March 31, 2013

Your Advocacy Connection

By Kathy Nitz
GolderCare Solutions

I serve as a Benefits Advocate at GolderCare Solutions. We solve long term care problems. I often ponder what our clients would do if someone like me, who understands the various rules and procedures associated with Medicaid, could not advocate on their behalf. The public generally takes it for granted that governmental agencies are there to help them. This is not always what happens, even though these programs are set up to help us. I would like to present just a couple examples, although this happens on a regular basis. I wish I could say these were exceptions rather than the norm, but that is not always the case.

Case One: “Dick” is in a nursing home, and “Jane” lives at home but is quite elderly, nearly blind with macular degeneration and has a very difficult time getting out. Advocating for Dick, GolderCare obtained Medicaid to pay for his care in a nursing home.

As is the rule with Medicaid, there is a yearly renewal called a Medicaid Review or Medicaid Redetermination. It comes in the mail and receipt of the forms is never on an exact date. We received the review form with a date of July 19 to have it completed and returned to the Centralized Facility in Council Bluffs, Iowa. I had everything ready to send off and had actually faxed in a majority of the information when our U.S. mail was delivered. In that mail was a notice from Council Bluffs terminating benefits for Dick because the information was not returned in a timely manner.

Wait a minute…it was due on July 19. The notice was dated July 16. How could that happen?

I put a call into the caseworker. I had to leave a message. I called a couple hours later. I had to leave a message. Finally, about two minutes before I was leaving for the day, the caseworker called back. Bureaucracy at its finest. She had no idea who sent the notices – although her name was on it. She had no idea about anything. After numerous phone calls and faxes and more phone calls and more documentation, I got nowhere. We are going to have to file the correct appeal paperwork with the correct supporting attachments to get this all straightened out.

Case Two: “Bob” is in the nursing home, and “Linda” is living at home. She still works full-time in an effort to make ends meet. Linda came to GolderCare after receiving advice from a local agency and spending most of their savings unnecessarily on her husband’s care. We also did some planning for Linda and eventually got Bob on Medicaid. More importantly for Linda, GolderCare did extensive care advocacy to make sure her husband is receiving the specialized care he requires.

I received Bob’s Medicaid Review forms in the mail with a due date of October 25. In the same day’s mail was a notice terminating Bob’s benefits because the review form was not returned in a timely manner. What? They send the review form AND the notice of termination of benefits on the same day? Unbelievable. I began the same process with Bob’s situation as I did with my other client.

The bottom line is this; if I had not had the knowledge and understanding of the system, along with my determination and willingness to push through the difficult State red tape, our clients would have been discharged from the nursing home and unnecessarily cost the spouse thousands of dollars that was needed to continue to live independently at home.

In last month’s article, I stressed the importance of talking to someone who has the knowledge and experience you need when faced with placing a loved one in a nursing home. The common man or woman does not know the rules. As is illustrated in the two cases above, the State surely isn’t looking out for your best interest, and in these cases, is simply wrong. Would you know what to do?

Kathy Nitz is a Benefits Advocate for GolderCare Solutions. She uses her wealth of knowledge and experience in benefits planning to help seniors and those who are disabled.