Friday, February 17, 2017

When the Fight Song Comes To An End

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If you've been reading about Noah for years you'll likely know that I've fought some really hard battles over the years for Noah.  Some that would leave any other person incapable of standing and moving forward.  I kid you not.  My resilience for the struggles, hardships and injustices are something even I am in awe that I've been capable of getting through - and even with the perseverance and spirit in which I do it. 

But there comes a time, I think when you have to really reflect on the success of the fight, and even more so what the fight has cost you.  I suppose I thought at some point I could turn pain into purpose.  That was always my goal.  I didn't want others to suffer in the ways that I have had to, navigate the hardships in which I've had to - to heal and fix a broken system that leaves children with disabilities lacking in all the things they need to better their quality of life - all of it.  I had this illusion in a way that I could be everyone's hero - including Noah's.   I'd be able to reach my hands in and help - make a positive difference and inspire change.  

The reality just isn't like that. 

Let's back up a little bit and I'll tell you how I've come to my new epiphany.


The beginning of this year, I've had three appeals stacked up for Medicaid and Medicaid Waiver denials thrown in Noah's direction.  I've fought a long while from start to finish.  From the time of initial funding request to conclusion of events often takes close to a year to obtain final resolution of a matter.   This isn't simple, even for me who has a strong legal background.  It is time consuming, it sucks all the energy out of you, and you know most generally your efforts will be futile anyway but you carry on because your motherly instinct says giving up because your child depends on you - isn't an option.   Trust me three hearings in less than ninety days time is just crazy.

The first appellate hearing centered around a request for technology called VocalID.  It would allow Noah not to have a pre-recorded digital synthesized robotic voice for his AAC device.  All devices like Noah's come with the standard little boy voice "Josh"  and all children using AAC devices that have "Josh" sound the same.  VocalID would have customized his own individual voice using his personal vocalizations combined with his brother's donated voice to give him the voice of what he would sound like if he were a verbally speaking child.  Noah had doctor's recommendations and therapist recommendations for the technology all very strongly written that outlined his safety and need for having this feature on his device.  His Medicaid Waiver approved it, but because Noah has gone over $10,000 funding in a five year period, requests in certain categories (like assistive technology) must be reviewed and escalated to a State level.  As such the State disagreed with the Waiver's approval and a three person panel (made just for Noah's requests) ultimately entered a denial.  The software retails for $1,499.   I battled it out - the State asked for extensions of court hearings, claimed they couldn't get their evidence packet in on time - stretched it out for nearly a year.   I was hopeful an Administrative Law Judge would be able to see through these games that the State keeps playing with me.  Convinced myself I'd prevail because I always do - because there is no other option not to.  I cannot fail my son.

However, the Judge in this case decided that he wasn't going to essentially play "middle man" or second guess if the State department's denial was in error.  The Court's position was that it is the State's power of judgment and discretion whether or not to grant an exception to approving something if a child has exceeded a $10,000 cap during a five year funding period.   "The ALJ concludes that the "shall" language concerning the $10,000 limit is controlling for this review.  Because the Appellant (Noah) has exceeded this limit, the VocaliD is not approved.  Whether the limit "may" be exceeded is an independent decision of the Operating Agency that the ALJ will not second-guess under the circumstances of this case."   The decision to deny the request for the VocaliD is therefore upheld.

So, we now have a Court that says they won't intervene in deciding if a denial was entered in error regardless of meeting the burden of proof to specify otherwise.  If any Judge takes the position that they'll defer to the State's judgment rather than their own - then it makes the process that isn't on a fair playing field for children and families.  The Court is now stating it will stand behind Medicaid's decisions, regardless.

I had another appellate hearing January 30th.  I worked in the legal system for over a decade of my life before Noah's birth.  I'm great at deciphering the tone of hearings, and knowing immediately if there is a favored side or position in a case.  The same was true even with Noah's medical malpractice case.  It was evident that the Judge in that matter favored the Defense, even so much as not finding it a conflict of interest to allow a prospective juror to remain on the jury panel in Noah's case, even though his wife delivered the doctor's baby in which we were suing.   There are lots of reasons that Judges play favoritism, sometimes Judges would even personally discuss that favoritism with me behind closed doors - perhaps they went to law school with someone and maintained a friendship, perhaps their children played together, or sometimes it wasn't really all that subjective like they didn't like what a defendant was wearing or how someone presented themselves. 

The last appellate hearing, the State called in their top expert witness to go against me - the senior director EQ Health - which is a third party agency that Medicaid contracts with to make determinations on eligibility and requests.  She certainly had moments when the Judge should have checked her back in line and he didn't, yet he was quick to correct me on small courtroom formalities. It's also curious that the same Judge has been assigned to the last four of Noah's cases.  Something that usually doesn't happen docket wise unless someone intentionally assigns it that way.  Conspiracy theory?  Maybe - maybe not.  In any case the odds have turned and they are not in my favor, I know it, I recognize it and I feel it.

I don't expect favorable outcomes from the next two hearings either.

Which brings me to reaching the end of my fight song.  I've been a special needs parent advocate for others in the community for years, have pursued legislation, attended board meetings, even gone on local television all in the hopes of shedding light on some very bad things that are happening.  It's come at a great price to Noah.  When you step out of the box there are consequences and these come in the form of retaliation and retribution.  It is real.  I promise you that it is.  I am living proof of it.  The State has labeled me as a "problem parent" and as such has done their best to send me a message.

