CHARLESTON, W.Va. (AP) - As the state prepares to announce proposed changes
to a Medicaid program that serves mentally retarded and developmentally
disabled children and adults, advocates say they want to be more involved in
the decision-making process.

The Title XIX Waiver program's draft renewal application is scheduled to be
posted online today at www.wvdhhr.org/bms and will be discussed at several
public forums next month, said state Bureau of Medical Services Commissioner
Nancy Atkins.

"We may be changing the parameters a little bit to do better utilization and
to hopefully meet the needs more of the clientele and to make it more
self-directed," Atkins said last week.

Advocates say participating in the public forums is not enough because by
that time the plan is already written.

"We want to be part of the development, we want to be on the front end,"
said Ken Ervin, organizer of ADAPT West Virginia. "Don't make us outsiders
in our own lives."

"Comments are not the same as dialogue," said Scott Miller, coordinator of
the People's Advocacy Information and Resource Services Center.

Atkins said the state has worked with the West Virginia Developmental
Disabilities Council and the West Virginia University Center for Excellence
in Disabilities, considered volumes of written comment from advocates and
consumers, and met with advocates earlier this year.

Tailoring Medicaid services to fit a person's individual needs is one idea
proposed by advocates that state officials are considering, Atkins said.
Clients have complained that service providers require them to accept
unneeded help to get the services they do need, so the agencies can boost
their bills.

Miller developed a case study of a client whose care cost $12,279 a month
for nine services. But the woman only needed three services, which would
cost about $6,535, Miller said. If the woman could build her own budget
around only the services she needs, that would save the state about $5,744 a
month or $68,928 a year, Miller said.

Atkins said that's one direction the state might go.

"We're leaning to where you would have an assessment of a person's needs,
and based on those needs they'd have an allocation of so much resources to
purchase the services that they want or need as opposed to, 'Here's your
plan of care and you must receive those services,'" Atkins said.

But the state has to balance that with "folks who say, 'I need every service
I get. Don't take anything away from me,'" Atkins said.

West Virginia is considering several proposals to cut $115.7 million out of
Medicaid, which faces a $156 million deficit. Overall, about 373,000 West
Virginians receive services from the state-federal health-care program for
the needy, aged, blind and disabled, and low-income families with children.

The Medicaid Title XIX Waiver program waives Medicaid family income
guidelines for middle-income families and provides services to more than
3,800 adults and children who otherwise would have to live in a residential
care facility for the mentally retarded. The idea is it is cheaper for the
government to pay for services that allow people to stay in their own homes
than it is to pay for institutions.

West Virginia has to renew its waiver application every five years. The
latest application was due to be filed with the federal government on March
31. The state got an extension and revamped its initial proposal after a
public comment period in March. A new version, incorporating those comments,
is being released for comment on Monday.

Public forums regarding the draft will be held June 6-9. The first meeting
will be for service providers and the last three will be for recipients.

Comments made at the meetings will be seriously considered, said Pat
Winston, program manager with the Bureau of Medical Services.

"We want to hear everyone's point of view," Winston said.

The meetings will be:

- 1 p.m. to 4 p.m. Monday, June 6, at West Virginia State University's
Erickson Alumni Center in Institute. Only providers will be allowed to
speak.

- 6 p.m. to 9 p.m. Tuesday, June 7, at the Clarion Hotel in Shepherdstown.

- 6 p.m. to 9 p.m. Wednesday, June 8, at the Ramada Inn in Morgantown.

- 6 p.m. to 9 p.m. Thursday, June 9, at the Tamarack Center in Beckley.