In Medicaid’s CHOICES, Don’t Take “No” for an Answer

medicaid_advocacyLast year I did a lot of blogging about changes to Medicaid’s CHOICES program, which took effect on July 1, 2012. That’s because the changes were significant, affecting both current beneficiaries and new applicants for coverage. Both care providers and geriatric social workers such as myself recognized that it may now be more difficult for individuals needing care to qualify using the CHOICES program’s new Need Acuity Scale.

Since the changes took place, I have personally handled cases in which a client was denied coverage based on their initial assessment. These individuals were clearly in need of care and ought to have qualified for coverage based on their level of disability. It took some additional documentation, but I was able to help the clients appeal the decision – and in all cases, with little difficulty, the original decision was reversed and the client was granted the level of CHOICES care being sought.

I have spoken with other professionals in the field, and I have heard several similar stories of an initial denial followed by a relatively painless appeal process resulting in CHOICES approval. While the initial denial of coverage can be frustrating, it is encouraging to know that in cases of obvious need, with appropriate advocacy Medicaid usually does provide coverage in the end.

My own experiences and the experiences of my professional colleagues also illustrate the importance of advocacy for an older adult or disabled person. Having someone ready and able to contest unfair or inappropriate decisions on their behalf can make an enormous difference in an elder or disabled person’s overall quality of life. Sometimes public benefits assessors, medical professionals, and other people providing services to elders and disabled persons simply get things wrong. Having someone familiar with the elder’s or disabled person’s situation who is prepared to do what it takes to make a case on their behalf is essential to getting the best treatments or benefits for that person.

As Care Coordinator at Elder Law of East Tennessee, part of my job is advocating for my clients to ensure that they receive the best possible care and all the benefits to which they are entitled. I feel a deep personal satisfaction when I know that the people I serve are well cared for and that their families can enjoy peace of mind. Please get in touch with me if you or your loved ones are in need of assistance with public benefits applications or other long-term care arrangements. I would love to help you get the benefits and the care that you deserve.