A Pained Life: Marginalized in Louisiana

A Pained Life: Marginalized in Louisiana

From the official guidelines of the Louisiana Medicaid Program:

“Louisiana Medicaid covers the epidural injection of an anesthetic substance for the prevention or control of acute pain such as that which occurs during delivery or surgery. Billing of these procedures subsequently for pain management, pain control, or any another reason is not covered. Medicaid does not cover spinal injections to alleviate chronic, intractable pain. 

Louisiana Medicaid does not cover any services for chronic pain management.”

This scares me. What it says is if you are poor and sick in Louisiana, the state will not help you if you have a chronic pain disorder.

Woman in painHow is it that medicine and its practice has become more the purview of politicians then doctors?

My concern has mostly been about the legalization of medical marijuana for those in pain, as well as other diseases and disorders that have been shown to benefit from this drug.

It never occurred to me, until I saw a post in a support group about the Louisiana rule, that the government, at least in one state, has decided they are doctors and can pronounce what illness is not worthy of state dollars.

It would be one thing if all chronic pain disorders were in doubt. Although fibromyalgia still has its detractors, Chronic Regional Pain Syndrome, trigeminal and other cranial neuropathies, multiple sclerosis, lupus, and many other chronic pain conditions have been repeatedly proven to be of medical origin, their “legitimacy” not in doubt.

What troubles me even more is that those who need the aid of the state already have few resources. They cannot afford alternative treatments or pay for the medications and treatments that a doctor might prescribe. Hiring aides, home healthcare workers, etc. is going to be financially difficult, if not impossible.

What is more concerning is the question of the slippery slope.

How many other states might jump on this bandwagon?

We, as pain patients, and the medical community who treat those in pain, are already in a fight with the DEA over how and sometimes what may be prescribed.

The media has fallen on the bandwagon of blaming those in chronic pain for the opioid “epidemic.” These two entities have helped to make our fight harder, because we have to fight just to be believed and to not be thought of as drug seekers.

Many of us are either disabled by our pain or just working part time when able. Those who can work have often taken jobs that pay little. Poverty is often a side effect of our pain.

At what point will we be treated as equals to all other patients, and chronic pain accepted as equal to other disorders and diseases?

Pain often makes it harder to gather the strength to fight. It seems to make us easy prey.

I want to end with an answer but all I can posit is the question: Why are we denied what other patients can take for granted?

Carol Levy

Carol Levy

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol was accredited to the United Nations Convention on the Rights of Persons with Disabilities, where she helped get chronic pain recognized as a disease.

Carol is the founder of the Facebook support group “Women in Pain Awareness”. Her blog “The Pained Life” can be found here.

The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that!  It is for informational purposes only and represents the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

For more information, read our User Agreement and Terms of Use.

Authored by: Carol Levy, Columnist

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BL

Since Medicaid is mentioned here, I thought some of you might find this interesting. There are all sorts of reports that have to go to the Federal Government regarding Medicaid. One of those reports is below, it is in regards to certain Prescription Drugs. Put , PDMP, in the find part of your browser for state info required regarding Prescription Drug Monitoring Program. Continue to scroll down to see info regarding Pain Management Controls, Opioids, ect.

MEDICAID DRUG UTILIZATION REVIEW ANNUAL REPORT-
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Downloads/DURSurvey_20140617.pdf

BL

Maryanne D, “Louisiana Medicaid does not cover any services for chronic pain management.” It does cover pain management for things like Labor & Delivery that are acute. Since the management of chronic pain is not a mandatory benefit under federal medicaid, it is up to each state to decide if they want to cover it and in what situations. Most state Medicaids also have limits on the meds they cover for chronic pain. These decisions are made by the states and they don’t have to have a basis for them. Meditation, accupuncture, etc are not cover under Louisiana Medicaid. Chiropractic Services are also not covered under Louisiana Medicaid, unless the receipent is 21 or under.

Maryanne D

I have a few questions regarding this topic. When did they begin this practice? Does it apply to all forms of chronic pain or specific ones, such as low back pain? What is the state using as justification for stopping coverage…such as journal articles especially those referring to success rates of different types of treatment. This is such a tough and wide ranging topic. In today’s “health care coverage world” many are looking for alternative treatments due to the limited results of the traditional treatments. Alternatives include meditation, deep breathing, graded activity. One thing is for sure. It is a very scary topic as from personal experience those making decisions usually lack the correct background on the topic.

Janice Reynolds

The steroid injections issue is a McGuffin. It is the not paying for any treatment which is the problem.This is indeed scary. At least with MaineCare, they made exceptions for Cancer patients, HIV/AIDS patients as well as EOL and offer ineffective alternatives to opioids (generic, limited medication and insufficient non-pharma. Maine Care’s rules went into effect not to limit opioids but to save money (never quite figured that one out). Could that be Louisiana’s excuse also? In any case we have a whole population of people being discriminated against. Where is the ACLU? If this was about race or just poverty they would be all over it. Instead we have a population of people with an established disease who face discrimination. Those who are Medicaid are also poor and lack the resources to find alternatives. When insurance is doing the limiting all people with persistent pain are affected so I repeat, where is the ACLU? The World Health Organization has said “it is a human right to have chronic pain treated”. Why are the rights of people with persistent pain being abrogated and dismissed?