I was scheduled to offer testimony as to why the Medicaid Waiver rates were unsatisfactory for families March 17th.  I've devoted so much of my precious time and energy into things in which I thought I could change.  But I need you to hear me when I tell you this:  You cannot change it - not by yourself and usually not with the help of others.  It is a powerful system and one that will never care to listen.  Your testimony - your advocacy at these matters aren't to take your words into consideration or your story to heart - it's simply to identify you.  To have you out yourself as a potential "problem parent."  They want to know who to keep an eye on.  And I would strongly encourage you to think twice, three times, four times - one-hundred times before putting yourself out there all for nothing.  Don't be baited.  Don't be like me.  Don't let it make things even harder on you and your child with special needs.

So, I've decided after I see my way clear of the last scheduled appeals hearing March 21st, I will not be filing anymore.  I've also decided that I will simply be using minimal benefits for Noah under his CES Waiver, and will not put in additional requests for medical items and equipment that he needs.  In the end it simply results in a denial and I'm going to save myself the headache.  This means the State will get to chow down on likely close to nearly $20,000 (if not more) of unused funds yearly of Noah's Medicaid Waiver Cap.  Funding they don't even have to legally account for what they do with if it doesn't go to him.   His EPSDT Medicaid a completely different ball-game but yet not exempt from denials either.   The hearing January 30th was an EPSDT Medicaid denial for a Mygo Leckey Tour base, the State thinks I should ask for a hoyer lift instead and because I am Noah's licensed Certified Nursing Assistant that my job is to lift him - even if that means lifting him through Target or the grocery store without a wheelchair - as court testimony provided it's optional if I chose to take Noah out in public all Medicaid cares about is meeting his needs at home.  Not to mention that Noah's DME, NuMotion, did a tremendously dirty deed and corresponded with the State behind my back and provided a copies and pictures of everything they thought they had provided to Noah since birth to demonstrate to the Court that they feel all of Noah's needs are being met and he needs nothing additional at his age (as equipment he had received at age 2 should still fit).  Beginning to realize who's team everyone is on.  Something I only found out about because there was an oops in court exhibits and a personal email was accidentally disclosed to me.

There just comes a point in time you have to realize that you're spinning your wheels and going no where.  I'm not being successful in helping Noah despite my hardest and strongest efforts - the end result is generally the same - whether I win before the ALJ and the State reverses the Judge, or whether the Judge says he's going to defer to the State for their judgment if they felt the denial was appropriate.  Either way I'm losing.  It's just how is that loss defined on paper. 

And it's evident the denials are not going to stop.  I appealed a $100 Wedge Pillow they denied.  A $100 Wedge pillow when Noah is allotted close to $40,000 yearly out of a Medicaid Waiver Cap.  Ironically because they think I should pick out a medical grade one that will cost them close to a $1,000 instead that also does not have the features Noah needs.  I present them with the least costly option and they still snub their noses at me.  I ask them for a product called Carpet Saver to prevent Noah's drool, vomit and incontinent accidents from soaking through to the Carpet and they deny it citing it's carpet - even though it's not carpet.  It's a foam fabric layer you put over any flooring surface to prevent moisture from soaking through - that retails for about $500 for what Noah needs.  Not a break the bank request.

I'm going to find peace with all this, and find more constructive ways to help Noah.  God I don't even know what that is going to look like - but, I know where the help isn't, and barking up that tree is futile.  So, I'm throwing in the towel.  I'm done.  The Fight Song has quit playing.  May the State and Noah's CCB Medicaid Waiver throw a party and celebrate.

Love,



Noah's Miracle by Stacy Warden is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.

Friday, February 3, 2017

What Would Maya Do?

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Special needs parent and advocacy is built in many layers over the course of several years.  When Noah was first born I was just clueless.  Utterly clueless on how to navigate anything special needs related.  I was just trying to survive the moment, and perhaps I continued to do just that in Noah's early years. In the beginning you're desperately trying to balance hope, faith and acceptance.  Learning the abbreviations for all the things that will become a daily routine for you is really secondary to what happens to a parent.  Now terms, like CP, OT, PT, SLP, DO, MD, DME, and ATP feel like a familiar language and if you know all of them then you're likely on the same team I am.  But it took me a long while to get my footing, to learn the in's and out's of SSI, Medicaid, Waivers, assistance programs, grants, foundations all of it.  You don't just melt into it. The process is time consuming and overwhelming at times.  Years later it still is, because you are continually learning something new all the time - and the rules will inevitably change on you when you least expect it.

It is always a humbling and honoring experience when another special needs parent looks to me for advice and support and finds importance, value and even comfort in my words with my shared experiences with Noah.  I wished in the beginning that I would have had someone's footsteps to follow in - and I didn't.  Social media was in it's early stages of existence, and bloggers like me were once upon a time rare.  I've never had someone to really turn to on this journey to say gosh what the hell would you do if you were in my shoes because I'm just at my wits end with what to do.   It's a bit like walking in the dark all by myself and then telling others guess what?  I found a way out.

I don't always have all the answers, I wish I did.  I can be walking in the dark a long time before I find my way. And lately it feels like I've been in the dark a lot.  And I have a lot of lose-end fires that seem to be burning for Noah.

I'm stressed, overwhelmed, tired, a tad directionless with what to do next, I'm disappointed in others, I know I'm alone and I'm saddened, and yet I remain hopeful and full of faith that the doors I need to open - hope that the doors of help aren't padlocked with no key.

