Expanded Medicaid to Restrict Psychiatric Medication?

Update: It is apparent that this is in fact still happening and expanding to more patients and more programs. That they have decided to expand this national dereliction of duty and institutionalized malpractice to Medicaid is born out by the concerns expressed in the New York Times article Plan to Limit Some Drugs in Medicare Is Criticized

Leaders of numerous patient advocacy groups said they were worried that patients could be harmed if the policy changed.

“The proposal undermines a key protection for some of the sickest, most vulnerable Medicare beneficiaries,” said Andrew Sperling, a lobbyist at the National Alliance on Mental Illness.

Under the proposal, Mr. Sperling said, a Medicare drug plan could have a list of preferred drugs with just two medications to treat schizophrenia. That is inadequate, he said, because antipsychotic drugs work in different ways in the body, and have different side effects. “You get much better outcomes when a doctor can work with patients to figure out which medications will work best for them,” he said.

As I had stated originally, I have been receiving disturbing reports regarding New Mexico Centennial Care’s disastrous roll out. I am prompted to share some of these issues due to a dire situation that appears to be a national Medicaid policy that I recently learned of. I have my own experiences with the so called “Medicaid Expansion” to share, but first the alarming situation of restricting psychiatric medications for those who need them.

Mental health has been in the national news a lot lately with all the mass shootings at schools and other public places. New Mexico made the list with the Berrendo Middle School shooting in Roswell. The nightly news is full of domestic violence, homicides, and other violent crimes. Perfect timing for restricting psychiatric medications. Since my original write up, New Mexico has received national attention for the “U.S. Department of Justice finding that the Albuquerque Police Department engages in a pattern or practice of excessive force in violation of the Fourth Amendment of the United States Constitution.” – koat.com

Encounters between Albuquerque police officers and persons with mental illness and in crisis too frequently result in a use of force or a higher level of force than necessary. The DOJ said the problems dealing with mental health is a failure of the entire community and needs to be addressed. – koat.com

What is so concerning in light of all this is that I am hearing direct patient reports that over the past month (January/February), a majority of psychiatric patients have been required to get a pre-authorization  in order to receive their medications. Many patients are going without medication as this process can sometimes take weeks. The entity that is reportedly enacting this practice is Presbyterian Health Plan, Inc. (see the Drugs Requiring Prior Authorization, and the What if my drug is not covered? pdfs, under the Prescription Drug Benefits section at that link. Those are the documents that are being used to restrict psychiatric medications from many New Mexicans in need).

Presbyterian Health Plan, Inc. has set up a system where insurance providers are effectively prescribing alternate medications to patients without seeing the patient or consulting with the patient’s physician. What is happening is that doctors are prescribing medications and if those are not on an approved list, the medicine is not covered and the patient is left to either take a medication that does not work for them and that their doctor has not prescribed, obtain the money for expensive medications on limited income, or go without.

This situation is based on eyewitness reports. Updates will be posted as they arise.

When is it ever a good idea to restrict psychiatric medication from patients in need?

Sources

Agave Health, Inc.
https://www.agavehealth.org/

Expanding Health Coverage for Low Income Adults: The Medicaid Opportunity under the Affordable Care Act (ACA)
http://conalma.org/wp-content/uploads/2013/06/EP-Medicaid-Expansion-and-Centennial-Care-2013.06.pdf

Koat News
http://www.koat.com/news/us-department-of-justice-releases-findings-on-albuquerque-police-department/25413344#ixzz2ymCBcbLn 

New Mexico Centennial Care
http://www.hsd.state.nm.us/Centennial_Care.aspx

Plan to Limit Some Drugs in Medicare Is Criticized
http://www.nytimes.com/2014/02/22/business/plan-to-alter-medicare-drug-coverage-draws-strong-opposition.html?partner=yahoofinance&_r=0

Presbyterian Health Plan, Inc.
https://www.phs.org/insurance-plans/our-plans/employer-offered-plans/Pages/state-of-new-mexico.aspx

Iceland Helps Icelanders Not Banks

I am often wondering about how we here in the US, and the world over, can recover and thrive in the wake of the recent financial crash. I have been following the story of Iceland from the beginning and it seems to consistently be one of resilient recovery. Would this work on a global scale?

When Iceland’s banks went under, and the economy with it, many homeowners were put under water over night. Instead of foreclosure deserts like Americans saw, the government stepped in to prevent Icelanders from losing their homes.

The banks’ first task was restructuring the loans of companies and households that could no longer pay them. The government passed a law mandating that loans had to be reduced to no more than 110 percent of the underlying property — helping homeowners who had ended up underwater. source

This kept people afloat while they restructured their mortgage and found new jobs in the recovering economy. Without the government intervention, many Icelanders would have been reduced to poverty and potential homelessness.

More here

Pueblo Food Experience

The video really speaks for itself, but here is a writeup that can be found on the videos page providing a little bit of important background:

“The process of assimilation of Native Americans by the outside world, which started centuries ago, continues to this day. One aspect of this continued assimilation is the change in traditional diets. As a result, our health has suffered greatly. Diabetes, cancer, kidney and liver failure, hormonal imbalances, inflammation, allergies, obesity, alcohol and drug addictions are but a few of the symptoms of living in this modern time. One can blame some of this on the environment and life styles, but much these symptoms come from what we put in our mouths. Native peoples are particularly susceptible to diabetes because of their inability to process refined sugar and carbohydrates. Over-processed and packages foods have become the normal diet. These foods contains high levels of sugar and ingredients that are heavily sprayed with chemicals, bleached, and genetically modified (GMO) which side effects are still being learned. These food products are harming to all people, but the Native populations are being hit the hardest because we were not used to eating European foods. Our bodies have not had the long evolutionary time to adjust and are suffering greatly because of it.

Flowering Tree Permaculture Institute put together a program in an attempt to address some of these health issues. A group of Native volunteers agreed to eat only their native foods for a determined period of time. Their health conditions were monitored. Improvement of their overall health was achieved while encouraging cultural preservation. The results will be used to show how eating this way might improve health. Recipes and food sources are being collected in order to share with others that might want to eat this way also.

floweringtreepermaculture.com

Earth Prayer

Earth Prayer

I clipped this out of the paper several years ago. It use to ride with me in my old truck, clipped to the sun-visor. It really resonated with me then. I came across it while cleaning today. Still relevant, and still resonates.

The notion of seven generations has come up several times in that last week. What does that mean? Seven Generations. This week a colleague of mine referred to the work his organization does as considering seven generations into the future (and more). In another instance someone was talking about it on the radio and asked, “What are you working for? Who’s empire are you building?”

What does it really mean, and does anyone really do it?

Society’s Systems Pattern and Shape

Just as nature’s patterns shape who we are, so too do our society’s systems and patterns. In what ways have society’s patterns shaped your health and wellness, and who you are? Can we learn to recognize and align ourselves with healthier, more natural patterns to improve our health and our lives?