Medicaid Unwinding Decried as Biased Against Disabled People

Published

4 months ago

May 14, 2024

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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

Entertainment

Artist behind ‘disturbing’ sculpture says it’s not intended to cause upset

Published

14 hours ago

September 22, 2024

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Artist behind 'disturbing' sculpture says it's not intended to cause upset

The artist who created a sculpture which has been called “disturbing” and “shocking” says he’s been “surprised” at the backlash but welcomes difficult conversations it might inspire.

Jason deCaires Taylor told Sky News: “I don’t strive of my artwork to divide people or cause upset. But I do try to talk about issues that are pertinent and relevant to our current times.”

The 50-year-old artist has a history of producing political work but says this one contained “no political intentions at all” and is based on the painting which inspired Shakespeare‘s tragic heroine Ophelia.

The Alluvia – which is made from recycled glass and steel and features LEDs which light up at night – was installed in the River Stour, in Taylor’s hometown of Canterbury in Kent around a week ago.

However, comments posted on Canterbury City Council’s official Facebook page have included accusations that the work is “tone-deaf” and “offensive”.

One wrote: “I can’t be the only person who finds this deeply offensive. She looks like a drowned woman. How did the council not see the link to women as victims of crime or the sad fact so many drown off the Kent coast as refugees.”

Another said: “I find this sculpture absolutely appalling. It’s not just offensive, it’s downright disturbing. The imagery of a submerged figure, reminiscent of a drowning victim, is both morbid and utterly tone-deaf given the tragic drownings that occur along our coastlines. What on earth were the council thinking?”

Others stood up for the work, with one commenting: “More people seem to be “disturbed”, “offended” and “shocked” by this than they do by images of actual drownings which are happening daily along our coasts. Rather than wasting your hate on an artwork that is designed to provoke, why not put some of that energy into something constructive?”

Another wrote: “It’s a beautiful piece of art and nowhere near as disturbing as the previous sculptures that it has replaced. What kind of world do we live in when anything that offends or “triggers” someone, must be removed??”

The sculpture had replaced two similar female forms, also created by Taylor, which had been in the water since 2008 but which had been damaged due to dredging.

‘If it fosters care and sympathy, that’s good’

Taylor told Sky News: “I was surprised… 99.9% of all the feedback that I’ve received has been very positive… But at the same time, I appreciate everybody takes something different from everything they see.”

While he says there is “no connection” between the work and the ongoing migrant crisis taking place further along the Kent coast, he hopes it could inspire empathy for what’s happening out in the Channel.

He said: “It’s an extremely tragic situation, and I don’t think ignoring it is the solution. If [this work] can foster any kind of care and sympathy for that situation, then I think that’s a good thing.”

More than 21,000 people arrived in the UK in small boats between January and September, according to government figures, with at least 45 people dying in Channel crossings this year.

Taylor also said the fact the subject is a young woman is because it draws reference from Sir John Everett Millais’s celebrated painting, on display at Tate Britain.

‘Art without questions is pointless’

Some of Taylor’s past sculptures have raised issues around the climate crisis, Brexit and the plight of those risking their lives on the perilous migration route from West Africa to Spain.

Taylor says: “Art should ask questions. They should make people think about things that should elicit emotions, that’s really critical.

“If things were ignored and if you tried to please everybody with all your artwork, I think you’d make something very benign and quite frankly, pretty pointless.”

He also feels our age of information overload could be part of the reason for the negative feedback.

“We’re so inundated with images and media, with having our phones interrupting us and screens everywhere we look that people look for divisiveness and things that cause clickbait. I think there is an element of people sort of seeking out controversy.”

Taylor said the majority of negative comments online had come from people who had not been to Canterbury and seen the work in real life, with one call for the statue’s removal coming all the way from Orkney.

Responding directly to calls for his work to be taken out of the river, he said: “People are perfectly in their rights to have [an] opinion. But I would urge them to go and see it first.”

‘A dead body doesn’t light up at night’

Chair of Canterbury Commemoration Society Stewart Ross, the charity that commissioned the work, told Sky News: “Some people find it offensive and shocking, we have no objection to that. All public art is open to discussion”.

Comparing calls for the work to be removed to the destruction of art during the Reformation, he said: “I feel strongly about this [call for censorship]. It’s what the Taliban do. If you don’t like it, don’t look.”

