Raul is enrolled in the Medi-Cal NF/AH waiver. Under this waiver the state is supposed to cover his nursing care. There are three levels of care in the waiver: A/B, Sub Acute, Acute. Each level has different “cost cap”. The state cannot spend anything above that “cost cap”. Additionally, pediatric patients have a higher “cost cap” than adult patients. You qualify as pediatric until you turn 21.
When he was first enrolled in the waiver as a teenager the state evaluated him as being Sub Acute. Because he was not 21 years old yet he was still receiving enough nursing care. However, as soon as he turned 21 they told him that his “cost cap” would be going down. Raul and his family appealed this and scheduled a state “fair hearing” in order to try and fight it. They met with a lawyer and he told them that their best chance at winning would be to argue that he qualifies for Acute level care. When Raul and his family looked at the criteria for Acute level of care, they realized that he does qualify for it and thus, a higher “cost cap”. Raul and his family went to his “fair hearing” and their lawyer successfully argued his case. The judge agreed that he qualifies for acute level care. However, these “fair hearings” are not like the traditional court system. The judge has to have his/her decision approved by the head of the Department of Healthcare Services (DHCS), which oversees the program. The judges decision was not approved and the director, David Maxwell-Jolly, left Raul at the Sub Acute level of care despite a mountain of evidence against it.[/spoiler]
[spoiler title=”What is Medi-CAL?” open=”1″ style=”2″]Medi-CAL is California’s version of medicaid.[/spoiler] [spoiler title=”Who is responsible for this?” open=”1″ style=”2″]The director that overturned the decision was David Maxwell-Jolly. He has since been given a promotion to another department. The new director, Toby Douglas, is now responsible for the program.[/spoiler] [spoiler title=”Who has the power to put Raul in the Acute level care?” open=”1″ style=”2″]There are two people who have the power to do that. They are Toby Douglas and California Governor Jerry Brown. If you would like to contact them you can do so at 916-440-7600 (Toby Douglas) or 916-445-4481 (Jerry Brown)[/spoiler] [spoiler title=”Is Raul on IHSS (In Home Supportive Services)?” open=”1″ style=”2″]Raul receives 96 hours of IHSS a month.[/spoiler] [spoiler title=”What’s Raul’s disability?” open=”1″ style=”2″]Raul has a disease called Muscular Dystrophy. It’s a progressive disease that prevents his muscles from making any energy. This, in turn, causes the muscles to atrophy over time. As the years have gone by he has lost the ability to walk, move his arms, eat and breathe. Because of this he requires around the clock nursing care. However, this has not stopped him from striving for an independent life.[/spoiler] [spoiler title=”Why did Raul have to come back home from UCLA?” open=”1″ style=”2″]There were many reasons why Raul had to come back home, but one of the main reasons was that his “fair hearing” was going on while he was at UCLA. If he hadn’t come back home he would have never been able to get the lawyer that his family found and would not have had the knowledge to convince the judge that he qualifies for Acute level of care.[/spoiler] [spoiler title=”Has Raul tried getting private insurance?” open=”1″ style=”2″]Raul’s family did get a private insurance through Anthem/Blue Cross. The plan is called “MMRIP” and cost them $460 per month plus $2,500 out of pocket per year. The problem is that it has a yearly limit of $75,000 a year. Additionally, Medi-Cal won’t cover anything until it goes through this insurance. So any doctor visits or medications have to go through this insurance first. As you can imagine that can add up. Raul and his family originally planned to use this to supplement the nursing hours that were cut by Medi-Cal, but because of the yearly limit, it’s only enough to cover 4 months out of the year of nursing care. After those 4 months they won’t cover anything more.[/spoiler] [spoiler title=”Will Obamacare help Raul at all?” open=”1″ style=”2″]Obamacare would help Raul in the sense that a private insurance won’t be able to deny him care based on pre-existing conditions, but even if it does pass through the Supreme Court it won’t go into effect until a couple of years from now.[/spoiler] [spoiler title=”How much does Raul’s nursing care cost?” open=”1″ style=”2″]For him to receive 24 hour nursing care it would cost around $312,000 a year. This does not include the price of his equipment, which costs over $75,000 a year to maintain.[/spoiler] [spoiler title=”Wouldn’t it be cheaper for the state to put Raul in a nursing home?” open=”1″ style=”2″]No, it would not. Numerous studies suggest that nursing homes are not only more expensive for the state, but actually provide less effective care with less desirable outcomes. It’s actually cheaper for the state to give people the opportunity to stay in their own home and be responsible for their own care. This results in people being more involved in their own care and reduces costly hospital visits.[/spoiler] [spoiler title=”What do you hope to accomplish?” open=”1″ style=”2″]We have two goals with this website. The first goal being for the state of California to put Raul at the Acute level of care. The second goal (please don’t take this to mean that it’s less important) is to end the cuts to Medi-Cal and stop Governor Jerry Brown’s attempt to privatize Medi-Cal.[/spoiler] [spoiler title=”What other government assistance does Raul receive? ” open=”1″ style=”2″]He receives about $650 a month from SSI.[/spoiler] [spoiler title=”How did he get this website? ” open=”1″ style=”2″]His good friends, Oliver and Sarah made it for him. Oliver runs a business called Realize Marketing, you should check it out. Realize Marketing.[/spoiler] [spoiler title=”I’d like to get in touch with Raul or one of the other bloggers, how do I do that?” open=”1″ style=”2″]To get in touch with any of us you can use our contact form at the top of the page. Contact Team Raul[/spoiler] [spoiler title=”What will Raul do without nursing care?” open=”1″ style=”2″]Without nursing care his family will take care of him. He also has a brother with the same condition and he’s also about to turn 21. We expect that he’s going to go through the same thing that Raul is going through, though we hope to stop that from happening.[/spoiler] [spoiler title=”Do you have 501c(3) status?” open=”1″ style=”2″]Not yet, that is something that we are working on. If we do start a charity it’s not going to be just for Raul, but for a wide range of disabled people.[/spoiler] [spoiler title=”Can I donate?” open=”1″ style=”2″]You certainly are more than welcome to donate to Raul. Any money that you donate will go directly to his medical bills and we will make sure to post on the donation page when he uses any donations. Donate Here[/spoiler]