And then I sat here thinking with all that I'm currently facing in order to help Noah, and that I'm dealing with to give him the best qualify of life I can, the challenges that come along with that - and the circumstances beyond my control that go along with special needs parenting and the continual road blocks I'm up against - what would Maya from Speechless do? 

Although Maya is a simply a sitcom character - the story line is centered around the creator Scott Silveri's life growing up with a brother who had special needs.  It's quite evident that the story line is real.  I feel it weekly almost as if our lives are being shadowed or copied.  Or marriage dynamic, our sibling dynamic, the struggles - our humor to lighten up all the hard parts, and yet our seriousness about the situation still shines through.  To outsiders it's just a one-half hour comedy - for those living with a family dynamic centered around a child with special needs - it's so much more.
It's a validation on screen that we're not crazy.  That the system hasn't driven us mad while we're trying desperately to get approvals for wheelchairs and adaptive equipment, that the struggle is real with quirky and crazy therapists, that everyday hold a new challenge for us - and they certainly won't run out of material any time soon - Speechless will have a multitude of story lines to touch upon with the journey we have with our children.  It gives us a sense of relief because we can say yes, without a doubt Speechless continues to hit it out of the ball park every week.  Even re-runs are extra special because they serve as reminders that yep you're having one of these days again - but some our days and challenges repeat themselves no matter how much they wish they didn't.

I'm not even going to try to glam it up - the reality of the last month has really knocked me to the ground.  It really would the strongest of any special needs parent.  The habitual fight to help your child, the appeals hearings, the therapists who just don't get it, the realization of those who you thought perhaps cared about your child more than they did show true colors, the constant begging - and do mean I have begged for help from others to do their jobs and help me meet Noah's needs, the endless research for avenues to pursue for help, foundations, what to do if I can't get approvals for things Noah needs.  The whole leaving no stone unturned idea is exhausting.  And yet I look at him so precious, so perfectly precious and know that I cannot quit.  Even though my soul is so tired, even though I am fighting with all that I have -

So what would Maya do?  Would she curl up in a little ball and admit defeat?  Nope.
Would she pretend that no one failed her child and turn the other cheek?  Nope.

Maya would get up, she'd brush her teeth in a bathroom with no door because when you have a child with special needs you can't fix anything when you house is falling apart.  She'd take care of everyone else before herself, and then she'd kick butt the entire day and take names.  Settling is not on the table.  Raising the white flag - not an option.  Finding and demanding better because she knows her child is worth it and so do I - absolutely.

Noah is worthy.  He's so worthy of and deserving of an amazing professional team.  And if people can't deliver that then they don't deserve me to grieve their absence in his life.  He's worthy of Medicaid recognizing he is deserving to have his basic needs met both in and out of the home.  He is deserving of sensitive, understanding and competent caseworkers that understand the drive and need behind his requests.  He is an incredible little boy.  He really is.  And I'm not just saying that because he's mine.  To know him is to experience the purest love imaginable.

So in true Maya style, she'd say oh bloody hell with all of it.  And keep moving forward.  I will too.

Love,




Noah's Miracle by Stacy Warden is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.

Friday, January 20, 2017

Strength of The Banyan Tree

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In 1999, I had decided to gift myself with a college graduation gift.  Something that I worked all through college to save up for while working full time and attending college as a full-time student.  I had never been away from home, never been on an airplane, never ever broke away from my own personal comfort zone of what was familiar, easy and safe.  I booked a flight to Maui - for reasons to this day I can't even tell you.  Maui wasn't a life-long dream.  I wasn't running from or trying to escape anything.  It was almost as if I blindly pointed out a destination on a map and chose it.  An eight-hour flight later, with palms so sweaty that I thought I was going to literally fall out of the sky to an early death, I landed and was greeted by a lei of welcoming flowers, bright sunshine and a soft breeze. 

There were things I pushed and dared myself to do - like drive the road to Hana.  Which is an insane road, even for an experienced mountain driver like myself, but it took me to some of the most breath-taking destinations.  Black sand beaches, water that swelled red with shrimp, beautiful and peaceful cemeteries that I walked through, high cliffs and the ocean that I had never ever seen before.  The bluest of the blue that just went on for what looked like eternity.  I learned to love the stripped down version of myself there.  I went without make up, my naturally curly hair completely untamed, wild and free from products and hair accessories, my dress attire simple Hawaiian sundresses.  I had my first Mai Tai drink and went to a traditional Hawaiian Luau.  I did all the tourist kinds of things like a dinner boat ride, submarine exploration, and found myself emerged in a freak wave from the ocean while attempting to build a sandcastle in the sand like a small child.  I lost a flip flop, and the beach chair from the hotel that all went out to sea, and learned sometimes when your back is turned that you can get hit by the biggest wave when you least expect it.  

Yet, with all the things I did, it was that banyan tree in Lahania, Maui that perhaps gave me the biggest lesson of all.  It's this incredibly massive tree with branches that are just endless.  The tree's canopy spans a quarter-mile, but it's base perhaps the most intriguing.  Buddhists refer to it as the "tree of enlightenment.'  The banyan tree is majestic and strong and represents personal growth and wisdom.  Through life's experiences your roots get driven down deeper, and you become even stronger - stronger than you ever thought you could be when you were simply starting out as that small tiny seed. When I touched it, it was like the tree was schooling me.  I sat there in awe of it's enormity.  Yet, in hindsight I hadn't a clue what it was trying to tell me at the time - I just was allowing it to record it's message into my soul, so that I'd be able to replay what I needed at a later time.   
I couldn't have imagined or predicted at that time where my life would lead me.  I certainly wasn't given any warning or preview into the future, but the tree did tell me I'd have to be strong.  Oh, so strong.  That much I understood about that experience.  Perhaps for the average college graduate it would have been just a vacation, but for me it was building upon the foundation and strong roots that already existed within.  I came back both different and the appearingly the same.  But I've never left everything I felt or those lessons behind.  

