You may have read that the Supreme Court ruled that
state workers cannot sue under the Americans with Disabilities Act. That's true. Now it is
up to the states to provide its workers with laws that protect each person with a
disability. That means we need to be lobbying. Many state workers have disabilities and
this ruling from a very conservative Supreme Court will hurt them. For one thing, if the
state does not establish some laws to protect their workers, then employees with
disabilities will never have adequate protection from discrimination. Second, and closer
to home, few citizens with disabilities who have sued this state in the past ten years
have met much sympathy from the Texas Supreme Court. The key is to contact our
Texas is one of the worst states for protecting its disabled population. Without the
ADA, many counties would never have put an elevator in their courthouses (and, all or most
of the courtrooms are on the second floor in many courthouses). Some county courthouses
have never installed ramps or elevators. Even the Texas Supreme Court is almost
inaccessible. So, we will need to work hard to demand that laws be passed now. We need to
be lobbying the legislature. Remember, no change has ever been made by compliant citizens
who are unwilling to stand up for what is right.
Someone said (and I'm paraphrasing) that the reasonable man conforms himself to the
world. The unreasonable man demands that the world conform to him. Therefore, all changes
in this world are made my the unreasonable man. Let's be a little unreasonable and insist
that the laws get passed quickly so that all citizens have equal protection under the law.
Second, I'd like to take the time to respond to some emails I
I found your site in some desperation this evening and am writing in the hope you may
have some thoughts to share with me on our situation. My son is 20 years old and joined
the Army in northern Arizona six months ago. At the time, the recruiter assured him that
the Army could assist with care for his wife who has Muscular Dystrophy during his
military service. She has no function in her legs, some in her arms, and is very clearly
in need of 24-hour care. She has little ability to care for herself. My son graduated from
basic training and completed Military Police training. He was then given a 20-day leave
and allowed to return to his wife who traveled with her mother for my son's graduation,
meeting many of his commanding officers during her visit there. Her doctor completed all
the paperwork requested by the Army that stated her limitations and recommendations for
her future care, and these were submitted to my son's commander prior to his leaving in
January. While on duty last month, my son was engaged in recruiting activities in the
local high school at the Army's direction. My son and the other recruiters returned to the
base as directed last week, spent one night on base and were given written orders to
proceed to another base. My son told me that his wife was "written into" the
orders, which is apparently unusual. He was told to report the the Housing office and they
would put him in touch with the Exceptional Family Member Program which would arrange for
care for his wife while he was oriented to his new assignment, located housing, etc...
However, after traveling by car for several days on arrival and report at the new base,
my son has been told that the Army has no provision for assisting with his wife's care. He
was given three options:
- Send his wife back to live with her mother while he applies for a caretaker through the
State of Texas.
- Pay $12.50/hour for care.
- Take an administrative discharge from the Army immediately.
These are all very difficult options for my son. His wife was separated from him for
five months during his training and they were led to believe they could be together
following completion. He doesn't make $12.50/hour to cover the cost of a paid caretaker.
My son really loves the Army, has been very committed to learning and focusing on a career
in the military. Tonight his hopes are pretty slim. He chose to marry young, has little
training and is responsible for the care of his wife. His job options are very limited.
His wife previously received disability benefits in the previous state, however, they were
denied based on my son's minimum wage income, prior to his entering the Army. They were
told if they had benefits in place in the other state, those would be transferable;
however, at this point they'll need to go through the entire process again and hope to
have benefits reinstated in the future. Meanwhile, he's being advised that the
administrative discharge is in his best interest. Do you have any experience with the
military in this area?
I know the military. They are pretty inflexible and work by their own rules. I would
suggest going to the chaplain and to a military attorney. It is possible that the military
might be willing to at least pay for some employment training for your son. I would also
suggest that your son begin the process of applying for benefits immediately. Have your
son contact Advocacy, Inc... They can provide a list of other resources who might be able
to help your son. Also, have your son contact United Way. At the very least, United Way
has a book of resources that can be useful. I would not suggest that your son voluntarily
leave the Army. They did make a promise to him. I would suggest a call to your son's
representative in Austin but the Army has a severe negative reaction to anyone going
outside the system. However, that might be a last resource.
Believe me, your son will be fighting an uphill battle but there are resources in Texas
that can help including adult daycare programs. Please suggest that he do the research. I
wish him and his wife the best of luck. Please contact me again if your son needs more
P.S. Please see the letter below regarding the Exceptional Family Member Program of the
Army from Kerry C. Dauphinee.
