A Ric Crowley Anecdote about Medicaid and Self Determination:
In the 1990s in New Hampshire There Was a Person I'll Call Alan…
…who for whatever reason always wanted a cow! Now when I was young I always wanted a pony. No, not Alan! There I was, sitting in my comfortable executive director's office, when a case manager and her supervisor came in, shut my office door, told me to sit down (I always obeyed case managers), and proceeded to tell me the following story:
"Ric, you know how you signed authorizations without reading the detail?" It was true. "Well, six months ago you signed an authorization for Alan to purchase a calf with $200 dollars using Medicaid waiver funds!" With some concern (and trepidation) I asked for more detail. Well apparently I signed the document and Alan purchased a calf with Medicaid funds. I know, readers are thinking that you cannot purchase a calf with Medicaid funds.
Look, I read the Medicaid regulations and they are silent on calf purchases. So I figured it was ok, if not expressly forbidden! It is after all better to beg for forgiveness rather than ask for permission. Can you imagine if I had asked the state administrator if it would be OK for Alan to spend $200 Medicaid dollars to purchase a calf? I don't think so! Let it be known that at this point in Alan's life our agency had failed him. We had spent approximately $300,000 over a ten year period and he was lonely, unemployed and not living where he wanted to live and had no friends! We truly had failed him!
Anyway, Alan loved to visit farm stands and he got to know a farmer who agreed to help Alan care for and feed the calf if Alan would do chores for the farmer. One thing led to another and Alan met the farmer's family, friends and got to know the farmer's community and ultimately got a life! The system tried and spent $300,000 dollars and failed. Alan spent $200 and succeeded. This is a real Medicaid Cash Cow story!
So, what happens to calves when they grow up? They become steers or cows! And they weigh a lot—they have value! Oh no! Alan may lose his SSI if the value exceeds $2000! Hey! Wait a minute! If Alan has the steer slaughtered and put in his freezer it will be food and not counted as an asset! And so on, ad nauseum!!!
This is where I stepped in and stopped the conversation. Some people were getting serious and I was concerned about funding herds of cow and who knows how many goats, pigs, chickens and sheep I had authorized—I did not want to know! The point of this story is to emphasize that a person can get a life without throwing a lot of money at the person through traditional "programs." Community presence, community connections, flexibility, listening to the person and the wise use of limited funds are the basic ingredients of "how to get a life."
Ric Crowley is a long time professional in the field who has helped pioneer changes in employment, living, and self determination. He currently lives in Louisiana.