                                                              *********

There are countless times once you become a special needs parents that you have to exercise being unpopular.  Times when you have to have the bravery, courage and strength to be your child's advocate and champion in all things.  You cannot take the path of least resistance - even when you may want to.  Finding your footing the equivalent to realizing how deep your roots are planted and just how strong your branches are.   You can't look back on anything with regret, because the focus is always and forever the best interests of your child.  
 
It is often very difficult to find quality therapists - especially the older your child grows.  It's almost as if therapists prefer to wash their hands of children once they get to a certain age in childhood and express to parents that their child has no more potential to progress.  In reality the their jobs indeed do get harder, just as our jobs as parents get harder as they grow.  There is more lifting required, sometimes limbs stiffen more, children's over all tolerance may vary, and it's not as easy as it is to work with a three or four year old little cutie.  What I call therapist abandonment happens frequently and for a variety of reasons.  


I had such an abandonment today in fact.  In the course of four years Noah has gone through six speech therapists.  It's a type of therapy that simply doesn't have therapists that have a longevity of their profession.  Many leave and move onto jobs in public schools, or resume furthering their education, leave to become instructors, some have complete career changes - turn over for speech therapists is uniquely high - higher than both physical therapists and occupational therapists combined.   Finding a therapist - a good therapist that is skilled and proficient in AAC communication is very hard.  Most therapists may briefly touch on those things, but unless your child has a mild speech impediment, or needs to learn sign language your options for AAC therapists are super small.   Three years ago, Noah's then speech center no longer had an in-home therapist willing to drive to our area and we were transferred to a "sister company."  

It was evident that the our first therapist with the new agency was new both to her job and profession and lacked that employment spark and interest and made it known that the job was a stepping stone and resume builder for her attempts to further her education.  Half-way into our year with her she told me that Noah wasn't making significant progress and that it wasn't worth the investment of her time and asked me to invite the owner of the company to come along to one of Noah's sessions so she could show that Noah was making no progress.  I should have kicked her to the curb then for having little faith in my child and should have had the backbone then to speak up and tell her that it was indeed her shortcomings of knowing how to work with children an AAC devices, yet I consented to the meeting which years later turns out wasn't even the owner of the agency - in fact to this day I have no idea who her companion was that she was demonstrating that Noah had no capabilities in AAC communication to, even though he had and was using a device for some time. She eventually decided to pursue a master's degree in Georgia and I was relieved that I didn't really have to address her lack of confidence in Noah and his capabilities.  


You always hope you will get an upgrade when any therapist moves on to something else.  But my hopes were quickly dashed when her replacement worked at a local college as a speech pathologist instructor and made it known that she had little time for Noah.  In fact, I was lucky to see her once monthly, even though I know she continued to bill Medicaid for weekly visits and was thereby committing fraud.  She hated Luke, and demanded that I have him leave the home while Noah did therapy - something that was impossible.  Luke never caused any trouble but she did not appreciate his presence nor his interest as a sibling.  I got in the habit of asking my mother to come over to play with Luke in his bedroom to pacify her dislike for Noah's little brother and her unwillingness to allow him to simply watch his brother's therapy session.  I spent eight months asking her to do an evaluation and trial for a new speech device for Noah only to be met with continual excuses and resistance for ignoring my continual requests.  The final straw was when she called to tell me she had acquired PTSD because her neighbor's house had been broken into and she couldn't see Noah for two more weeks until she recovered from the stress.  I expressed my concerns to the company and at that time was met with understanding.  

A temporary therapist came into the home to conduct the evaluation for Noah, complete paperwork and submit referrals.  He was a rather impressive therapist and rare.  His eye to detail and willingness and techniques to draw out the very best in Noah was indeed inspiring.  Yet, sadly a therapist that didn't do home visits and we didn't have the ability to make the drive to him weekly.  He was patient, kind and understanding and even willing to come to the home multiple times to get the evaluation completed even when Noah fell critically ill last April and was out of commission with all therapies for three weeks.   He worked timely, his correspondence and communication with me was excellent and it was what any parent could have hoped for.   

We were put on a wait list of sorts for Noah's newly assigned therapist to complete school and move to Colorado.  I was cautiously optimistic.  I know that freshly graduated speech therapists can be either a blessing or a curse.  Sometimes they're so motivated to learn they succeed and even do dances around their well-seasoned co-workers, and sometimes they fall flat on going the distance and really learning their craft well.   I started to experience frustrations with the lack of ability to program and learn Noah's new device.  Which was causing me to download all of Noah's needs, learn the system on my own, and expect very little troubleshooting help or assistance from Noah's speech therapist.  Of course there were other little difficulties too, like the therapist repeatedly holding Noah's eye lids open when he felt that Noah was being lazy or tired or tickling him.  Something that you absolutely do not want to do to a child like Noah who has a severe sensory processing disorder. 

