Alternative therapy could be the next step for those with spinal cord injuries

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.

Chanda, age nine, before she was shot.

Anthony Camera

Fritz Haenel does physical therapy to help him stay strong and increase his mobility after a car accident left him paralyzed.

Details

See also:
- Photos: Chanda Hinton Leichtle is out to change how Medicaid treats spinal cord injuries
- Alternative therapies: Florida program similar to Colorado pilot saved money, improved health

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More About

• Medicaid
• Fritz Haenel
• Andi Leopoldus
• Spinal Cord Injuries
• Injuries and Traumas

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.

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

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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.