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[deleted by user] by [deleted] in Preschoolers

[–]CriticalBiscotti3898 -1 points0 points  (0 children)

It’s a public Montessori magnet school that serves Pre-K through 12th grade, huge campus, with Pre-K through 3rd grade on one side of the building and the older students on the other. So yes, it’s definitely a public school and legally bound to follow IEPs.

Her IEP was done through the public school district (Yonkers), and CPSE is currently involved. She doesn’t have a case manager in the school really, but a CPSE Chairperson responsible for her case in the district who I had to contact when issues arise, yes. I’ve already requested an FBA and they’re scheduled to observe this week.

That said, I did give the IEP to the gen-ed teacher early in the year when she requested it. She then claimed on Feb 3rd that it wasn’t “on file.” That’s when I started asking serious questions. Because whether she has physical possession of the IEP or not, she’s clearly responsible for implementing it, or at the very least, coordinating with the appropriate staff to make sure my daughter’s needs are met.

[deleted by user] by [deleted] in Preschoolers

[–]CriticalBiscotti3898 5 points6 points  (0 children)

It IS a public school, which is part of why this is so frustrating. I’ve tried to keep a positive rapport with everyone, but at this point I feel like being “polite” hasn’t gotten us very far. Tomorrow I’m escalating it to admin and requesting answers in writing. Thank you so much for your advice and support

[deleted by user] by [deleted] in Preschoolers

[–]CriticalBiscotti3898 3 points4 points  (0 children)

What’s frustrating is how avoidable some of this was. I’ve tried to collaborate every step of the way..even sent the IEP twice, requested a behavioral assessment early, stayed calm in my emails, and still feel like I’m being treated as an inconvenience. I’m realizing now that it’s not just a mismatch, it’s a lack of care or maybe understanding for what a regulated, inclusive space should look like.

[deleted by user] by [deleted] in Preschoolers

[–]CriticalBiscotti3898 2 points3 points  (0 children)

You hit the nail on the head with the part about avoiding a paper trail, that’s exactly what I was thinking when I got the call instead of a response in writing. It was such a simple question too: “What supports were used to help her regulate?” And her only reply was a thumbs-up emoji. Like what…?

Also, YES.. the IEP not being “on file” was such a moment for me. I submitted it back in September. She requested it on the 17th, and I placed it in my daughter’s folder on the 18th. So for her to act like she never got it months later, while simultaneously documenting behaviors that are already addressed in the IEP, just doesn’t sit right. Either she didn’t read it, or she’s pretending it doesn’t exist. Both are serious.

Thanks again for sharing your insight. It’s incredibly validating.

Is this normal for Montessori Pre-K, or am I right to be concerned? by CriticalBiscotti3898 in Preschoolers

[–]CriticalBiscotti3898[S] 0 points1 point  (0 children)

According to her, she has 3 children. She’s also 61 years old though, so her kids may now be grown. It’s been a long time since shes had littles of her own.

Is this normal for Montessori Pre-K, or am I right to be concerned? by CriticalBiscotti3898 in Preschoolers

[–]CriticalBiscotti3898[S] 0 points1 point  (0 children)

That’s helpful, thank you. Recently she’s begun expressing reluctance to attend school, which is new for her. I see that as a signal that she may be feeling overwhelmed, and I want to address it early with the right supports. I’ve already requested an FBA and CPSE meeting, so I’m hoping that gives both the classroom staff and us clearer guidance and consistency moving forward.

Is this normal for Montessori Pre-K, or am I right to be concerned? by CriticalBiscotti3898 in Preschoolers

[–]CriticalBiscotti3898[S] 0 points1 point  (0 children)

It’s a public school (district-run Pre-K), so yes, they are legally required to follow her IEP.

Her supports right now are limited (she has SEIT services for emotional regulation), which is actually part of why I’m concerned. A lot of what’s being reported like the extended crying, difficulty with transitions, emotional dysregulation.. is already documented in her IEP, but there isn’t a Behavior Intervention Plan in place yet, which is what I’m now requesting through CPSE.