The agency's response of Noah's therapists lack of programming skills and knowledge continued to be reaching out to the manufacturer of the device instead for tips.  Noah's had his new device since July of 2016, yet still doesn't have any functioning mount for his wheelchair.  The agency attempted to make him one out of spare parts that turned out to be neither safe or secure for Noah or his device.  It could easily tip over and hit the ground if you so much breathed on it.  I asked the agency to help me troubleshoot with finding a workable mount - knowing that I would have to fully fund it out of pocket because of Medicaid's low reimbursement rate - but there were no suggestions or options presented.  So I'd spend nights after Noah went to bed into the early hours of the morning researching mounting options on the Internet looking at pictures and specifications to find viable options because I couldn't light Noah's speech therapist or agency to assist me.  I asked for a trial of a couple products that I felt might be a good mounting match, only for the agency to deflect responsibility onto Noah's DME who has no experience or contract with mounting agencies.  After two weeks time I hadn't heard back from anyone, so I coordinated trials on my own within 2 hours time.   

There is nothing worse than feeling like you're doing a therapists job and not getting paid for it.  I'll have to pay shipping costs both ways on both devices, submit a credit card to secure a deposit of sorts - and fill out applications on my own.  And I am sure the therapy center simply didn't want to incur the costs of trials for a client thereby trying to push responsibilities back onto Noah's DME instead. 

Yesterday, I outlined all these difficulties with the hopes that the agency would step up and say yeah we've kind of failed a bit and dropped the ball and we're willing to see what we can do better or how to make this better for you and Noah.  Yet, today the response email was we're dumping you as a client, here is a list of companies you can check out instead, and by the way we want our parts back that we lent you for Noah's "Frankenstein" mount.  I'm disappointed of course that was the response and the feelings of the agency, and I know that there are lots of other parents experiencing similar difficulties with the same agency because we all talk to each other - so these difficulties are not isolated to just Noah.  I would have hoped that they took my concerns seriously and didn't take a dismissive tone or attitude towards it all.  

Parents like me tend to stay in bad situations because we feel like we don't have a lot of options.  There are not many speech therapists experienced in AAC devices - and as such we're often willing to assume a bad therapist over no therapist.  But we're doing such disservice to our children when we do that - and to ourselves.  I deserve to have the kind of genuine help that I need, my child needs support and deserves to not be without a speech mount for now going on seven months because I can't light anyone's fire to care enough to get it right.  I don't deserve to have to ask for the company to come out and train me because the speech therapists are unwilling to learn the device well enough to know what they're doing. 

So, Noah is Speechless - (yes, find the humor in it) because we all need a little laugh to get through the hard parts.  But I'm going to pick up the pieces and find something better. I know I will - because I have faith that someone will go the distance for Noah.  Someone will be his champion, someone will care enough to be beyond awesome.  And so I wait for that next door to open.  But while I do, I take solace in the strong roots that continue to drive down even deeper.    

"From little seeds grow mighty trees."

Love,


Noah's Miracle by Stacy Warden is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.

Friday, January 6, 2017

Don't Be Mercurial

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It's a new year, where some people turn over a new leaf... and well others don't. 

It appears that it's going to continue to be the same song and dance from Noah's Medicaid and Children's Extensive Support Waiver (CES).  I do try to give them the benefit of the doubt - no correction - I have given them amble time to redeem themselves.  Yet the hole they dig and the divide they place on any type of functional parent/caseworker relationship just burns to the ground time and time again.   Eight years in to this - I'm just done being nice about it.  I'm no longer entertaining any more artificial interest in how my son is doing, fake chit chat to make me feel and think they're on my son's team, no more believing not one ounce of the fluff I'm fed to stall me in the pursuit of helping my child.  I don't do games and that is what this has become.

Right before Christmas I filed yet another appeal before the Administrative Law Courts.  That makes three hearings for me in the next forty-five days, and I have another 60 days to file the fourth.  And this is just the beginning of the year and all of these requests were from 2016.  Can you imagine the trail of denials and appeals hearings that I'm facing this year alone?

I filed the most recent appeal just prior to Christmas.  Really the documentation and exhibits so blaring obvious that Noah's Community Centered Board, either has no real understanding of the State's policies, rules and regulations, or they are simply being spiteful.  My guess is likely both, but perhaps more the latter.
December 27th, Noah's caseworker called to say after receiving my Motion that was submitted to the Court of Appeals that they had a change of heart and realized they entered the denial in error.  She asked a handful of questions; how did I fund these requests in the past for Noah on our own and why were these items requested over other potential options.

I answered in honesty because that's the only way I know how to be.  God made me a lot of things but a liar was never one of them.  I explained that all these years we've fundraised for help.  Noah's maternal grandmother has done all that she's been able to in order to help when she was employed, even giving her severance pay to help Noah at they very last of her available resources, we've looked for foundations and grants to assist. It's not like parents like us have any other choice other than to ask for help from foundations, grants, and fundrasisers.  The costs of raising a child like Noah out of pocket can be more than a mortgage payment each month - especially when the State is in cost savings mode and doing their very best to withhold funding from your child.

She said that was all that she needed and that one of the missing supervisors from the review team would be in the following day to sign off on the approval and reverse the previous denial.  She also was confident that Noah's approval for these requests would come out of the 2016 CES Cap.  I was rather relieved because let's face it appeals hearings take up a lot of my time, and the Court's time when it's really unnecessary to do so for something that should be easily approved.