Mr Ross said the “confected anger” around the sculpture was “unnecessary” and that the charity was simply “trying to do its best,” adding: “People have been comparing it to a dead body, but I have yet to meet a dead body that lights up in the night”.

Taylor, who has been working as an artist for over 25 years, has sculptures in marine locations around the world including Australia, Mexico, Grenada and Norway. Prices for his sculptures start at around £1,300.

He first donated the two original Alluvia figures to the city of Canterbury in 2008.

Technology

Middle Eastern funds are plowing billions of dollars into hottest AI start-ups

Published

14 hours ago

September 22, 2024

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Middle Eastern funds are plowing billions of dollars into hottest AI start-ups

Sovereign wealth funds out of the Middle East are emerging as key backers of Silicon Valley’s artificial intelligence darlings.

Oil-rich nations like Saudi Arabia, United Arab Emirates, Kuwait and Qatar have been looking to diversify their economies, and are turning to tech investments as a hedge. In the past year, funding for AI companies by Middle-Eastern sovereigns has increased fivefold, according to data from Pitchbook.

MGX, a new AI fund out of The United Arab Emirates, was among investors looking to get a slice of OpenAI’s latest fundraise this week, two sources told CNBC. The round is set to value OpenAI at $150 billion, said the people, who asked not to be named because the discussions are confidential.

Few venture funds have deep enough pockets to compete with the multibillion-dollar checks coming from the likes of Microsoft and Amazon. But these sovereign funds have no problem coming up with cash for AI deals. They invest on behalf of their governments, which have been helped by rising energy prices in recent years. The Gulf Cooperation Council, or GCC, countries’ total wealth is expected to rise from $2.7 trillion to $3.5 trillion by 2026, according to Goldman Sachs.

The Saudi Public Investment Fund, or PIF, has topped $925 billion, and has been on an investing spree as part of Crown Prince Mohammed bin Salman’s “Vision 2030” initiative. The PIF has investments in companies including Uber, while also spending heavily on the LIV golf league and professional soccer.

UAE’s Mubadala has $302 billion under management, and the Abu Dhabi Investment Authority has $1 trillion under management. Qatar Investment Authority has $475 billion, while Kuwait’s fund has topped $800 billion.

Earlier this week, Abu Dhabi-based MGX joined a partnership on AI infrastructure with BlackRock, Microsoft and Global Infrastructure Partners, aiming to raise as much as $100 billion for data centers and other infrastructure investments. MGX was launched as a dedicated AI fund in March, with Abu Dhabi’s Mubadala and AI firm G42 as founding partners.

UAE’s Mubadala has also invested in OpenAI rival Anthropic, and is among the most active venture investors, with eight AI deals in the past four years, according to Pitchbook. Anthropic ruled out taking money from the Saudis in its last funding round, citing national security, sources told CNBC.

Saudi Arabia’s PIF is in talks to create a $40 billion partnership with U.S. venture capital firm Andreessen Horowitz. It also launched a dedicated AI fund called the Saudi Company for Artificial Intelligence, or SCAI.

Still, the kingdom’s human rights record remains an issue for some Western partners and start-ups. The most notable case in recent years was the alleged killing of Washington Post journalist Jamal Khashoggi in 2018, an event that triggered international backlash in the business community.

It’s not just the Middle East spraying money into the space. French sovereign fund Bpifrance has inked 161 AI and machine learning deals in the past four years, while Temasek out of Singapore has completed 47, according to Pitchbook. GIC, another Singapore-backed fund, has completed 24 deals.

The flood of cash has some Silicon Valley investors worried about a SoftBank effect, referring to Masayoshi Son’s Vision Fund. SoftBank notably backed Uber and WeWork, pushing the companies to sky-high, valuations before going public. WeWork spiraled into bankruptcy last year after being valued by SoftBank at $47 billion in 2019.

For the U.S., having sovereign wealth funds invest in American companies, and not in global adversaries like China, has been a geopolitical priority. Jared Cohen of Goldman Sachs Global Institute said there’s a disproportionate amount of capital coming from nations like Saudi Arabia and UAE, and a willingness to deploy it around the world. He described them as “geopolitical swing states.”

