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One man's loss-of-freedom story can shine light on needed Medicaid reforms
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Feb. 11, 2003 UPDATE --Late yesterday, HHS Secretary Tommy G. Thompson announced the approval of a new Medicaid waiver in Alabama to provide services "to certain Medicaid-eligible individuals" which "will assure continued support for people who might otherwise lose their services simply because they turn 21." Attorneys for Nick Dupree had filed for an junction to keep the 20-year-old Mobile man out of an Alabama nursing home; a hearing is scheduled for today. But the real impetus behind the action was pursuit of the story by NPR's Joe Shapiro. Yesterday Shapiro reported on Dupree's fight on All Things Considered."

Listen to NPR's All Things Considered with Joe Shapiro's report on Dupree's nursing-home battle.

Read story in Mobile Register.

Feb. 2, 2003 -- In last week's e-letter, we noted that Pres. George Bush would propose in his budget a new $1.75 billion, five-year program to help Americans with disabilities transition from nursing homes or other institutions to living in the community. (Read last week's e-letter at

Nick Dupree, 20, who has a type of muscular dystrophy, is a perfect case of why the money's needed. "My quest to stop Alabama Medicaid from ending my home care services when I turn 21 years old is now reaching a critical point," he writes on the iCan website. The day he turns 21, he writes, "I lose the nursing care available to me under Medicaid's Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program.

"The federally mandated EPSDT program is the only long-term home care program providing enough care hours to avoid institutionalization in Alabama and often in other states like Georgia, Mississippi and Louisiana, where they have some of the lowest average incomes, poorest state budgets and lowest Medicaid budgets in the country," he says. "Unfortunately, when Medicaid passed in 1965, Congress set up the 21 age limit for EPSDT because the program's intent is to provide care for children." Alabama does not offer any program of in-home services. (Read Nick's article at the website at

"Dupree has been pressing a campaign for several years to draw attention to Alabama's archaic, pro-nursing home Medicaid rules -- and to push for changing federal Medicaid law to let 'money follow the person' to live in the community," says an article in the Mar./Apr. 2003 Ragged Edge magazine (online at But his story has gotten little coverage other than in Mobile media. There's been virtually no national coverage to shed a light on the problems Medicaid policy is causing Nick Dupree -- and countless others like him.

The group Advancing Independence: Modernizing Medicare and Medicaid ( is trying to draw attention to Dupree's situation, urging advocates to contact Ala. Gov. Bob Riley and "insist that he take immediate action as the new Governor of Alabama to reverse his state's policy of forced institutionalization."

Visit Nick Dupree's website at

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