VAN BUREN, Ark. (KNWA)– A healthcare program meant to help Arkansans is creating life-threatening problems for one family.
The Provider-Led Arkansas Shared Savings Entity or PASSE program aims to help Medicaid recipients who have behavioral health needs or developmental disabilities connect with health providers.
But for one family, it’s blocking their ability to get their daughter the medication she needs.
“It was probably the worst moment of my life realizing that you know, your child could pass away at any point in time,” said Tiffany Nance, whose daughter uses PASSE.
Tiffany Nance is a mother of seven, one of those seven being her daughter Josie who was diagnosed with cerebral palsy.
Josie had a one percent chance of survival when she was born and has relied on Medicaid her entire life to keep her going.
“She has tube feedings throughout the day. You know, her lifeline is pretty much-being tube fed,” Nance said.
But she said she’s been having trouble getting tube formula through a new program under Medicaid.
The PASSE program was created to help Arkansans like her daughter Josie, who have developmental disability needs or complex behavioral health, connect with specialty providers and reduce the cost of care.
According to the Arkansas Department of Human Services, the need to create the PASSE program partially stemmed from the fact that nearly 3,000 people were on a waiver wait list for intellectual or developmental disabilities, accounting for $32 million in Medicaid costs for over 2,000 people.
There are three different PASSE programs, each with a number of providers under them that can be found through their respective websites.
But, Nance said her provider didn’t even know they were part of the program.
She said, “I’ve been turning in her new PASSE card to the providers, and I even had one provider tell me ‘that looks like a dental card.'”
This has led to her to not be able to bill her daughter’s formula. which she said was previously approved by Medicaid.
This leads to her having to pay out of pocket or not receive it at all.
“We’ve spent every last nickel and dime that we possibly could to provide her formula and at the $400-plus-a-month, that’s just not feasible with seven kids,” she said.
After reaching out to DHS, Marci Manley said in a statement that PASSE members should never have out-of-pocket costs for covered services.
She also says services that people got before the program should continue to be covered.
Nance said, “We don’t have formula at all. We’ve been having to give baby food patches through her tube which nowhere meets her caloric intake.”
She adds that after reaching out to her PASSE coordinator and her provider about the issue, they assured her they would fix the billing problem and send her more formula.
But, she said it’s past the deadline of when they promised to deliver it.
On May 1, members of PASSE can opt to switch to a different program if they choose to do so.
If you are a PASSE member, and you’re having trouble accessing services or connecting to your provider you can call the PASSE Ombudsman office at 1-844-843-7351.
If you’re a provider and need help navigating the PASSE system, you can reach the DHS Provider Line at 1-888-889-6451.