Troubled Iowa teen's progress stalled again by private Medicaid manager

In his worst moments, Logan Polly kicked holes in walls, beat himself and attacked others. He threatened to kill his mother, filled his school locker with hoarded food, ran away often and stopped eating for days at a time.

Back in April, the 14-year-old adopted teen’s prospects of a productive future seemed dim and getting dimmer.

His hard-to-find treatment, funded by Medicaid, was at risk of being cut short. AmeriHealth Caritas, one of three firms Iowa hired to manage Logan's care, was trying to rein in the cost of his care, Tina Polly said.

Today, Tina Polly of Council Bluffs is ecstatic to report that her troubled son is doing much better. Once defiant, he is now cooperating and participating in his own treatment.

"He's doing everything that they ask him to do — a complete 360," she said.

After Logan’s plight was detailed by the Reader's Watchdog, insurance coverage was extended to allow the boy to stay several months more at Piney Ridge Treatment Center in Waynesville, Missouri. There, he received specialized treatment for a hard-to-treat case of reactive attachment disorder.

But this week, AmeriHealth attempted to pull the plug again. Tina Polly says she was told early in the week her son could be discharged from Piney Ridge as soon as Friday.

“I was directly told by a guy on the phone from the insurance company that if they do discharge him and I am not there to pick him up, they will call (child protective services) on me,” she said.

State officials announced Oct. 31 that AmeriHealth was pulling out of the state. Members' coverage shifts to another company Dec. 1.

Tina Polly says she and Piney Ridge workers were trying to place Logan in a facility closer to Council Bluffs so they can do home visits and eventually transition the now 15-year-old back to their house.

Hear from Tina and Logan in this video from April: 

“He’s been locked up this whole time and needs what they call a step-down facility, but Iowa doesn’t have any. So I’ve been checking into other (residential behavior and psychiatric problems), but insurance is saying (they're) not going to pay for that.”

Before Logan landed at Piney Ridge, Tina Polly collected letters of rejection from 13 treatment providers — including every residential treatment program in Iowa that provides intensive psychological and behavioral treatment for youths such as Logan.

The teen has a mix of mental health disorders, but reactive attachment disorder is the most severe. The condition is sometimes diagnosed in abused or neglected children who have not been able to bond with caregivers or learn healthy attachments.

At Piney Ridge, Logan has been under watch by staff members who are trained in helping him and other youths with extreme behavior or mental health issues.

But Paul Smith, the administrator of Piney Ridge, said last April that Iowa's decision to have private companies manage Medicaid and its low reimbursement rates for residential care jeopardize the success of such treatment.

"We need time to do our jobs," Smith said.

AmeriHealth has the largest share of members of any of the three Medicaid-managed care companies working in Iowa. Its members include about three-quarters of Iowa Medicaid recipients who have serious disabilities.

 All of its members are to be auto-enrolled into UnitedHealthcare coverage on Dec. 1, unless they choose the third company, Amerigroup.

Tina Polly said Friday that officials haven't given her time to find any place in Iowa that will accept her son on short notice.

Amy White, admissions coordinator for Orchard Place’s psychiatric medical institute for children facility in Des Moines, told her in an email that Logan would have to be screened and interviewed, and that the facility has no single rooms coming available through December.

Another in Council Bluffs indicated it might have room if given a little more time.

By Friday afternoon, a Piney Ridge manager emailed Polly saying they were still waiting for word from the insurer about whether Logan could stay longer.

Then Tina Polly got a call from a top AmeriHealth case manager, Diana Dainty — the same woman who pushed to end treatment at Piney Ridge last September — saying that the boy would stay in Missouri, but that he would need a transition home in 30 days.

"I had hoped to get time to get him closer to home, so we could do home visits while working to get him home," Polly said. 

I asked AmeriHealth for comment on Logan's case, noting that Tina Polly signed a release form permitting others to comment on his treatment. 

The company sent me the same statement it sent last September: "While we’re not going to comment on this specific case, what we can share is that each member’s health is evaluated individually, and appropriate medical criteria are used in all situations. It is also important to know that we do not make treatment decisions, but rather coverage determinations based on the physician’s prescribed treatment."

Tina Polly says she'll continue to fight to get Logan to a facility closer to home, so he and her family can get the support they need before breaking with treatment.

"But I shouldn't have to be this strong of advocate for my son to get him the care he needs," she said. "I shouldn't have to fight this hard."

Lee Rood's Reader's Watchdog column helps Iowans get answers and accountability from public officials, the justice system, businesses and nonprofits. Contact her at lrood@dmreg.com, 515-284-8549 on Twitter @leerood or at facebook.com/readerswatchdog.