8-5.

Each conference would have more high-value inventory to sell to broadcast partners, but it’s not some enormous windfall. Likewise, four more first-round playoff games would need to find television slots and relevance.

Is anyone sure this is necessary? Do we need 16 at all, let alone with multibids?

In the 12-team format, the first round wasn’t particularly competitive — with a 19.3-point average margin of victory. It’s much like the first round of the NFL playoffs, designed mostly to make sure no true contender is left out.

Perhaps last year was an outlier. And maybe future games will be close. Or maybe they’ll be even more lopsided. Wouldn’t it be prudent to find out?

While there were complaints about the selection committee picking SMU and/or Indiana over Alabama, it wasn’t some egregious slight. Arguments will happen no matter how big the field. Besides, the Crimson Tide lost to two 6-6 teams last year. Expansion means a team with a similar résumé can cruise in.

Is that a good thing?

Whatever the decision, it is being made with little to no real-world data — pro or con. Letting a few 12-team fields play out, providing context and potentially unexpected consequences, sure wouldn’t hurt.

You don’t have to be Gordon Gee circa 2007 to favor letting this simmer and be studied before leaping toward another round of expansion.

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Arch to victory? Texas preseason pick to win SEC

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Arch to victory? Texas preseason pick to win SEC

Texas, with Heisman Trophy candidate Arch Manning set to take over as starting quarterback, is the preseason pick to win the Southeastern Conference championship.

The Longhorns received 96 of the 204 votes cast from media members covering the SEC media days this week to be crowned SEC champion on Dec. 6 in Atlanta at Mercedes-Benz Stadium. Georgia, with 44 votes, received the second-most votes.

If that scenario plays out, it would mean a rematch of the 2024 SEC championship game, which Georgia won in an overtime thriller. The SEC championship game pits the two teams with the best regular-season conference record against one another.

Alabama was third with 29 votes, while LSU got 20. South Carolina was next with five, while Oklahoma received three and Vanderbilt and Florida each got two votes. Tennessee, Ole Miss and Auburn each received one vote.

Since 1992, only 10 times has the predicted champion in the preseason poll gone on to win the SEC championship.

The 2024 SEC title game averaged 16.6 million viewers across ABC and ESPN, the fourth-largest audience on record for the game. The overtime win for Georgia, which peaked with 19.7 million viewers, delivered the largest audience of the college football season.

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World

Every shop and home burned or ransacked: The Syrian city engulfed in tribal violence

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Every shop and home burned or ransacked: The Syrian city engulfed in tribal violence

The Syrian presidency has announced it’s assembling a special taskforce to try to stop nearly a week of sectarian clashes in the southern Druze city of Sweida.

The presidency called for restraint on all sides and said it is making strenuous efforts to “stop the fighting and curb the violations that threaten the security of the citizens and the safety of society”.

By early Saturday morning, a ceasefire had been confirmed by the US special envoy for Syria, Tom Barrack, who posted on X that Syrian President Ahmed al Sharaa and Israeli Prime Minister Benjamin Netanyahu had agreed to a ceasefire supported by US secretary of state Marco Rubio.

The post went on to state that this agreement had the support of “Turkey, Jordan and its neighbours” and called upon the Druze, Bedouins, and Sunni factions to put down their arms.

Sky News special correspondent Alex Crawford reports from the road leading to Sweida, the city that has become the epicentre of Syria’s sectarian violence.

For the past 24 hours, we’ve watched as Syria‘s multiple Arab tribes began mobilising in the Sweida province to help defend their Bedouin brethren.

A fighter aims a gun
A body is wrapped in a blanket

Thousands travelled from multiple different Syrian areas and had reached the edge of Sweida city by Friday nightfall after a day of almost non-stop violent clashes and killings.

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“We have come to protect the [Arab] Bedouin women and children who are being terrorised by the Druze,” they told us.

A fighter in Syria
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Arab fighters said they had come to protect the Bedouin women and children

Fighters at a gas station
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Fighters at a petrol station

Every shop and every home in the streets leading up to Sweida city has been burned or ransacked, the contents destroyed or looted.

We saw tribal fighters loading the back of pickup trucks and driving away from the city with vehicles packed with looted goods from Druze homes.

A burning building
Image:
Shops and homes leading up to Sweida city have been burned or ransacked

A burned out car

Several videos posted online showed violence against the Druze, including one where tribal fighters force three men to throw themselves off a high-rise balcony and are seen being shot as they do so.

Doctors at the nearby community hospital in Buser al Harir said there had been a constant stream of casualties being brought in. As we watched, another dead fighter was carried out of an ambulance.

The medics estimated there had been more than 600 dead in their area alone. “The youngest child who was killed was a one-and-a-half-year-old baby,” one doctor told us.

A doctor talks to Sky's Alex Crawford
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Doctors said there had been a constant stream of casualties due to violence

The violence is the most dangerous outbreak of sectarian clashes since the fall of the Bashar al Assad regime last December – and the most serious challenge for the new leader to navigate.

The newly brokered deal is aimed at ending the sectarian killings and restoring some sort of stability in a country which is emerging from more than a decade of civil war.

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