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Group for adults with different abilities waiting on $180,000 after Medicaid funding change

4Abilities meets at home
Posted at 9:34 PM, Mar 24, 2023
and last updated 2023-03-26 20:24:22-04

CENTENNIAL, Colo. — Last week, Denver7 introduced you to 4Abilities, a group that describes itself as a “not for profit, grassroots effort in Centennial, CO” to “provide community-based support services to individuals with different abilities.” The organization works to partner its members with fitness and health coaching, community connections, job training, and residential services.

We met the group at the Aurora YMCA at Wheatlands, as its members were working out together.

As a Program Approved Service Agency (PASA) recognized by the state of Colorado since 2018, 4Abilities has received Medicaid funds to support its services. Founder and president Kelly Wilson said she’s never had a problem with government agencies or funding, until last May.

“All my claims came back denied,” Wilson recalled. “So I reached out to my CCB, which stands for Community Center Board. They’re the organization where the service plans are housed. They’re my first line. So, I called them and they said, ‘Everything looks find here. There’s no issues.’ And I said, ‘Well, billing’s being declined.’ They sent me to two other agencies… I checked with them, they said, ‘Everything looks fine here.’ But, my bill was not going through.”

That was the start of months of back-and-forth with the Colorado Department of Public Health and Environment (CDPHE) and Health First Colorado, the state’s branch for Medicaid. Wilson forwarded Denver7 several email chains, showing her communications with representatives from each agency to identify and fix the problem.

“Come to find out, there were three residential billing codes, and on April 1, our Medicaid office changed the codes,” Wilson said, describing her ongoing conversations with the agencies involved. “They updated their system, and they eliminated one of the billing codes. That was the billing code that I was using to bill for residential services. So the whole code was eliminated, and it took me two and half months to find that out.”

In the months since, Wilson has continued corresponding with representatives, working to rectify her organizations standing within the systems to resume billing.

On several occasions, emails show representatives informing her that her organization had been approved, but she remained unable to bill Medicaid for services.

During that time, 4Abilities continued to operate and provide its services. Wilson said she took on extra jobs to pay the individuals working for 4Abilities, with the understanding that she would receive back pay when the billing issues were resolved. She said she has not received about $180,000 in expected funds from Medicaid.

“In February, I was told that you have to make sure you bill your services within 365 days,” she said. “I have not been able to bill for residential services since April 1 of 2022. We are now at the end of March of [2023]. I am quickly approaching that deadline where I’m not going to be able to bill for those services because they’re over a year old.”

Denver7 worked to find our own answers Friday, reaching out to both CDPHE and Health First Colorado. A representative for CDPHE told us he would look into the issue. A representative for Health First Colorado said the individuals with knowledge of the situation were out of the office, but would get back to us with more information next week.

Wilson said each representative she’s spoken with through the process has been courteous, and has tried to be helpful. But with a deadline approaching, that could mean costs her small organization can’t afford. She feels desperate for real answers and resolution.

“I don’t think people are realizing that for every gap and every hole, and every miscommunication and every misstep in their system, there’s a real life consequence,” she said. “And that real life consequence hits us here. And when that goes on for 11 months, we get to a place where I don’t know what the next step is.”

Editor’s note: Denver7 has chosen to use phrasing involving “different abilities” in this story because the founder of 4Abilities specifically and intentionally uses it to describe members of her family and her business, in contrast to terms like “disability.”

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