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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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How Jim Abbott changed the world

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How Jim Abbott changed the world

JIM ABBOTT IS sitting at his kitchen table, with his old friend Tim Mead. In the late 1980s and early 1990s, they were partners in an extraordinary exercise — and now, for the first time in decades, they are looking at a stack of letters and photographs from that period of their lives.

The letters are mostly handwritten, by children, from all over the United States and Canada, and beyond.

“Dear Mr. Abbott …”

“I have one hand too. … I don’t know any one with one hand. How do you feel about having one hand? Sometimes I feel sad and sometimes I feel okay about it. Most of the time I feel happy.”

“I am a seventh grader with a leg that is turned inwards. How do you feel about your arm? I would also like to know how you handle your problem? I would like to know, if you don’t mind, what have you been called?”

“I can’t use my right hand and most of my right side is paralyzed. … I want to become a doctor and seeing you makes me think I can be what I want to be.”

For 40 years, Mead worked in communications for the California Angels, eventually becoming vice president of media relations. His position in this department became a job like no other after the Angels drafted Abbott out of the University of Michigan in 1988.

There was a deluge of media requests. Reporters from around the world descended on Anaheim, most hoping to get one-on-one time with the young left-handed pitcher with the scorching fastball. Every Abbott start was a major event — “like the World Series,” Angels scout Bob Fontaine Jr. remembers. Abbott, with his impressive amateur résumé (he won the James E. Sullivan Award for the nation’s best amateur athlete in 1997 and an Olympic gold medal in 1988) and his boyish good looks, had star power.

That spring, he had become only the 16th player to go straight from the draft to the majors without appearing in a single minor league game. And then there was the factor that made him unique. His limb difference, although no one called it that back then. Abbott was born without a right hand, yet had developed into one of the most promising pitchers of his generation. He would go on to play in the majors for ten years, including a stint in the mid ’90s with the Yankees highlighted by a no-hitter in 1993.

Abbott, and Mead, too, knew the media would swarm. That was no surprise. There had been swarms in college, and at the Olympics, wherever and whenever Abbott pitched. Who could resist such an inspirational story? But what they hadn’t anticipated were the letters.

The steady stream of letters. Thousands of letters. So many from kids who, like Abbott, were different. Letters from their parents and grandparents. The kids hoping to connect with someone who reminded them of themselves, the first celebrity they knew of who could understand and appreciate what it was like to be them, someone who had experienced the bullying and the feelings of otherness. The parents and grandparents searching for hope and direction.

“I know you don’t consider yourself limited in what you can do … but you are still an inspiration to my wife and I as parents. Your success helps us when talking to Andy at those times when he’s a little frustrated. I’m able to point to you and assure him there’s no limit to what he can accomplish.”

In his six seasons with the Angels, Abbott was assisted by Mead in the process of organizing his responses to the letters, mailing them, and arranging face-to-face meetings with the families who had written to him. There were scores of such meetings. It was practically a full-time job for both of them.

“Thinking back on these meetings with families — and that’s the way I’d put it, it’s families, not just kids — there was every challenge imaginable,” Abbott, now 57, says. “Some accidents. Some birth defects. Some mental challenges that aren’t always visible to people when you first come across somebody. … They saw something in playing baseball with one hand that related to their own experience. I think the families coming to the ballparks were looking for hopefulness. I think they were looking for what it had been that my parents had told me, what it had been that my coaches had told me. … [With the kids] it was an interaction. It was catch. It was smiling. It was an autograph. It was a picture. With the parents, it ran deeper. With the parents, it was what had your parents said to you? What coaches made a difference? What can we expect? Most of all, I think, what can we expect?”

“It wasn’t asking for autographs,” Mead says of all those letters. “They weren’t asking for pictures. They were asking for his time. He and I had to have a conversation because this was going to be unique. You know, you could set up another player to come down and sign 15 autographs for this group or whatever. But it was people, parents, that had kids, maybe babies, just newborn babies, almost looking for an assurance that this is going to turn out all right, you know. ‘What did your parents do? How did your parents handle this?'”

One of the letters Abbott received came from an 8-year-old girl in Windsor, Ontario.

She wrote, “Dear Jim, My name is Tracey Holgate. I am age 8. I have one hand too. My grandpa gave me a picture of you today. I saw you on TV. I don’t know anyone with one hand. How do you feel about having one hand? Sometimes I feel sad and sometimes I feel okay about it. Most of the time I feel happy. I hope to see you play in Detroit and maybe meet you. Could you please send me a picture of you in uniform? Could you write back please? Here is a picture of me. Love, Tracey.”