WATCH: OpenAI is the indisputable leader in AI supercycle

UK

Ex-Harrods director reveals how ‘paranoid’ Mohamed al Fayed created toxic culture at store

Published

14 hours ago

September 22, 2024

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Ex-Harrods director reveals how 'paranoid' Mohamed al Fayed created toxic culture at store

A former Harrods director told Sky News he does not see how security at the department store “wouldn’t have known” about Mohamed al Fayed’s behaviour towards women.

Five women have alleged they were raped by Fayed, who died last year at the age of 94, with several others alleging sexual misconduct.

A legal team representing alleged victims confirmed on Saturday morning they have “had over 150 new inquiries” since the airing of a BBC documentary on Fayed.

The Harrods’ ex-director, who reported directly to Fayed, said: “There was security everywhere, all the phones and offices were bugged, with cameras everywhere.

“I just put it down to paranoia, wanting to know he was getting his pound of flesh from us. The nature of the man was to set everyone against each other, to set directors against each other.

“Whether Fayed’s own offices or stuff had surveillance, I wouldn’t know. But to get into his suite of offices you had to have an appointment, PAs had to arrange it, it was very secure.”

He added: “The only thing I was aware of was that someone said he had lots of PAs and they were all blondes. I thought that he just wanted to surround himself with pretty women.”

The former director, who spoke to Sky News on the condition of anonymity, said the culture at Harrods was toxic.

“It was very much keep your head down, no one helped each other. It wasn’t a team as you knew Fayed was trying to catch everyone out.

“He was always trying to make fun of people in front of others, which he thought was very funny.”

Harrods said in a statement on Thursday it was “utterly appalled” by the allegations of abuse and apologised to Fayed’s alleged victims.

The department store has also set up a page on its website inviting former employees to come forward if they have allegations.

Meanwhile, Education Secretary Bridget Phillipson has defended Sir Keir Starmer after it emerged the Crown Prosecution Service (CPS) declined to bring charges against Fayed while the prime minister was director of public prosecutions.

The CPS considered bringing charges against the former Harrods chairman in 2009 and 2015 but concluded there was not “a realistic prospect of a conviction”.

The minister told Sky News that tackling violence against women was a “personal priority” while Sir Keir was head of the CPS as director of public prosecutions between 2008 and 2013.

“I don’t know the details of what happened in 2009, there sometimes can be issues with the evidence that’s presented by the police, whether that can lead to a conviction,” Ms Phillipson said.

“The first time that I ever knew who Keir Starmer was when I saw him on television as director of public prosecutions, talking about the personal priority that he attached to tackling violence against women and girls, so he’s got a personal commitment to it.

“He turned the CPS around while he was leading it to focus on that. But, clearly, if there have been issues that should be considered, that should happen.”

A Downing Street spokesperson said Sir Keir did not handle Fayed’s case, adding it “did not cross his desk”.

The CPS also provided early investigative advice to the Metropolitan Police in 2018, 2021 and 2023 following allegations made against Fayed.

However, a full file of evidence was never received by the CPS in each of these instances and they were given no further action by police.

Former Victims’ Commissioner Dame Vera Baird accused the CPS of only taking “cases they could win”, saying the organisation was “a den of negativity for all sexual offence allegations and for the people who made them”.

She told Sky News: “They have always been valued for the proportion of cases they win. So you do 20 [cases] and you [win] 15 – 75%, that’s good. But if you only do 10 because 10 are really, really safe, then you get nine of them – that is a super rate of conviction.

“Their interest mitigated for all of that time against the interests of people who severely needed to have the help of the criminal justice system to get over the awful way that they were treated by their assailants. And now it’s very clear that Mr Fayed was one of those.“

She also said the CPS’s treatment of women may have affected its decision to not take charges against Fayed.

“Women who come forward with complaints of this kind are underestimated and undervalued, and to some extent seen as a liability who [is] likely to be volatile or emotionally not very well, largely because of the way they’ve been treated,” she said.

But Dame Vera defended Sir Keir for his “ahead of the game” approach to violence against women while he was director of public prosecutions.

“They were doing their best and for instance, the CPS was the first ever government organisation to have a violence against women and girls strategy.

“Keir initiated a report by a very highly-regarded lawyer about how the CPS should systematically get away from the myths about prosecution and about sex offences, that it impeded them from taking cases forward. That was a very strong thing to do.”