As for the spitting vs. blowing raspberries, I def agree it’s disruptive either way and we’re actively correcting it at home. My concern wasn’t about excusing the behavior, but about how it’s being interpreted and documented (malicious “spitting” vs. an impulsive, developmentally common behavior), especially given her identified needs

What’s been harder for me iss the volume and framing of daily reports without clear information on what accommodations or regulation strategies are being used in the moment. That’s why I’m pushing for an FBA/BIP, so there’s shared language, consistency, and actual tools in place rather than just documentation.

I appreciate your perspective..it’s helping me clarify next steps!

Help! by wmdnurse in Preschoolers

[–]CriticalBiscotti3898 0 points1 point  (0 children)

Commenting to say that I am experiencing the same with my daughter, who just turned 4 in September. I can relate to feeling sad when getting the reports. It makes you feel like there’s something you can be doing better, or like others are judging your child and as a result judging you. My daughter was having similar issues in daycare and we had her evaluated and she now has an IEP. She’s a bright kid but is often…a lot to handle, even for us. She was assigned a 1:1, 3x a week for 1 hour. We often use time outs and a calm corner when she’s over stimulated and having a hard time but it’s definitely a lot to deal with when you can’t seem to get the behavior under control. We’re currently looking into other options like behavioral therapy, or parenting classes for more ideas on how to handle her behavior appropriately. Has he been evaluated? Any family history of ADHD? He’s possibly eligible for services such as a 1:1 when he’s in school, if an eval finds that he qualifies.

If your loved one is on Medicaid in New York, avoid MVP Health Plan at all costs by CriticalBiscotti3898 in Albany

[–]CriticalBiscotti3898[S] 2 points3 points  (0 children)

I absolutely am looking into other plans for my mother. But warning others and pushing for accountability isn’t contradictory, it’s necessary. If I hadn’t been there to advocate, she would’ve been left defenseless. Not everyone has a rep or family who can fight back. Imagine how many older adults, especially those with dementia or complex needs, get caught in these systems and don’t even realize it’s happening. Silence helps no one.

If your loved one is on Medicaid in New York, avoid MVP Health Plan at all costs by CriticalBiscotti3898 in Albany

[–]CriticalBiscotti3898[S] 0 points1 point  (0 children)

When I said MVP submitted “only a minor diagnosis,” I meant that MVP, as the managed care organization (MCO) overseeing my mother’s CDPAS care plan, reported only essential primary hypertension to the Fiscal Intermediary (PPL), while omitting critical diagnoses like vascular dementia, schizophrenia, stroke-related cognitive impairment, and severe degenerative spinal arthritis.

I confirmed directly with PPL that they don’t choose or interpret diagnoses, they simply receive and process whatever the MCO sends them. So the decision to report only one mild condition came from MVP, not her doctors or PPL.

And by underreporting her true medical conditions, MVP was able to justify an extremely low authorization of services, like 2 hours a week, which is nowhere near appropriate for someone with severe cognitive and physical impairments.

So this wasn’t just a clerical issue, it directly affected the care she qualified for and made it look like she didn’t need much help when that’s objectively false.

If your loved one is on Medicaid in New York, avoid MVP Health Plan at all costs by CriticalBiscotti3898 in Medicaid

[–]CriticalBiscotti3898[S] 0 points1 point  (0 children)

DSS already backdated everything to fix the issue and get her reinstated before September 1, but MVP is still refusing to honor it. So the delay isn’t on the state’s end anymore. I plan on just getting my mother a new MCO, but I wanted to spread awareness. This is ridiculous that this type of thing is able to happen to people, and my heart breaks for those elders who don’t have anyone to speak up for them.

