Pine Belt companies explain MS Medicaid coverage after mom's str - WDAM-TV 7-News, Weather, Sports-Hattiesburg, MS

Pine Belt companies explain MS Medicaid coverage after mom's struggle for diabetic testing supplies

Diabetes testing supplies. Source: WDAM archives Diabetes testing supplies. Source: WDAM archives
HATTIESBURG, MS (WDAM) -

After a Mississippi mom received backlash from a state lawmaker for expressing concerns about the state's medicaid program not covering her child's diabetic testing supplies, the agency and Pine Belt companies are answering the questions the house representative did not. 

Nicole Nichols sent an email to Rep. Jeffrey Guice, who represents Harrison and Jackson Counties, saying she was "having a lot of problems with Medicaid/CHIPS coverage for of the essential diabetic supplies needed," and asking the representative "Is there someone in the legislature that can and will help these children stay healthy?" 

Guice's terse response, "I am sorry for your problem. Have you thought about buying the supplies with money that you earn?"

While the representative's response drew a lot of reaction, it did not offer help to Nichols or explain the Mississippi Division of Medicaid does cover diabetic testing supplies, depending on the program someone is enrolled in.

"It depends on what program someone is enrolled in (for) the coverage and benefits that they get," said Erin Barham, deputy administrator for communications for the Mississippi Division of Medicaid. "A person has to be deemed medically necessary. It has to be cleared by a physician, so it's hard to say just (as a) blanket (statement) 'you get this. You don't get this.' It depends on the person and the coverage they get and what program they're in." 

Matthew Boyd, chief operating officer for Jones County Medical Supplies, Inc., said he sees dozens of diabetic Medicaid patients with prescriptions for testing supplies everyday.

"We have everyday multiple patients coming in for diabetic supplies," Boyd said. "For Mississippi Medicaid, for diabetic supplies to be able to be covered, a patient has to have type 1 or type 2 diabetes, and then we do have to have the appropriate paperwork completed by the physician. That determines the amount of supplies the patient can get."

Boyd said the easiest way to determine if diabetic supplies are covered is to ask your physician then ask the pharmacy or medical supply company your doctor refers you to.

"Ask that doctor immediately," he said. "They will usually refer you with a prescription to a medical equipment company. Then (the patient) can come in, and we start that process immediately. You can call the Division of medicaid, but most medical equipment companies you will go to, if they do carry diabetic supplies, will have the appropriate forms and be able to send all of that in."

Boyd said Medicaid covers all the major diabetic supplies, like testing strips, lancets and monitors, but he said no all brand names are available.

"With the reimbursement coverage, unfortunately, and Medicare and Medicaid reducing those rates dramatically, not every brand supply we're able to carry anymore, simply due to cost," Boyd said. "That has been one of the biggest problem for some patients. They want to be able to get a certain monitor that might do certain things, and unfortunately, we're just not able to supply those due to cost."

Barham said, "It's very complicated, we understand. We've reached out to that beneficiary's family, and we are going to work diligently because we understand it's really complex."

Park Place Pharmacy in Petal is attempting to remove some of the complication by offering free testing supplies through its diabetic care club.

"Instead of all this paperwork for Medicaid and Medicare and all these formularies of different insurance companies, we just decided to come up with a diabetes care program, which provides a free meter every year to every patient enrolled in the program, and it's free to join. They also get free test strips every month," said Brent Lindley, pharmacist at Park Place Pharmacy. "One of the challenges or burdens of taking care of yourself as a diabetic patient was testing blood sugar like a doctor prescribes. We know that tighter control of blood sugar over a period of years really benefits each patient as far as reducing the risk of heart attack, losing kidney function, eye function and stroke as well."

Boyd said without some kind of help to cover the cost, diabetic testing supplies can cost patients thousands.

"It could range from a hundred dollars to a couple thousand (dollars) depending on if they're on an insulin pump and everything else," Boyd said. "Those supplies can definitely be $2,000- $3,000 dollars a month in some cases."

Lindley said, "Most people really don't believe it's for free. it really is. It's just our way of saying, 'hey, we're going to help you take care of you.'"

Barham said the Mississippi Division of Medicaid released this statement in response to Nichols and Guice's email exchange:

"Once we were made aware of this situation we immediately started investigating the concerns expressed.

Medicaid provides health coverage for eligible, low income populations in Mississippi. Mississippi Medicaid health benefits and coverage encompass multiple programs administered by the agency. Those benefits and coverage can vary depending on the program a beneficiary is eligible for and enrolled in. Enrolled and qualified Medicaid providers are reimbursed for health services.

 We have reached out to this beneficiary’s family and will continue to work diligently to get more details about their situation."

Copyright WDAM 2016. All rights reserved.

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