MEDICAID EXCEPTION REQUEST FORMS AVAILABLE

If you are a Medicaid recipient and have lost a service that is medically necessary, you can apply for a Medicaid Exception. The Medicaid Exception Request form along with a Certificate of Medical necessity requires a physician’s statement of medical need. The physician must indicate if the request is an emergency or non-emergency. Mail forms to Exceptions Unit, Division of Medical Services, PO Box 6500, Jefferson City, MO 65102-6500. The Exceptions Unit obtains a decision from the appropriate medical or pharmaceutical consultant &/or administrative official and informs the treating prescriber, provider of service and recipient of all approved decisions. In the event of a denial, only the prescriber and recipient are notified.

TO INCLUDE OR NOT TO INCLUDE … A QUESTION MANY PARENTS HAVE STRUGGLED WITH FOR YEARS

For years, Eli Lewis was the only student in his class with Downs syndrome. The genetic condition, which causes a range of cognitive and physical impairments, made it harder for him to do his school work. But his parents felt strongly that he could succeed. They hired a reading tutor. An aide worked with his teachers to modify tests and lessons so that he could be in the same classroom as everyone else. He participated in his middle school’s award-winning chorus and was treated as a valued member.

But, when all the other kids in his class were making plans to go to the local high school this fall, Eli, 14 years old, said he didn’t want to go. He wanted to be in a small class with other students like him. “I don’t want to get lost in a big crowd,” Eli says.

Eli’s declaration surprised his parents. Then his mother recalled the many times she stopped by the school to check on her son, only to find him eating by himself….”The kids liked him, they knew him, they spoke to him,” says his mother, Mary Ann Dawedeit. “They just didn’t think of him as a peer.” Eli, she says, was tired of “being the only kid who was different.”

Federal law mandated in the 1970’s that children with disabilities be offered a “free and appropriate public education” in the “ least restrictive environment,” rather than being separated only in special schools or institutions. Over the years, advocacy and additional laws resulted in efforts to get children with disabilities placed in regular classrooms, with proper support, whenever possible. The process, called “inclusion” or “mainstreaming” has largely been an academic success.

Studies have shown benefits for all children, not only those with disabilities, who study together. Many researchers argue this is one reason why people with Downs syndrome have made such remarkable progress in recent decades…They have significantly higher rates of employment after they graduate and earn more money than peers who studied mainly in self-contained classes.

And yet, Eli Lewis’s experience poses a difficult dilemma, one that is only now starting to be recognized and addressed...he felt isolated...In a survey of 5,600 seventh and eighth grade students from 70 schools across the country, more than half of the youths said they were willing to interact with students with intellectual disabilities at school. But only one third said they would be willing to invite such students to their house or go to the movies with them.

In May, at the science exposition at Eli’s middle school, her (Mrs. Dawedeit’s) feelings changed. ..Here was Eli, successfully participating in a science exposition with peers who don’t have disabilities—but still talking about wanting to be with other people with Downs syndrome.

She says she realized she needed to try to accommodate her son’s desire for a social group. “I really had to step back from my personal beliefs”, she says.

In the fall, Eli enrolled in the 9th grade...He is in a special program with 20 other students who have disabilities, including one who gets around in a wheelchair and has difficulty talking. Six of the students in the class have Downs syndrome. Eli already knew some of the kids from various activities, such as a drama class and Special Olympics, where he participated in soccer, basketball, swimming & bowling.

On a recent morning at school, Eli weaved around the teenagers lining the hallway...Eli didn’t talk to any of the students. He walked with purpose, heading to the special-education room.

When he got there, his face brightened when he saw one of his friends. “This is my best friend,” he said, throwing his arm around the other boy, who also has Downs syndrome. He pressed his face close to his friend’s until their cheeks almost touched. Eli smiled. “What table are you sitting at lunch today?” he said as they walked together down the hall. “Come on, make sure you sit with me.”

The entire story, Eli’s Choice, can be found in The Wall Street Journal, Saturday,/Sunday Dec. 31, 2005—Jan. 1, 2006
By Amy Dockser Marcus or by contacting our office at the toll-free number .

If you know of a situation needing our attention, please do not hesitate to call. Your call can remain confidential.

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