I was just trying to get information on disability & not sure if you can help or
not. I was trying to find out if you could help or give me tips on where to look for info
on disabilities on who is eligible? I have a daughter that is a senior in high school
& was trying to find out if she will be able to receive help when she moves out going
to college. She has a handicap on her left leg she is unable to bend it the knee has been
fused & it limits her qualifications to get a job. So if you have info I would greatly
appreciate the help to get started looking for her some help.. Thanks so much & Have a
Please contact the Texas Rehabilitation Commission immediately (or your local
rehabilitation agency if you are not in Texas). Also, contact Terragenesis. (I do not
promise that the spelling is correct but I'll get back to you if I am wrong.) They publish
a booklet called, The Solution. They can provide you with a rich source of information.
Thank you for writing. Let me know if I can provide you with more information.
We have a 3 year old boy who has hearing loss. We have done the tests but they are not
sure how significant the loss of hearing is. They will put hearing aids on him but the
insurance company will not pay for them. The initial cost is about $2500 and every six
months part of the hearing aid will have to be replaced. Is there any state assistance or
some organization to help defer the cost? We live in Florida.
Contact your local school district. Under the Individuals with Disabilities Education
Act, your child is entitled to a free and appropriate public education and any and all
adaptive equipment (including hearing aids) that he may need. The school district will
provide speech and language services. Contact me if you have any problems obtaining the
services you need. (The school can also guide you to local resources.)
My name is Vincent Beanes, I am 37 and was recently diagnosed with degenerative disc
disease, I undergone l-4, l-5 lumbar disctectomy, Jan 4 and currently in P.T. for the next
4 weeks, my neurologist gave me a unfavorable prognosis. the disease is spreading up my
spinal column and I may need spinal fusion, I know my condition may not qualify as a
disability but I work in an environment where heavy lifting is a daily requirement.... I
work for a VA medical center, and their policy will not give me any accommodation nor
light duty, unless the injury is job-related.... my condition is not job-related..... I
sought assistance from their union... but they could not help me in my case..... I also
sought assistance from a veteran outreach worker.... and still found no help....I
explained my need for accommodation with the labor relations specialist representing my
dept.... having medical documentation explaining that on-going heavy lifting will
accelerate my condition unfavorably....but was turned away I was told to "deal with
it or quit"......I am the sole breadwinner for my family of 4, my wife and my two
stepdaughters moved from another state last May, our son was born here in September, I am
pleading for any assistance or information you could spare. Thank You and may God Bless
Unfortunately, employment law is not on your side. And, even if you had a case against
the VA, the court system is so conservative that you would be unlikely to prevail. That's
the bad news. Apparently, a large enough percentage of the population support the
conservative trend so I do not see that changing.
On the brighter side, you can continue to ask for a move to another department. You can
also seek employment elsewhere. You can sue the VA under the Americans with Disabilities
Act or, at least threaten to do so. You live in an area where there are numerous resources
including organizations that will legally support people with disabilities. Start calling
around. Let me know what you find out. Finally, call the state bar and ask for a lawyer in
your area who specializes in disability law. You may be surprised at the help you can get.
I am a 100% disabled veteran and recently had a specially adapted home (wheelchair
accessible) built. My biggest problem is the driveway, which has a 14 degree slope which I
believe is excessive , but I have been unable to find any information on any standard
degree number as acceptable. The VA only says that the driveway should be relatively flat.
The builder keeps saying that the present driveway cannot be leveled and their proposals
are not really solutions to the problem. And there are other things wrong with the
property as I am almost a prisoner in my own home. The yard is also not accessible to me
due to the slopes.
Do you think you can help?
I do have to ask why you purchased property with all of those slopes when you knew you
had a disability that would limit your use of that land comfortably. But, regardless of
the answer, please get a copy of the Americans with Disabilities Act. Then check your
local building code. Both should help you on the slope of the driveway. Have somebody from
Advocacy, Inc... or another local agency that assists the disabled, do a walk-through of
your home and property. Ask them for suggestions.
If your house is already built, go see an attorney who works in the area of disability
law. Call the state or local bar for a referral to a nearby attorney. Also, contact your
state representative for assistance.
Finally, and I hate to suggest this solution, you may have to sell your home and buy or
build another that meets your needs. An able-bodied person might buy your house.
Best of luck. I sincerely hope that your property and home problems can be resolved in
some manner. It would be terrible to be a prisoner in one's own home.
