There has been a rise in the number of people denied the Medicaid waiver after reassessment. Duane Mayes, Director of Senior and Disabilities Services or SDS says the department wasn’t able to conduct its annual evaluations of waiver recipients’ eligibility up until several years ago because of a series of lawsuits.
“So literally for a period of seven to eight years we were unable to remove anybody that no longer met level of care from our waiver system,” says Mayes.
Mayes says the lawsuits were settled three or four years ago and that made it possible to trim people from the program. In the last five years the department has carried out 8,253 reassessments for its waiver recipients in southcentral Alaska yielding a roughly 70 percent approval rate. That also left 2,464 denials. Marian Friedrich, a resident of Main Street Assisted Living in Homer, received one of the denials and she disagrees with the way her assessment was carried out.
“When they came and assessed me the woman who did the marking paid absolutely no attention to any mental or behavioral issues. She entirely skipped a whole half of the form as if it wasn’t important anymore. To me if you’re going to throw away half the form you better throw away the whole form,” says Friedrich.
Holly Chipps has been a Certified Nursing Assistant for 30 years. She’s worked at Main Street Assisted Living for the past two years.
“It is a very vague list, and vagueness connotes insincerity. To ask a resident can you take a spoon, put it in your bowl, and feed yourself is not a fair depiction. Can they go to the store? Can they cook their own meal? Can they determine what is good food and bad food, prepare it and then feed themselves? No they can’t. That’s why they’re here,” says Chipps.
To be fair, Mayes says the face-to-face interview isn’t the only research SDS conducts to determine a person’s eligibility. They check the questionnaire against medical records and the ultimate decision is reviewed by a third party contractor.
And lastly applicants are given a chance to appeal a denial.
Still, Chipps is certain not a single one of her residents in danger of losing their waiver can live by themselves. But, SDS has checked the paperwork and it says these people don’t qualify for that magical Nursing Home Level of Care. So for now, people like Friedrich have a couple of options. They can fight the system through appeals. Or if that doesn’t work, take the denial and try to get on the department’s other services.
“There’s general relief, there’s personal care attendant services. We spend 100 plus million in personal care attendant services. We also have about $27 million in grant services,” says Mayes.
But these fallbacks might not be enough. Ruth Babcock, owner of Main Street Assisted Living, says General Relief is a temporary aid.
“General relief was originally setup to deal with people who did not have any resources and were younger and maybe were injured. [They] had a health issue [and] needed a place to get well for a few months maybe,” says Babcock.
The grant services are designed to help people before their health becomes so poor that they need round the clock care. And Personal Care Assistance (PCA) doesn’t necessarily guarantee all the services that could come with the waiver. PCA is also only available to people living in their home. People in assisted living centers would be left out.
Mayes says he’s heard the concerns that their continuum of care is not comprehensive enough. Partly for that reason, SDS is trying to bring two new waiver options online. One of these will serve seniors who aren’t eligible for Nursing Home Level of Care. The problem is it could take two years for those tools to come online. They won’t be around to help Marian Friedrich, and another 8 of 15 residents at Main Street Assisted Living who could lose the waiver in the next year. Friedrich still has a ray of hope. Her lawyer from Alaska Legal Services found a problem in the paperwork she received from SDS so she’s clinging to that.
This is the second in a three part series. To see part one click here.