"When I found out he was going to be here in Omaha, I put my two week's notice in, and drove him out here."
Shayla Alex is a young mom who moved from Scottsbluff to Omaha five years ago - to get help for her son.
He was severely aggressive, and had been diagnosed with an "alphabet" of ailments. Between the ages of five and six, he was hospitalized six times. Five years ago, he spent eight months in Boys Town, a residential treatment center, and Alex said his behavior became much more manageable. Then, he hit puberty and his aggression got out of control.
"My son has beat me to a living pulp," Alex said. "I've had black eyes, broken lips. And I'm not a small person. When he goes into a rage, even though he's 12, he goes into a rage and there's nothing that can stop him."
Alex is trying to get her son back into Boys Town. But Nebraska's Medicaid office said he no longer qualifies.
"And that is the most frustrating feeling in the world," Alex said. "When there's services that your child could benefit from, has proven to benefit from, but Medicaid just refuses to pay for them."
"The decision to deny is done by psychiatrists who have practices here in Nebraska," said Vivianne Chaumond, the director of the Division of Medicaid and Long-Term Care at Nebraska's Department of Health and Human Services. "And you can have the care," she said. "What we decide is whether or not we're going to pay for it. And that's pretty standard practice."
Two years ago, Medicaid may have paid for Alex's care. But Chaumond said the state was notified by the federal government that it was out of compliance. She said it was covering too many out-of-home services for children who shouldn't qualify. Chaumond said the state developed a case plan to move into compliance, and that included a more restrictive definition of who qualifies for high-level treatment.
"It's very complicated," said Carolyn Rooker, the Executive Director of Voices for Children in Nebraska. "It's very difficult to understand what is really the (federal government) saying that you can and can't fund with Medicaid, and what the states are choosing not to, in terms of trying to save money."
"The interesting part of that," she said, "is if they don't fund those things, it ends up going to the child welfare system, and it costs more."
Rooker said the state is deliberately applying a narrow interpretation of federal guidelines to save money. And she said Nebraska is failing its kids by not choosing the cost effective, fiscally responsible, and smart approach: provide the right care at the right time.
Nebraska's child welfare system has undergone major reforms in the past two years - in an attempt to provide more cost-effective care. And part of that approach included privatizing some services. But a recent audit of DHHS showed millions of dollars had been spent - unaccounted for - in that effort.
Senator Kathy Campbell, who chairs the Legislature's Health and Human Services Committee, said "I think that's where the legislature has had some frustration in the last couple of years, because we have not really been able to have a handle on what is the budget for child welfare - all the components to it, and what is being spent."
Campbell also said she's concerned the state is reducing out-of-home options for families, before expanding and improving in-home and community-based services as alternatives. A principal goal of Nebraska's child welfare reform is to reduce the number of children removed from the home. The state removes children at one of the highest rates in the nation, and critics say it does so, in many cases, unnecessarily.
Campbell's committee released a comprehensive report in December that detailed some of those complaints, and made recommendations to help make the system more accountable. The report also made other recommendations, including returning duties like case management from private contractors to the state. Governor Dave Heineman has expressed some concern about those recommendations - and how much they will cost the state, although he said he's open to discussion.
"A lot of this has been about money," said Vicki Maca, an administrator with DHHS, who heads the child welfare reform efforts. "And I'll just be very honest with you. That's been a hard one for me as a social worker. A lot of the attention has been on the dollars and the funding and while that's very, very important, I don't want people to lose sight about what this is all about."
"This is about keeping the most vulnerable population in our state, kids, safe."
Child welfare is set to be one of the main priorities for Nebraska lawmakers at the Capitol this year. Legislation has already been introduced to roll back more planned cuts to Medicaid and increase oversight of the child welfare system. Vivianne Chaumond in the Medicaid office also said she is taking another look at some of those restrictions to see if there's some flexibility there.
Shayla Alex will have to wait to see if any of those changes will affect her son. And in the meantime, she said she'll to continue to ignore those voices telling her to give up her child. "Every time I turn around, people are coming to me saying just sign him over, sign him over to the state, just make him a state ward," she said. "Why would I want to place him with people who don't know him, don't understand him?"
"I would never walk away from my son," she said. "I will always love him, regardless of battle scars or not. I know deep inside that he would never want to do that to me. He just doesn't know what else to do right now."