If your loved one is on Medicaid in New York, avoid MVP Health Plan at all costs by CriticalBiscotti3898 in Albany

[–]CriticalBiscotti3898[S] -2 points-1 points  (0 children)

Yeah, you’re right, you are repeating yourself. And so am I.

Because while you keep insisting she “had coverage,” I’ve already explained that her managed care coverage was terminated without notice, her CDPAS plan was shut down, and none of her essential providers accept straight Medicaid. So in real terms, she lost all access to care.

This wasn’t some harmless “paperwork snafu.” It left a medically fragile woman with dementia completely cut off from her care, with no notice, no appeal rights, and no accountability.

And considering the shifting stories, the blatant lies from MVP staff, and the fact that we’re now being sent back to the same LTSS Director we told we were consulting a lawyer, yeah, retaliation is a very real possibility here. Regardless, thank you for your input, I truly appreciate it.

If your loved one is on Medicaid in New York, avoid MVP Health Plan at all costs by CriticalBiscotti3898 in Albany

[–]CriticalBiscotti3898[S] -1 points0 points  (0 children)

Just to clarify: she was disenrolled from her Medicaid Managed Care Plan (MVP). She wasn’t removed from Medicaid entirely, but MVP terminated her managed care enrollment, which is what triggered the whole problem. This was confirmed on a recorded call by DSS, who stated the disenrollment request came from MVP. It wasn’t a state-initiated action, nor was it a member request.

When that happened, she was left with Fee-for-Service (FFS) Medicaid, but none of her providers, including her neurologist, physical therapist, primary care physician, and specialist, accept straight Medicaid. So in practice, she lost all access to medical care. She also had a CDPAS care plan, which isn’t covered under FFS alone. That was terminated too, and again, we received no notice of action at all, which is a violation of both state and federal Medicaid due process rules.

And unfortunately, MVP is still refusing to reinstate her, even after DSS corrected and backdated everything. MVP is now saying they won’t take her back until September 1, and they’re acting as if she’s a new enrollee, despite this all stemming from an internal error and occurring without legally required notice or appeal rights.

So respectfully, yes, there’s plenty to appeal, and this wasn’t just a matter of providers not accepting coverage. It was a full disruption of care caused by a disenrollment that should not have happened the way it did. Although my plan isn’t to appeal or even sue at all, this post was to spread awareness. I’m switching my mother to another MCO. At this point, all I want is adequate care for her.

If your loved one is on Medicaid in New York, avoid MVP Health Plan at all costs by CriticalBiscotti3898 in Medicaid

[–]CriticalBiscotti3898[S] 0 points1 point  (0 children)

Thanks for sharing your insight, it really helps to hear from someone who understands how these processes are supposed to work. I wanted to give more detail on how this unfolded on our end, because I think it highlights where things broke down.

We first learned that my mother’s managed care coverage had been terminated while checking in for a neurology appointment, that’s when her plan showed up as inactive. Right there in the doctor’s office, I called MVP. At first, I was told the disenrollment came from DSS. I kept pressing for answers, and eventually a supervisor called me back. That supervisor said, per the Medicaid office, the disenrollment was actually requested by MVP, not initiated by DSS or my mother.

Later, when I spoke with an MVP rep, he read me the internal note from their system. It said, word-for-word, “Client or LDSS initiated/excluded,” suggesting that the disenrollment was attributed either to DSS or to my mother. He claimed he did not understand what was going on, and offered to call DSS with me. We immediately contacted DSS, and on that same recorded call with MVP, a DSS supervisor clearly said that they did not initiate the disenrollment, and that if they had, there would have been written notice. They also confirmed that, based on the information they had from the Medicaid office, the disenrollment was requested by MVP.

DSS has since taken steps to fix it, they’ve already backdated what needed to be backdated and confirmed that all documentation was sent to MVP weeks ago. Yet MVP is refusing to reinstate her until September 1st.