Holgate’s letter is one of those that has remained preserved in a folder — and now Abbott is reading it again, at his kitchen table, half a lifetime after receiving it. Time has not diminished the power of the letter, and Abbott is wiping away tears.

Today, Holgate is 44 and goes by her married name, Dupuis. She is married with four children of her own. She is a teacher. When she thinks about the meaning of Jim Abbott in her life, it is about much more than the letter he wrote back to her. Or the autographed picture he sent her. It was Abbott, all those years ago, who made it possible for Tracey to dream.

“There was such a camaraderie there,” she says, “an ability to connect with somebody so far away doing something totally different than my 8-year-old self was doing, but he really allowed me to just feel that connection, to feel that I’m not alone, there’s other people that have differences and have overcome them and been successful and we all have our own crosses, we all have our own things that we’re carrying and it’s important to continue to focus on the gifts that we have, the beauty of it.

“I think sometimes differences, disabilities, all those things can be a gift in a package we would never have wanted, because they allow us to be people that have an empathetic heart, an understanding heart, and to see the pain in the people around us.”

Now, years after Abbott’s career ended, he continues to inspire.

Among those he influenced, there are professional athletes, such as Shaquem Griffin, who in 2018 became the first NFL player with one hand. Griffin, now 29, played three seasons at linebacker for the Seattle Seahawks.

Growing up in Florida, he would watch videos of Abbott pitching and fielding, over and over, on YouTube.

“The only person I really looked up to was Jim Abbott at the time,” Griffin says, “which is crazy, because I didn’t know anybody else to look up to. I didn’t know anybody else who was kind of like me. And it’s funny, because when I was really little, I used to be like, ‘Why me? Why this happen to me?’ And I used to be in my room thinking about that. And I used to think to myself, ‘I wonder if Jim Abbott had that same thought.'”

Carson Pickett was born on Sept. 15, 1993 — 11 days after Abbott’s no-hitter. Missing most of her left arm below the elbow, she became, in 2022, the first player with a limb difference to appear for the U.S. women’s national soccer team.

She, too, says that Abbott made things that others told her were impossible seem attainable.

“I knew I wanted to be a professional soccer player,” says Pickett, who is currently playing for the NWSL’s Orlando Pride. “To be able to see him compete at the highest level it gave me hope, and I think that that kind of helped me throughout my journey. … I think ‘pioneer’ would be the best word for him.”

Longtime professional MMA fighter Nick Newell is 39, old enough to have seen Abbott pitch for the Yankees. In fact, when Newell was a child he met Abbott twice, first at a fan event at the Jacob Javits Center in Manhattan and then on a game day at Yankee Stadium. Newell was one of those kids with a limb difference — like Griffin and Pickett, due to amniotic band syndrome — who idolized Abbott.

“And I didn’t really understand the gravity of what he was doing,” Newell says now, “but for me, I saw someone out there on TV that looked like I did. And I was the only other person I knew that had one hand. And I saw this guy out here playing baseball and it was good to see somebody that looked like me, and I saw him in front of the world.

“He was out there like me and he was just living his life and I think that I owe a lot of my attitude and the success that I have to Jim just going out there and being the example of, ‘Hey, you can do this. Who’s to say you can’t be a professional athlete?’ He’s out there throwing no-hitters against the best baseball players in the world. So, as I got older, ‘Why can’t I wrestle? Why can’t I fight? Why can’t I do this?’ And then it wasn’t until the internet that I heard people tell me I can’t do these things. But by then I had already been doing those things.”

Griffin.

Pickett.

Newell.

Just three of the countless kids who were inspired by Jim Abbott.

When asked if it ever felt like too much, being a role model and a hero, all the letters and face-to-face meetings, Abbott says no — but it wasn’t always easy.

“I had incredible people who helped me send the letters,” he says. “I got a lot more credit sometimes than I deserved for these interactions, to be honest with you. And that happened on every team, particularly with my friend Tim Mead. There was a nice balance to it. There really was. There was a heaviness to it. There’s no denying. There were times I didn’t want to go [to the meetings]. I didn’t want to walk out there. I didn’t want to separate from my teammates. I didn’t want to get up from the card game. I didn’t want to put my book down. I liked where I was at. I was in my environment. I was where I always wanted to be. In a big league clubhouse surrounded by big league teammates. In a big league stadium. And those reminders of being different, I slowly came to realize were never going to go away.”

But being different was the thing that made Abbott more than merely a baseball star. For many people, he has been more than a role model, more than an idol. He is the embodiment of hope and belonging.