Less than twenty-four ours later on December 28th, that same caseworker calls to say, that they had changed their minds again and were not going to reverse their denials on either item.  Kind of like the joke is on you...

Stunned I'm like dealing with a Bi-Polar agency - that just can't get it's shit together.  They have the rational that a floor protector that prevents urine, vomit, acid reflux and Noah's drool from soaking through to the carpet or pooling on tile or laminate flooring is considered "carpet" and thereby an uncovered benefit.   They clearly don't understand the definition of carpet.   Even after providing a detailed letter from the manufacturer on exactly how different his product is from carpet that is permanently fixated to the floor, that you can neither put in the washer or dryer and that doesn't repel things like vomit, drool, urine, acid-reflux.  

A $100 Wedge pillow was also requested.  Let's just focus on that price tag for a moment.  One-hundred dollars.  A lot - but not a lot when it comes to special needs price tags.  Most adaptive equipment for Noah starts in the thousands of dollar range and I'm not exaggerating.  Any special needs parent will confirm that awful prices that are attached to things our children need.  

My mother and I found it by chance at Bed Bath & Beyond.  We felt it in the store, seen the height of it, and said I think this would just work for Noah beautifully.  We came home consulted with Noah's therapist who also agreed it was perfect for his needs.  Because Noah has a lot of sensory issues good adaptive equipment matches can be a challenge. It was a win finding a typical item that would work for Noah.  Since typical items neither have a DME distributor or a Medicaid Code they have to be sought out through Noah's Medicaid CES Waiver.  The Waiver covers items that Medicaid doesn't (or so is the theory behind the Waiver).  His CCB/Waiver denied it on the basis that it has a Medicaid code.  Even though I provided a letter from his DME representative that states otherwise and confirms what I am telling them to be true.  They insist they want to provide a medical grade wedge pillow, that will be hundreds of dollars more, have me seek that through traditional Medicaid, and then the Waiver will hire someone - a personal seamstress to make a custom cover for it that might be agreeable for Noah's sensory challenges.  Because that all sounds so much more inexpensive and uncomplicated than just purchasing a simple one-hundred dollar wedge pillow off of Amazon right? 

So, after telling me they hadn't changed their minds at afterall, they said they needed more time to investigate their options based upon me telling them that I had received past fundraising and foundation help for items such as these in the past and then maybe they'd reconsider once again.  Perhaps they were trying to find a foundation that would assist Noah so the State wasn't obligated to.  They after all do their very best to retain as much funding as they can rather than allow it to assist the very children it's designed to.  They also wanted to do research and call around and see how other CCB's handled requests of a similar nature.  

Today I received another email that they are certain now that they won't change their minds and that the denial is firm.  I suppose this is their declaration that their wishy-washy behavior has come to an end.  So now we face an appeal on these two items, with a warning that should I win, they'll simply continue to file Exception to Initial Decisions which makes the Appellate process moot.  

Yes - can you believe it that the very agency that has the power to deny something also has the power to reverse anything a Judge says?  True.  It doesn't go back before a Supreme Court Judge or stay in the Judicial System in some way.  It goes back to the State Department of Health Care Policy and Financing and they can say so what the Judge reversed the denial - we want it to remain a denial - and when that happens my friends - it's pretty much game over. 

With the exception that a family can file the matter into District Court and re-challenge the State.  Something I think they aren't prepared for me to do - but I'm so tired of being jacked around that it's likely time to do just that. Until they are penalized for their naughty behavior and called out for their incredibly unfair practices and tactics then this type of thing is going to go on and on until the end of time. 

Who knows why they can't pick a side of the fence and stay on it.  It could be that I talk a lot about my grievances quite openly and in this circle of advocacy you never really know who's team anyone is on.  You may think you've got someone in your corner and confide in them only to realize that they're playing devil's advocate instead.  It's also likely a combination of continued retribution and retaliation for me calling them put publicly on local television and trying to draw everyone's attention to the blatant mishandling of State funding that is supposed to be set aside for children like Noah.  The world will only turn the other cheek for so long.  And as more parents bravely and courageously step up and speak up about what is happening the more it points the finger right at them for literally stealing from these children.

And let's not forget Conflict-Free Management.  If you haven't heard of it:

"Pursuant to authority provided by 1915(c) of the Social Security Act, the Department has established contractual agreements about services and supports provided to eligible individuals with Intellectual and/or Developmental Disabilities. Commonly called Medicaid Waivers, the federal government, through the federal Centers for Medicare and Medicaid Services (CMS), provides approximately 50% of the total funding for these Medicaid Waiver services. The federal Centers for Medicare & Medicaid Services passed a final rule (42 CFR § 441.301(c)(1)(vi)) in March 2014 requiring separation of case management and direct services.  Colorado must comply with this rule to continue receiving these funds."  It's 2017 and they are still not compliant with Federal Law.

Self-policing is a conflict of interest, as well as well as holding true to the definition: “real or seeming incompatibility between one's private interests and one's public or fiduciary duties."

The State hides behind their lack of compliance saying it would be too disruptive to comply. They instead think that they can stay out of compliance by offering what they refer to as "extensive conflict of interest mitigation controls," like giving families "person centered" control over providers.  But let's be clear that the providers they offer to us are still contracted, limited and very much under CCB control.

