One of many reasons for fighting this waiver denial-
If our sons’ waiver denial is reversed without the need to appeal, they will be admitting that the screening was not adequately conducted, and they will also be admitting that he was wrongfully denied. I want to get help for my son, and I want to help others who have gone through the same or may go through the same in the future. I’m sure there will be others, as our screening and denial was not a unique case.
We wrote a 3 page letter to DSS and Department of Health BEFORE the denial was written. In the letter we addressed our concerns and the troubling comments and actions that were made during the screening that lead us to believe he would be denied. Our biggest argument? The screeners stated multiple times during the screening that “he will not get this waiver. He was denied before, and he will be denied again!”. By law, the team must be made up of 3 individuals to review ALL documentation; a nurse, a social worker, and a medical doctor. Only TWO were present to possibly review, which they did not, any documentation. (Three do not have to be present, however all must assess all documents and information). This means that by making those statements repeatedly, along with MANY other troubling actions, they predetermined that he was not going to get the waiver without following state law to fully assess all information.
Additionally, the information we provided to them is full evidence that he meets ALL criteria. But it gets worse.
In the denial letter it states that there was “no evidence” to find a change in available care, and no documentation of a physician’s findings were provided, and that that is the reason for denial. The denial letter was a complete LIE, as they WERE provide all of the information. There was a major change in care since we had in-home care (ten hours a week) and the care was/is gone because it was no longer available.
Additionally, our son’s physician AND therapist who is certified by the Va Board of Medicine, both wrote letters naming his THREE diagnosis’ and stating the fact that his level of care is not being met. By Virginia state law, he DOES meet the requirements and was given documentation during the screening as proof! This is also evidence that they did NOT follow the law that states there must be a complete evaluation.
It wasn’t until I pressed them for answers over multiple phone calls, that they began to realize that they really messed up. They have offered to have it looked at again (to cover their butt!). There is no way they can deny him after having a second, third, fourth, etc. look at the case without further breaking the law.
Even if he is found eligible (which he already legally does) I will not stop. Just because they find him to meet criteria does not excuse the fact that they wronged us, our son, and the law. We will take this further until it reaches the top, and still not stop. I am determined that this will not happen to another family!! There is so much to be done for our autism community as well as any and all special needs.