Mary and Dave Rennich spent more than two months going back and forth with Great Plains Rehabilitation Services to get a wheelchair for their 9-year-old son. The process was delayed by Medicaid coverage.

The Rennichs were told by Great Plains representatives they had to wait for the go ahead from Medicaid to get the wheelchair, which was sitting in the company's warehouse. They gathered the $1,000 that their private insurance didn't provide and tried to get the chair.

The couple was told they couldn't use their own money to pay the difference as Medicaid receivers - their son would have to wait.

Their quest with Great Plains, which started in January, finally came to an end last week when they brought the chair home and the company absorbed the $1,000.

"They (Medicaid) have gone into a lot of cuts in terms of trying to balance their budget," said Kevin Holzer, coordinator for product services at Great Plains. "We have been careful so we know for sure what is going to be covered and what isn't. It takes awhile to determine coverage."

That turn around time has been slower because of cutbacks Medicaid has made to cope with a $16.3 million budget shortfall. Medicaid officials are scrutinizing equipment applications more, making sure large, expensive pieces of equipment are medically necessary and aren't just a convenience.

"Many times individuals are looking for Cadillac pieces of equipment when a Volkswagen would do," said Colleen Stockert, a liaison accountant for the Disability Services Division in Human Services, whose son is disabled. "Medicaid has to answer to the Legislature and they (Medicaid) have to show they are trying to contain costs or people will accuse them of being too loose with money."

The $16.3 million shortfall came from a decrease in anticipated state and federal funding, an increase in recipients and recipients eligible for full coverage and more recipients using their benefits. This has been coupled with an increase in high costing cases.

There is a bill in the House that would provide $16.3 million to make up for the shortfall. SB2025 was passed by the Senate with a 41-5 vote. If the bill doesn't pass in the House, more drastic cuts will be made in the program.

Although spending for durable medical equipment is what Medicaid officials budgeted for, Zentner said the program's budget has to be looked at as a whole and that means cuts in every area.

"Although durable medical equipment is pretty much on budget it doesn't mean we don't have to look at all of the services to make sure they are economical," Dave Zentner, director of the medical services division at the Department of Human Services, said. "I have to look at the big picture. We look at all of our services to see where we might economize."

Initially, Medicaid officials cut costly equipment like wheelchair tilts, but reexamined the decision after they received complaints.

"We had looked at those issues because they are very expensive pieces of equipment," Zentner said. "Since then we decided, depending on the circumstances, we would authorize coverage for them."

Medicaid employs a nurse and doctor who look at applications for large pieces of equipment and decide if the equipment is medically necessary.

"If it is, we provide it," Zentner said.

While officials are examining applications for equipment more carefully, the process has slowed down because often more information is needed.

"If all of the information is there and we can make a determination, we turn it around as fast as we can," Zentner said. "If we have to send the information back then it is going to delay things. We realize that people need equipment and we do not want to unduly delay things if we can help it."

Another factor that holds up the process is how quickly the provider gets needed information back to Medicaid.

(Reach reporter Sheena Dooley at 250-8225 or sheenadooley@ndonline.com.)