Lawmakers were receptive, but some thought the bill was too broad for a pilot. They amended it to narrow the program to allow only people with a spinal cord injury — not all disabilities, as originally proposed — to receive three specific treatments: acupuncture, massage and chiropractic. The pilot would be limited to 67 people who live in five counties: Denver, Adams, Arapahoe, Douglas and Jefferson. An independent evaluator would track their progress and document whether the program was saving money and improving participants' health. At the end of three years, state health-care policy officials would recommend whether to continue it or not.

The bill passed both houses and was sent to then-governor Bill Ritter in May. He vetoed it in June. In a letter outlining his reasons, Ritter said that putting in place a pilot program "would be a major undertaking" and noted that lawmakers failed to include money in the state budget to do so. In Colorado, Medicaid is funded jointly by the federal government and the state.

Hinton Leichtle was frustrated. She'd intended for the pilot program to be funded by gifts, grants and donations, and somehow that language was cut out of the bill. But Todd and Williams weren't deterred. After consulting with Ritter, they reintroduced the bill the following year with the needed language intact. It sailed through the legislature, and on June 2, 2009, Ritter signed it into law.

Chanda, age nine, before she was shot.
Chanda, age nine, before she was shot.
Fritz Haenel does physical therapy to help him stay strong and increase his mobility after a car accident left him paralyzed.
Anthony Camera
Fritz Haenel does physical therapy to help him stay strong and increase his mobility after a car accident left him paralyzed.

The bill specified that the three-year pilot program was to begin no later than January 1, 2012.

******

Hinton Leichtle is zipping down Highway 36 in her beige Honda Odyssey minivan, which is retrofitted to allow her to operate the gas and the brakes with a joystick. A touch panel mounted to her left has a button that puts the car in reverse; when it does, a screen embedded in the dashboard shows the view captured by a backup camera. A three-pronged grip on the steering wheel makes it possible for her to use her entire forearm, not just her hand, to turn the wheel.

"Okay, so here's the deal," she says. She's talking on her cell phone to a man whose case manager erroneously told him he wasn't eligible to enroll in the pilot program. "What she told you — there's a piece of it that's correct and a piece of it that's incorrect."

The client lives in Douglas County, which makes him eligible. But his case manager told him he wasn't because there are no participating acupuncturists or massage therapists in his county. That's true; to access the services, he'll have to drive to Denver.

"The process should be seamless," Hinton Leichtle says of transferring from his current Medicaid benefit plan to the pilot program. "But right now, I'm finding out that's not the case."

Ritter's warning that implementing a pilot program would be a major undertaking turned out to be correct. To do it, the state Department of Health Care Policy and Financing, or HCPF (pronounced "hick-puff"), had to ask the federal Centers for Medicare and Medicaid Services to approve a new Medicaid waiver for the 67 participants.

Though the bill was passed in mid-2009, that process didn't get started in earnest for more than a year, Hinton Leichtle says. There were some early delays that she attributes to poor staffing decisions at HCPF. "It got to a point where it was very, very frustrating because we were sending in money, but nothing was happening," she says.

The Chanda Plan vowed to raise $150,000 to pay for HCPF staff to write and submit the waiver, among other administrative costs. That $150,000 was matched by federal funds for a grand total of $300,000. "I was so scared that it was going to die," Hinton Leichtle says of the waiver. "I wasn't about to have that happen after we'd already gotten 150 grand into it."

Lawmakers Todd and Williams shared her concerns and facilitated a meeting in mid-2011 among themselves, Hinton Leichtle, HCPF and Governor John Hickenlooper's office.

"The department was not acting," Williams says. "What we encountered...was a lot of changes: changes of the department head, changes of deputies, changes of who knows the best and who's going to carry the ball into the waiver process." But several of those changes turned out to be good. The new HCPF director, Sue Birch, got the process back on track. "In this last change of directorship, it really started to happen," Williams says.

But by then it was too late to meet the January 1 implementation date. Hinton Leichtle got reassurance that the program could still go forward, even with the blown deadline, and the Centers for Medicare and Medicaid Services approved the waiver in June 2012.