So where does all this leave Noah?  Kind of stranded.  He has a list of things he needs and I mean the list is growing longer.  I don't really know where to go from here.  The first line of financial defense should be his Medicaid and Waiver funding.  But they are putting families like ours in a position of tremendous financial debt for out of pocket medical, therapy and equipment costs that they continue to deny.  And then when they're questioned about where all the unused money goes they say quick look over there it's a bird flying... look at the bird it's so much more interesting than anything that we're doing under the table.

I continue to file appeals, because that is the only way to document the absurdity of what is happening and can only hope that eventually someone in a position of power takes notice.

Love,

 


Noah's Miracle by Stacy Warden is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.

Saturday, December 31, 2016

One Word For The New Year

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There is something that about a new year that is a sense of starting fresh and a hope for something better to come.  A closure of past problems and complications with renewed faith that tomorrow promises greatness. I stumbled on this book called My One Word by Michael Ashcraft and Rachel Olsen.
Most of us make these lists - perhaps not on paper, or even out loud - but internally in our minds of things we wish to accomplish, change or even things we wish for in the new year.  Personal goals, silent prayers, hopes, dreams and wishes all wrapped up into what we label as New Year's Resolutions.  What we really fail at remembering is that there is so much about our lives that can be out of our control.  While we have power to some extent over our destinies there are things in life that we cannot stop or change, but how we rise to the challenges set before us,  is indeed up to each of us.  How will we process our grief, celebrate our joys, feel the sadness but not so deeply that it paralyzes us, how we make it our missions to leave this world with goodness and light and the legacy that we were once here even so ever briefly.

Disappointment comes all too frequently when we have these expectations and goals in mind without a concrete understanding that we can't just wave a magic wand and fix everything that we wish to.  We've got to work with what we've been given and go from there.  The concept of One Word is really simple.  You pick a word - any word that you hope God will work into your life all year long.

By picking just one word you never have to worry about falling off the New Year's Resolution wagon.  You don't have set yourself up for that inevitable feeling of failure or disappointment.  You get to focus on just one word the entire year.  When you're happy the word is there, when you are sad the word is still there, when you ask God for help that word is still there.  It's there always.  It's one word that won't let you down.  It's one word that you can use for comfort and guidance when all else feels lost. 

Eight years into the special needs journey with Noah, with each new year in some small way I've hoped the New Year would bring about new blessings and miracles for him.  This will be the year he sits, or walks, or self-feeds, or talks... or that I can do more to make that happen - that I'll be able to somehow find the rehabilitation he needs to make those goals possible for him.  But I forget that I'm not in the driver's seat of Noah's life.  And as much as I want those things for him, and all the New Years Resolutions that I attach to those thoughts and feeling can be so destructive to the joy, happiness and the acceptance of what is in front of us.  We're chasing a rabbit we may never reach, and fail to soak in what we have in this moment. 

I don't want to look back with regret and say I spent years chasing a rabbit that I could never catch.  You have to trust and be still and be confident that holding that carrot is good enough.  If the rabbit comes to you it will on it's own.  Don't chase it - just offer the carrot.

Thinking about what my One Word would be was hard.  I already feel like God has given me Hope.  He's given me Faith in the impossible.  He's given me this profound love that I never would have known existed without Noah. H'e given me a miracle.  He's given me humility, peace, joy and strength.  So I sat and reflected on what do I really need this year.   And the word "Relief" came to mind.

I need so much relief from these brick walls I keep hitting in my attempts to help and care for Noah in all the best ways that I know how.  I need relief from all the Medicaid and Waiver denials.  I need relief from the endless appeals hearings.  I need relief from the heavy weight of feeling like I'm failing Noah when it's the system that is.  I need relief from the financial strain of all of Noah's out of pocket medical, therapy and equipment costs. I need relief from idiotic caseworkers and inept government agencies.  I need Relief.  Perhaps more than I've ever needed it.  I've fought for long eight years for this precious human being to make sure all of his needs are met.  I fight harder than most parents are able to fight.  But it doesn't come without consequence.  I know that it is taking it's toll on my health and well-being.  I know that it depleting and draining my own personal battery.  I feel it happening to my body and my soul. I could use a little relief.    So that's my word going into the New Year.  And each time things get hard, I'm going to focus on that word.  The power of intention is real.  You can will so many things in your life to happen if you focus all of positive energy into a certain direction. 

Let's try this one word together.  Let's make this New Year's Resolution simple.  What will your word be?

Here are some options that might be a good fit for your life:

Reassurance
Consolation
Comfort
Recovery
Solace
Light
Hope
Faith
Rest
Strength
Courage
Devotion
Compassion
Kindness
Forgiveness

Find that word that speaks to you all year long.

May your New Year's be filled with warmth, camaraderie and kindness that touches the heart of all those you come in contact with.

Love,



Noah's Miracle by Stacy Warden is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.

All I Wanted For Christmas

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If you asked Noah, this year it would ring true that all he wanted was his two front teeth.   Seven was the year of six teeth that all were lost in a very short amount of time.  Our score was 5 of 6.  There was one tooth despite our best efforts that was never recovered.  Three of Noah's adult teeth came in very fast - like almost overnight he had new teeth.  The other three oddly have been missing for months.  In true special needs mom style, the Internet became my source of reassurance.  I quickly Googled how long it takes adult teeth to come in, as I perhaps was growing more impatient than Noah.