“I think more people need to realize and understand the gift of a difference,” Dupuis says. “I think we have to just not box everybody in and allow everybody’s innate light to shine, and for whatever reasons we’ve been created to be here, [let] that light shine in a way that it touches everybody else. Because I think that’s what Jim did. He allowed his light to permeate and that light, in turn, lit all these little children’s lights all over the world, so you have this boom of brightness that’s happening and that’s uncontrollable, that’s beautiful.”

“Southpaw – The Life and Legacy of Jim Abbott,” a new edition of ESPN’s “E60,” debuts Sunday at 9 p.m. ET on ESPN; extended version streaming afterward on ESPN+.

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Red Sox activate 3B Bregman from 10-day IL

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Red Sox activate 3B Bregman from 10-day IL

BOSTON — The Red Sox activated All-Star third baseman Alex Bregman from the 10-day injured list before Friday’s game against Tampa Bay.

Bregman, who has been sidelined since May 24 with a right quad strain, returned to his customary spot in the field and was slotted in the No. 2 spot of Boston’s lineup for the second of a four-game series against the Rays. He sustained the injury when he rounded first base and felt his quad tighten up.

A two-time World Series winner who spent the first nine seasons of his big league career with the Houston Astros, Bregman signed a $120 million, three-year contract in February. At the time of the injury, he was hitting .299 with 11 homers and 35 RBI. Those numbers led to him being named to the American League’s All-Star team for the third time since breaking into the majors with the Astros in 2016.

Bregman missed 43 games with the quad strain. Earlier this week, he told reporters that he was trending in a direction where he didn’t believe he would require a minor league rehab assignment. With three games left before the All-Star break, the Red Sox agreed the time was right to reinstate a player to a team that entered Friday in possession of one of the AL’s three wild-card berths.

“He’s going to do his part,” Red Sox manager Alex Cora said before Friday’s game. “Obviously, the timing, we’ll see where he’s at, but he’s been working hard on the swing … visualizing and watching video.”

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Cubs’ PCA on track for $1.1M from bonus pool

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Cubs' PCA on track for .1M from bonus pool

NEW YORK — Chicago Cubs center fielder Pete Crow-Armstrong is projected to receive the largest amount from this season’s $50 million pre-arbitration bonus pool based on his regular-season statistics.

Crow-Armstrong is on track to get $1,091,102, according to WAR calculations through July 8 that Major League Baseball sent to teams, players and agents in a memo Friday that was obtained by The Associated Press.

He earned $342,128 from the pool in 2024.

“I was aware of it after last year, but I have no clue of the numbers,” he said Friday. “I haven’t looked at it one time.”

Pittsburgh pitcher Paul Skenes is second at $961,256, followed by Washington outfielder James Wood ($863,835), Arizona outfielder Corbin Carroll ($798,397), Houston pitcher Hunter Brown ($786,838), Philadelphia pitcher Cristopher Sánchez ($764,854), Cincinnati shortstop Elly De La Cruz ($717,479), Boston catcher Carlos Narváez ($703,007), Red Sox outfielder Ceddanne Rafaela ($685,366) and Detroit outfielder Riley Greene ($665,470).

Crow-Armstrong, Skenes, Wood, Carroll, Brown, De La Cruz and Greene have been picked for Tuesday’s All-Star Game.

A total of 100 players will receive the payments, established as part of the 2022 collective bargaining agreement and aimed to get more money to players without sufficient service time for salary arbitration eligibility. The cutoff for 2025 was 2 years, 132 days of major league service.

Players who signed as foreign professionals are excluded.

Most young players have salaries just above this year’s major league minimum of $760,000. Crow-Armstrong has a $771,000 salary this year, Skenes $875,000, Wood $764,400 and Brown $807,400.

Carroll is in the third season of a $111 million, eight-year contract.

As part of the labor agreement, a management-union committee was established that determined the WAR formula used to allocate the bonuses after awards. (A player may receive only one award bonus per year, the highest one he is eligible for.) The agreement calls for an interim report to be distributed the week before the All-Star Game.

Distribution for awards was $9.85 million last year, down from $11.25 million in 2022 and $9.25 million in 2023.

A player earns $2.5 million for winning an MVP or Cy Young award, $1.75 million for finishing second, $1.5 million for third, $1 million for fourth or fifth or for making the All-MLB first team. A player can get $750,000 for winning Rookie of the Year, $500,000 for second or for making the All-MLB second team, $350,000 for third in the rookie race, $250,000 for fourth or $150,000 for fifth.

Kansas City shortstop Bobby Witt Jr. topped last year’s pre-arbitration bonus pool at $3,077,595, and Skenes was second at $2,152,057 despite not making his big league debut until May 11. Baltimore shortstop Gunnar Henderson was third at $2,007,178.

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