BL

Margo, you are right. When treatment and quality of treatment has been removed for one segment of society, they move up tp the next one. More and more people will suffer ad time goes on.

There is a limit of 12 office visits a year with Louisiana Medicaid. You can get an override, but very rarely are they done. The paper work has to be submitted after a visit has taken place and it must be a situation that would result in death or a condition worsing. And chronic severe pain isn’t viewed as a serious condition. So if someone wants to get a second or third opinion from a Dr and they receive Louisiana Medicaid, they run the risk of not being able to see the dr for regular treatment until the new year comes.

BL

Steve M, but when other drs in the Louisiana Medicaid program will not prescribe pain meds for chronic pain because they all tell a patient they need Pain Management. And no Pain Management dr will accept Louisiana Medicaid, those on Medicaid receive no pain management.

Pharmacist Steve, Some states, mainly the ones up north, have better Medicaid programs than those in the south. Although all of them have suffered cuts.

Mark S Barletta

Epidural injections for chronic pain in the spine could cause worse pain than a person already has if the doctor enters the spinal cord passing the dura space. So its best not to even consider a epidural injection to the spine, a fraction of a inch too far could pass the dura space and puncture the spinal cord causing Arachnoiditis which is difficult to treat. Surgical intervention generally has a poor outcome, and only provides temporary relief. Steroid injections administered either intrathecally or epidurally have been linked as a cause of Arachnoiditis , therefore they are generally discouraged as a treatment and may even worsen the condition. Doctors have different views about this disease so seeking a second opinion may be wise.

Margo

I agree. Unfortunately, I think the only “safe” people will be the very rich. Can you imagine our government watching their own children suffer? Or a senator suffer CAPS untreated? Don’t think so. Celebrities (Michael Jackson) will have the means, power and finances to get pain care on demand. Alcohol kills 1 in 10. I’m sure misuse of marijuana (driving under influence) will result in deaths. The country needs a new “cause” to hitch their do good wagon to. Unfortunately, it’s become anything even remotely associated with opiates. They sleep well at night knowing their “war on drugs” continues to save lives. They have no idea about the reality of the situation. They have no clue how many innocent patients are and will suffer due to their zealous attacks. The doctor/patient relationship used to be sacred. Now the government, insurance companies, pharmacies & pharmacists can decide on a whim from a desk miles away weather we will receive treatment. Doctors are scated their licenses will be revoked due to the crazy regulations being added daily to stop abuse. As usual, the addict is cared for more than the legitimate patients. I know we’re tired and we’re all very sick. We’re just grasping at regaining a remnant of our lives; lives that will never be the same. However, we must all try to post, share and respond to these articles. We need to make it known that we are the forgotten victims in this new mess. I wish I could use my energy to heal and be confident my care will continue, but instead I’m very scared. We all are.

The war on drugs has made a turn towards a war on pts.. now has the war on poverty taken a similar turn to be a war on the poor ?

BL

I can asnwer that question. Because Medicaid patients don’t have the money and resources and are viewed as being a drain on society, they are contributing nothing. It doesn’t matter if a Louisiana Medicaid patient is receiving SSI for disabilities that are painful and severely limiting their ability to do activities of daily living. The max monthly amount someone on SSI receives in Louisiana is $721.

Louisiana Medicaid Provider Update Volume 30, Issue 5 September/October 2012, Page 6 Louisiana Drug Utilization Review Education has an article. It discusses how debilating pain can be, it also talks about the high rate of abuse. No where in this article does it state that Louisiana Medicaid will not pay for the management of chronic pain.

The cost of going to a Pain Management Dr is app $200-$300 or more a month.This is not something someone who is receiving Medicaid, let alone SSI can afford.

Louisiana Medicaid does pay for Long Term Personal Care Services in someones home. They must have Medicaid and they must meet the criteria for going into a nursing home in order to receive these services. They must require some level of help with things like showering, preparing meals, laundry, light housekeeping, grocery shopping, getting dressed, ect. A social worker goes to their home to evaluate them and determine how many hours a week they are eligible for. By the way, Louisiana Medicaid has cut the the amount they pay the PCA’s and the max number of hours a person can rceive LTPCS.

Correct me if I’m wrong, but wouldn’t it be cheaper to provide some form of pain management to these individuals than for the state to pay for LTPCS, short term as well as long term ?

For the record, being a Louisiana Medicaid patient and being in a Nursing Facility does not mean that a patient will receive any treatment for their chronic pain then either.

To me this is cruel and inhumane treatment. I’ve been trying to help someone who is disabled, older and on Louisiana Medicaid find some help for their chronic severe pain. There is none, without the several hundered dollars a month to pay for it.

Steve M

I agree with Louisiana Medicaid, epidural steroids are not FDA approved and are dangerous.