I was relieved to read that it can often take up to six months for adult teeth to sprout.  Although I should already know better that everything including Noah's teeth happen in "Noah Time."  Christmas morning Noah's three missing little teeth peaked through his gums all at the same time.  Kind of fitting for my Christmas time child.
This was probably the leanest gift giving Christmas that we've given the boys, but neither seemed to notice the quantity of presents to open.  I'm really blessed that the boys don't measure their worth up against other children who are fortunate to be gifted with high end toys, and dozens of gifts from Santa - I suppose that is one of the benefits to homeschooling there is no comparison or competition of other children in relation to themselves.  I didn't even have to worry about either boy even knowing what a Hatchimal was and worried if their peers got one and they didn't.  They are so easy to please, and I love that they light up with small treasures.  I'm really lucky that life hasn't told them that they aren't enough or that you're lesser because there are only a few gifts.  I think we pulled off what the heart of Christmas is about with what was within our means to provide.
Noah and Luke had a Christmas sprinkled with lots of magic.  Santa's visit certainly was a highlight.  Each year Noah get more proficient with unwrapping gifts.  It's all of his coloring book shredding that has really helped.  Although it seems like a messy activity for me to pick up endless little pieces of paper off the floor, it's really a fantastic therapy exercise for Noah and is making him work really hard at using his hands.   Therapy comes in all forms - including a child's way of play.
Noah seems most excited about his season four and five of Night Court DVD's and his adapted switch Monkey from Santa's Little Hackers.  Luke's was his five dollar sled I found on clearance and a giant orca whale that he made as his sled team.  He also like to lay on his new quilt from The Butterfly Fund.  It's amazing how much both of the boys love their homemade quilts.  I kind of figured their novelty would wear off quickly but Luke carries his around and snuggles with his and Noah's is always close by.  Just goes to show you the best gifts are the ones that come with the most love.
Christmas as always just files by in blink of an eye and becomes a memory that you file in your heart and mind.

"Blessed is the season which engages the whole world in a conspiracy of love." -Hamilton Wright Mabie



Love,


Noah's Miracle by Stacy Warden is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.

Monday, December 26, 2016

Noah's 8th Birthday

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My whole world can be summed up in three letters...  Son  

My son… who's eyes give me the will to fight back, even when everything goes off-track. The tenderness in your hugs give me a reason to smile, even when our problems pile. Your love is the fuel that keeps me going, and my heart beating. The happiest 8th birthday my sweet boy. 
Noah had a Buddy the Elf themed Birthday party.  Very suiting given he starts watching Christmas movies in July.  He's never been one for much of a break from Christmas.  It brings him pleasure for a big part of the year. We ordered his Elf decorated cheesecake from the same bakery that has been doing his cheesecakes since his first birthday.  I think both the bakery and us feel this sense of mutual celebration each year.  They always do such a sweet and detailed job.  And a crust-less cheesecake just for Noah.   I also splurged on two large balloons for Noah - an elf and a candy cane.  Noah adores balloons and these two are likely as big as he is.  I suppose that is the only good thing about having unnecessary eighteen foot ceilings in a ranch home.

We planned Noah's favorite dinner Chick-Fil-A.  And when Chick-Fil-A heard it was Noah's birthday they were so kind and dinner was accompanied by a Santa Cow.  Noah really enjoyed having dinner side by side with his stuffed cow.  It made him feel very special.  Noah rather purposefully rushed through dinner - because we told him that Santa was coming afterwards to say Happy Birthday.  I could tell Noah couldn't think of anything else the entire day except that Santa was coming.  He adores Santa.  Santa is everything. 
Noah had another commitment on the day he was originally scheduled to see Santa, but was blessed that North Metro Fire & Rescue rescheduled for him and offered to come on his birthday.  I can't even really put into to words how incredible it is to hear those sirens down the street and seeing Santa is arriving and watching the joy not only in Noah's face, but Luke's as well.  I wish I could box that magic - that beautiful magic into a box and just open that feeling up each and every single day.  A reminder of the pure bliss that exists in tiny precious moments.


Santa and his fire crew elves are so special to us.  Since the moment Noah moved into this home, they've always been there for him and our family.  They've given us four years of treasured holiday memories. Their love so genuine, tender and filled with understanding for Noah's unique situation and fragile medical needs.  Santa brought Noah some birthday gifts and remembered his little brother too, which was the ultimate finale to Noah's birthday celebration.  Noah just lights up when he sees Santa.  It's his most cherished yearly experience. 

Eight years has gone by so fast.  Like a blink.  Each night I look at the framed collection of pictures that we thought would be our last pictures of Noah in the NICU as I snuggle with him in our bed after his evening juice.  Noah looks at them often too as I tell him that's "Baby Noah."  And he laughs and arches out of my arms as if he's itching to physically get up and touch those photos.  Those pictures speak to Noah perhaps more than they do us.  It is as if he remembers that exact moment in time and wishes to show us the excitement over the miracle of his life.  His daily exuberance certainly lessens the pain of what once could have been for his life.  He does us very best to remind us of what is important and where to maintain our focus. 

Noah laughed into the late night hours.  I'm not sure where that child gets his energy from or his ability to sleep only a handful of hours. But secretly even though I'm often very exhausted I adore the sound of his laughter and squeals and even the sound of him kicking his side rails of his bed and me needing to flip him over multiple times because he gets stuck, it is just so mushy and joyful to listen to him even if he goes on and on for hours on end.   And tending to him all night in some way makes me feel needed and loved.  He will always need me, and I will always need him.

May year eight be filled with great things to come.



Love,




Noah's Miracle by Stacy Warden is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.