Should Michigan Medicaid Pay for Durable Medical Equipment?

Walid K. Yassir
HCM 703
Final Paper
      About 10 months ago, right after the election, a man brought his daughter to see me.   Her complaints were of bilateral knee pain.   On examination, she had completely dislocated kneecaps.   She was tall for her chronologic age and because of the severity of her kneecap dislocations, I became concerned that she had Marfan’s syndrome, characterized by a defect in collagen fiber formation which resulted in increased elasticity of connective tissues, causing ailments such as flat feet, dislocating kneecaps, scoliosis, and more concerning, a dilatation of the aortic arch which could result in sudden death.   I prescribed physical therapy, a pair of knee braces for her to help her kneecaps track better, referred her to the cardiologist for an echocardiogram, and the geneticist for confirmation of the diagnosis.   She was a Medicaid recipient, enrolled in the Total Health Care plan.   Our on-site orthotic and prosthetic company, Wright and Fillipis, is not an approved provider for Total Health Care.   I provided a written prescription for the knee braces, which she would have to acquire from an approved provider.   I asked her and her father to make a follow up appointment in 6 weeks so I could check on her progress and review her test results.   6 weeks later, they returned for their appointment.   She had not yet received her knee braces or her consultant appointments.   She was also complaining of flat feet at this visit, and on examination, her feet were extremely flat, yet flexible.   Her father related to me his difficulty in getting the braces for her knees, because the Michigan Orthotic provider he had gone to insisted on first obtaining a preapproval for the braces, which takes over a week from Total Health Care, who are notorious for denying all reimbursement for care provided without authorization.   The preapproval had been obtained, but they had not yet had a chance to pick the braces up.   When it came to the...