Of the delays, HCPF spokesman Marc Williams explains that there's a lot of "homework that needs to be done" to submit an application, including presenting research on whether the waiver will be effective and save money. Colorado currently has twelve waivers. "There are always challenges of varying kinds," he says. "I'm not real clear on whether this was different."

With the waiver in place, Hinton Leichtle looked to hire an independent evaluator and recruit therapy providers who were willing to accept Medicaid. She approached clinics that could employ a supervising physician to evaluate patients and decide what therapies might be beneficial — a requirement of the waiver — and that already had acupuncturists, massage therapists and chiropractors on staff. It was a tall order, but the Progressive Health Center, a non-profit clinic, on the Swedish Medical Center campus in Englewood, fit the bill.

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My Voice Nation Help
9 comments
Corners
Corners

Hi Chanda, I appreciate all you are doing to try and help others with spinal cord injury. I have an L1-L2 level injury from an accident when I was sixteen years old. Today I am walking with crutches, but I have worked really hard in physical therapy for a lot of years to walk.You can learn more about my story: http://zinahermez.wordpress.com  I agree with you, and I have never been a fan of pain medication myself. 

patricia.calhoun
patricia.calhoun moderator editortopcommenter

we'd like to publish some of these comments in our print edition, ideally with the author's full name/town. If that's okay, e-mail me at patricia.calhoun@westword.com

notonmydime
notonmydime

Thanks Westword for alerting us to the use of the Medicaid waiver program to waste taxpayer money.

No one wants to say no to pretty victims of spinal cord injuries like Chandra, or self-motivated men like Mr. Haenel, so it is easy to see how the Chandra foundation has made progress. Sadly, its goals are clear--to get public money for unproven treatments.

 

Conventional medicine is based on scientific knowledge whereas alternative medicine is based on clinical or anecdotal evidence. We have an entire wing of National Institute of Health devoted to trying to prove that alternative therapies work (with little success, I add), and their website states: "there is insufficient evidence to draw definite conclusions about the effectiveness of acupuncture for acute low-back pain."

 

There are no control groups to this pilot program, and the medical person administering it is someone with a vested interest in the therapies offered. Proven treatments like physical therapy are lumped in with pseudo medicine, invalidating any objective demonstration of success that may come from the program. However popular these alternative therapies might be, we need to see evidence that they work.

 

I hope Colorado citizens and legislatures will thank the Chandra foundation for ironing out kinks in the Waiver program while demonstrating exactly how to suck scarce dollars from taxpayers in the name of the disabled. I also hope we demonstrate our thanks by showing poorly designed programs out the door, because our Medicaid patients deserve better.

 

kcm2us
kcm2us

gee Westword, could you make the lede to the story a little more lurid?

"carries her, like a bride over a threshold. He props a pillow between her legs, hikes up her redNebraska Huskers T-shirt, unwraps his sterile needles and taps them into the skin above where her black lace underwear peeks out from the top of her yoga pants."

 

kcm2us
kcm2us

Great! Will medicare start paying for my Budweiser? It kick-starts my kidneys, bladder and ureter and I prefer it to noxious drugs. 

cheryl.bianchi
cheryl.bianchi

this is fantastic news...now to get california to step up...thanks for your hard work

brendacombs
brendacombs

@notonmydime I certainly hope you never have a family member to suffer from a spinal cord injury and have only drugs with horrible side effects to deal with their health issues.  Please, where is your compassion?  Not all things are known and able to be proven by a medical system that will not listen to information that does not pad the pockets of  big pharma.  Is not the word of the patients any good for whether the alternative health care is working for them.  Would you rather pay for a surgery and and hospital bill with medicaid dollars than to pay for a few acupuncture treatments that takes care of the problem with no side effects?  Please open your mind and learn more about this issue before condemning disabled people to issues you can not begin to understand.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          

ybarcewski
ybarcewski

 @kcm2us I won't pay for you Bud but maybe it will pay for your rehab.

notonmydime
notonmydime

Medicaid and private insurance should both be paying for effective rehab, but this is a poorly designed program. We could just as well pay for toothpick based placebo treatment and point to its cost-effectiveness.

 
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