Need to know where to find educational programs for educable mentally retarded after my
son graduates WITHOUT diploma in June. The only option being offered by our school
district is three more years in food service. He's pealed cucumbers and cleaned up the
kitchen for three years. He wants to do more and deserves the chance for a more meaningful
Please contact your school and ask for an A.R.D. to consider other options. Also,
contact the Center for Health Care Services and Texas Rehabilitation Commission. Ask them
to attend the A.R.D. Both agencies can assist you after graduation. Personally, I would
not allow the student to graduate yet unless the school is absolutely useless. They can
provide additional job skills. You may need to get Advocacy, Inc... to provide an advocate
or contact an attorney to assist you if you believe your child's rights are being
Third, I'd like to share the following information with
everyone who has written and my readers:
All - The following is a listing of some resources for special needs...as I find more I
will post them.
Kerry C. Dauphinee`
Exceptional Family Member Program Manager
Army Community Service
Fort Sam Houston, TX
- Council for Exceptional Children: www.cec.sped.org
- LD Online: www.ldonline.org
- National Association of Private Schools for Exceptional Children: www.napsec.com
- National Information Center for Children and Youth with
Here is the memorandum about Medicaid rehabilitative services that Richard Lavallo
mentioned during his presentation on Friday. If any one has any questions about the memo
or knows of children who are having problems accessing such services, please email Richard
at email@example.com or call him at 512-454-4816.
REHABILITATIVE SERVICES COVERED UNDER STATE MEDICAID REGULATIONS
Chapter 419, Subchapter L of Title 25 of the Texas Administrative Code describes the
requirements for the delivery of rehabilitative services reimbursed by Medicaid. Section
419.453 (21) defines "rehabilitative services" as including the following
medical and remedial services:
- Community support services;
- Day programs for acute needs;
- Day programs for skills training;
- Day programs for skills maintenance; and
- Rehabilitative treatment plan oversight.
This memorandum will review each of the above-referenced services under the state
regulations and focus solely on the services that could be provided to children or
In order for a child or adolescent to be eligible for rehabilitative services covered
under Medicaid, he or she must meet the following eligibility criteria (§419.454):
- be under 18 years of age with a diagnosis of mental illness (but not a sole diagnosis of
substance abuse, mental retardation, autism, or pervasive developmental disorder) and
exhibit a serious emotional, behavioral or mental disorder;
- be enrolled in a school system's special education program because of a serious
emotional disturbance; or
- be at risk of disruption of the preferred living or child care environment due to
COVERED REHABILITATIVE SERVICES
Under the state Medicaid regulations, rehabilitative services include:
- Community Support Services (§419.456):
Community support services are provided in person one-on-one or in a small group (2 to
8 children and at least one staff), either on site (location operated by the Medicaid
provider at which the service will be provided such as clinic, clubhouse, school, or day
treatment setting) or in the community (including the individual's home).
The services include:
- initial and ongoing assessment of the child's psychiatric symptoms and skills and
deficits and their impact of child's ability to integrate into the community (e.g.
employment, school, housing, role-appropriate behavior, family and social relationships);
- designing, implementing and modifying interventions that are appropriate for the child's
needs as well as monitoring and evaluating outcomes of interventions;
- symptom management and support services which include nursing services (e.g.
administration of medication, monitoring efficacy and/or side-effects of medication, and
other nursing services that enable the child to attain or maintain an optimal level of
functioning); medication training and monitoring (e.g. information pertaining to the
purpose and side effects of medications and self-administration of medication provided to
primary care-giver of the child); other services to assist individual in the management of
symptoms of his or her mental illness (e.g. stress management, behavioral strategies or
techniques for coping with and managing symptoms, reality orientation and support services
during times of crisis or episodes of acute psychiatric symptoms); and other support
services to primary caretaker of child (e.g. training in stress management, behavioral
strategies or techniques for coping with or managing child as well as supportive
activities for the child when the child is in crisis);
- community living skills training which includes training in self-help skills such as
personal hygiene, household tasks and money management, supporting and training access to
community services such as medical care, legal services, transportation and living
accommodation; training in communication, interpersonal interactions and behaviors and
leisure time activities, and interventions to develop natural supports at home, work,
school and social settings; and
- employment-related supports and skills training which include interventions on or off
the job site or in school to reduce behaviors that interfere with job performance or
development of skills that would enable the child to obtain or retain employment.