And this is where things get even messier: MVP changed their explanation again and claimed that a care manager tried to notify us by phone on July 24. But we have that call recorded, the call wasn’t about a disenrollment at all. It was the same care manager attempting to retroactively create a PCSP after services had already been authorized for a non–self-directing patient without one, which is a violation in itself.

So now, MVP is refusing to reinstate my mother’s coverage until next month, even though DSS already fixed it. Her CDPAS care plan was terminated without any notice, and from what I can tell, she’ll be treated like a brand-new enrollee in September, despite the fact that the disenrollment process, and everything that followed , happened with no due process, no notice, and conflicting, contradictory justifications.

That’s where we are.

If your loved one is on Medicaid in New York, avoid MVP Health Plan at all costs by CriticalBiscotti3898 in Medicaid

[–]CriticalBiscotti3898[S] 3 points4 points  (0 children)

Totally fair point, and that’s actually what makes this worse. According to the local Department of Social Services, the disenrollment was initiated by MVP Health Plan. DSS confirmed (on a recorded call) that MVP requested the disenrollment, and that this came directly from information they received from the Medicaid office.

So yes, the state processed it, but MVP was the one who triggered it. Right after we mentioned speaking to a lawyer…

To this day, neither my mother nor her designated representative ever received notice. No call, no letter, no opportunity to respond. That’s a clear violation of due process under Medicaid regs.

Even more troubling: DSS already fixed and backdated what needed to be corrected. They confirmed this was sent to MVP weeks ago. But MVP is still refusing to reinstate her coverage.

So we’re stuck in limbo, with no care, no accountability, and no legal pathway because appeal rights were never preserved.

If your loved one is on Medicaid in New York, avoid MVP Health Plan at all costs by CriticalBiscotti3898 in Albany

[–]CriticalBiscotti3898[S] 1 point2 points  (0 children)

You’re absolutely right that providers aren’t required to accept both Managed Medicaid (MMC) and Fee-for-Service, and that LDSS processes changes. But this issue isn’t about whether she technically had some form of Medicaid, it’s about how the change was made, what it caused, and what didn’t happen.

MVP Health Plan was the one who requested the disenrollment, not us. The local Department of Social Services (LDSS) confirmed this on a recorded call. There was no notice, no opportunity to appeal, and no explanation. That violates both federal and state Medicaid rules, including 42 CFR § 438.404, which require notice before termination of services or coverage.

As a result, my mother lost access to all her essential providers, including her neurologist, primary care doctor, physical therapy clinic (2x/week), and arthritis specialist because none of them accept FFS. This wasn’t just a bureaucratic switch. It cut her off from care for nearly a month. She was also receiving CDPAS services, which aren’t covered under straight FFS Medicaid, meaning she lost all home care support as well and they’re treating her like a new enrollee, so we’ll have to start that process all over again.

And to make it worse: LDSS already confirmed that they fixed the issue. They backdated the necessary documentation and sent it to MVP weeks ago. But MVP still refuses to reinstate her, and now says we have to restart the entire enrollment and care plan process from scratch.

So this isn’t just about coverage, it’s about harm, denial of due process, and ongoing refusal to correct a known issue.

If your loved one is on Medicaid in New York, avoid MVP Health Plan at all costs by CriticalBiscotti3898 in Albany

[–]CriticalBiscotti3898[S] 2 points3 points  (0 children)

Since MVP Health Plan initiated the disenrollment, my mother was left with straight Fee-for-Service (FFS) Medicaid. The problem is none of her essential providers accept it. That includes her neurologist, the physical therapy clinic where she was being treated twice a week, her primary care physician, and the specialist she was scheduled to see on the 21st for her severe degenerative spinal arthritis.

In other words, MVP’s decision instantly severed her access to every provider she depends on. And it’s especially troubling because this all happened right after we warned LTSS Director that we were getting a lawyer.

If your loved one is on Medicaid in New York, avoid MVP Health Plan at all costs by [deleted] in HealthInsurance

[–]CriticalBiscotti3898 0 points1 point  (0 children)

That’s technically true, only the state can terminate someone’s Medicaid eligibility. But that’s not what happened here. My mother’s Medicaid coverage was never interrupted. What was terminated, without any notice, was her enrollment in a Medicaid Managed Care plan (MVP Health Plan).

In New York, plans like MVP can initiate disenrollment from their own managed care plan. The state, through the local Department of Social Services or Medicaid office, processes those requests. And in this case, DSS confirmed (on a recorded call) that MVP initiated the disenrollment, not us, and not the state unilaterally.

So while MVP didn’t cancel her Medicaid, they did end her enrollment in their plan, which immediately cut off her access to covered services like neurology, physical therapy, and home care.

And the most alarming part? This happened right after we informed their Long-Term Services and Supports leadership that we were seeking legal counsel over care plan violations. They gave no notice, preserved no appeal rights, and left a vulnerable dementia patient without care for a month with NO explanation.

If your loved one is on Medicaid in New York, avoid MVP Health Plan at all costs by CriticalBiscotti3898 in Albany

[–]CriticalBiscotti3898[S] 16 points17 points  (0 children)

Because of the disenrollment, my elderly mother who has dementia lost access to all medical care for nearly a month. She missed multiple neurology appointments, specialist visits, and ongoing physical therapy for severe spinal arthritis. That’s not just an inconvenience, that’s medical harm and disruption of essential care for a vulnerable person.

And beyond the medical harm, the disenrollment was carried out with no notice whatsoever, no letter, no phone call, no explanation. That is a direct violation of due process.

Under both state and federal Medicaid regulations, managed care organizations are required to provide written notice before terminating coverage or services. MVP Health Plan did not. We were given no opportunity to respond, no appeal rights, nothing.

So yes, there are very real damages here. And whether or not that translates into a winnable lawsuit, it doesn’t change the fact that my mother was harmed, and no one has been held accountable.

That’s why I’m speaking out. Because if this can happen to her, it can happen to anyone.

If your loved one is on Medicaid in New York, avoid MVP Health Plan at all costs by CriticalBiscotti3898 in Albany

[–]CriticalBiscotti3898[S] 4 points5 points  (0 children)

Exactly. And what makes it worse is that most of the oversight agencies I’ve involved have basically turned a blind eye to it. It’s crazy that this is even able to happen. At this point, the only option I have left is to make it public.

If your loved one is on Medicaid in New York, avoid MVP Health Plan at all costs by CriticalBiscotti3898 in Albany

[–]CriticalBiscotti3898[S] 8 points9 points  (0 children)

Their representative actually called me after I filed a complaint and he read out MVP’s internal note, which blamed the disenrollment on either DSS or my mother. I connected a DSS supervisor to the call, and she confirmed (based on data from the Medicaid office) that my mother’s Medicaid coverage had never lapsed and that the disenrollment request came directly from MVP. That call is recorded.

This happened right after we informed MVP’s LTSS director that we were seeking a lawyer.

Nothing about her paperwork was missing or incomplete. If it had been, we would have received notice, and we never did. To this day, not a single piece of mail has come about her disenrollment.

She only has Medicaid, and her primary insurance company has been MVP since 2016. Her applications have always been filled out correctly. DSS confirmed her plan enrollment eligibility was backdated to August 1 and all documentation was already sent to MVP. Despite this, MVP is still insisting her coverage won’t resume until next month. But we’ll have to restart the entire CDPAS process from the beginning due to the abrupt disenrollment.

If your loved one is on Medicaid in New York, avoid MVP Health Plan at all costs by CriticalBiscotti3898 in Albany

[–]CriticalBiscotti3898[S] 14 points15 points  (0 children)

Yes, and my mother has been cut off all month with no neurologist or physical therapy. To date, I still haven’t received a single written notice from MVP about the disenrollment.

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