- Day Programs for Acute Needs (§419.457):
Day programs for acute needs consist of short-term, intensive treatment provided in
highly structured and safe environment with constant supervision. Day programs for acute
needs include assessing child's psychiatric symptoms and current functional skills level
and identifying those skills necessary for the child to be maintained at home and
designing, implementing and modifying interventions as well as monitoring outcomes of
interventions. Unlike an adult receiving services in a day program for acute needs, a
child's length of stay per episode is not limited to 10 consecutive days. Day programs for
acute needs must be provided on site with staffing patterns to include a RN during all
hours of operation. Components of day programs for acute needs include:
- psychiatric nursing services, including crisis medical interventions (as ordered by a
- behavior skills training; and
- independent daily living skills training in self-care, social skills, integrating into
community services and other developmentally appropriate skills.
- Day Programs for Skill Training (§419.458):
Day programs for skill training focuses on amelioration of mental illness and
functional deficits through skill training and supportive interventions. Day programs for
skill training must be provided on site with at least one professional (e.g. a qualified
mental health professional-community services [QMHP-CS] as defined in 25 TAC §412.303) at
the day program's location during all hours of operation. Components of day programs for
skill training include:
- nursing services;
- medication training and monitoring;
- community integration skills training which includes instruction in behavioral skills
necessary for child to be maintained in his/her home or school, socialization skills,
stress management skills and other developmentally appropriate skills and for older
adolescents (16 and 17 years old) instruction in community integration (e.g. personal
safety, home maintenance, employment, security, mobility, accessing services, social
appropriateness), self-care tasks (e.g. personal hygiene, health, dress, grooming),
functioning as independently as possible (e.g. completion of education, money management);
- (d) symptoms management training (e.g. managing stress, behavioral strategies and
- Day Programs for Skills Maintenance (§ 419.459):
May not be provided to children or adolescents.
- Rehabilitative Treatment Plan Oversight (§419.460):
Rehabilitative treatment plan oversight is a face to face assessment and/or evaluation
of the child performed by a LPHA (e.g. a licensed practitioner of the healing arts such as
a physician, licensed professional counselor, master level social worker, psychologist or
advanced practice nurse) for purpose of determining child's continued need for and
appropriateness of rehabilitative services in child's rehabilitative treatment plan.
Rehabilitative treatment plan oversight must be provided not less than once every 90 days.
GENERAL REQUIREMENTS FOR REHABILITATIVE SERVICES
Section 419.455 establishes prerequisites for the delivery of rehabilitative services.
First, before rehabilitative services may be delivered, a child must have a current
rehabilitative treatment plan that is developed by a LPHA who has personally assessed the
child. A child experiencing a crisis that requires immediate rehabilitative services that
are medically necessary may be provided the services before having a rehabilitative
treatment plan. Second, a Medicaid provider must use a professional or paraprofessional to
deliver rehabilitative services. Third, community support services provided in response to
a crisis must be provided one-on-one and not in a small group. Fourth, multiple community
services occurring at the same time and at the same facility must be conducted by separate
staff and provided in separate locations within the facility. Fifth, with respect to
providing more than one rehabilitative service at the same time and on the same day, a
Medicaid provider is not prohibited from providing a community support service to the
child's parent or primary caregiver at the same time and on the same day the child is
receiving a separate community support service or attending a day program; but is
prohibited from providing more than one rehabilitative service to a child at the same time
and on the same day.
LIMITATIONS ON MEDICAID REIMBURSEMENT
Section 419.462 sets limitations on Medicaid reimbursement. Under the state
regulations, Medicaid will not pay for rehabilitative services delivered in excess of 12
hours per child per day. In addition, the state Medicaid regulations place a 6 hour per
day per child cap on one-on-one services, small group services and day program services.
Medicaid reimbursement for day programs is inclusive of all services provided within day
program delivered by day program staff including crisis intervention services. Medicaid
will not pay for community support services provided to a child on the same day as day
programming if the community support services are similar to day programming services
unless the services are in response to a crisis that occurred outside of the day program
or of such specificity as to enhance or reinforce training or services begun in a day
program. Medicaid will not reimburse services as rehabilitative services such as nursing
services that are incidental to another Medicaid covered service (e.g. office visit with a
physician); services that are integral and inseparable part of another Medicaid service;
outreach activities designed to locate potential Medicaid eligible clients; any medical
evaluation, examination or treatment that is billable as a separate and distinct Medicaid
covered service; educational or vocational services; services provided in an inpatient
hospital setting; services provided to children with single diagnosis of mental
retardation or developmentally disability without a dual diagnosis of mental illness; or
services provided to inmates of a public institution (e.g. penal institution) as defined
by 42 C.F.R. §435.1009.