Difference between revisions of "Josh/Medicaid"

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(updates: denial, and our responses to the March paperwork request)
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==Denial==
In chronological order:
Click either image for a larger version:
* '''2008-02-12''': We have the first meeting with Josh's case manager at [[htyp:Community Partnerships|Community Partnerships]], Yolanda, in order to put together his Personal Care Plan. She also gives us a Medicaid application to fill out.
 
* '''2008-02-15''': We belatedly start filling out the Medicaid application but question whether it is the right one, noting that it says "Application for Adult Medicaid" at the top and Josh isn't an adult.
[[Image:2008-06-05 Medicaid denied.web.png|350px]]
* '''2008-02-18''': We are told that it is in fact the correct form, and Medicaid will let us know if it is not. We ask some follow-up questions about this, because some of the questions on the form don't really make sense: "when we fill out Page 10 of 18 ("Tell us about you"), is it asking about Sandy or Josh? If it's asking about Sandy, why does it want to know all these things about her and not about Josh? It certainly sounds like they're asking about an adult, but why do they want all this information about Sandy and practically no information at all about Josh?" Lacking an immediate response, we make some guesses, finish the application, and send it to Yolanda, who submits it the next day.
[[Image:2008-06-05 Medicaid denied - back.web.png|350px]]
* '''2008-03-14''': The Medicaid office [[/2008-03-14 request|requests some additional paperwork]]
 
* '''2008-06-05''': Our first application is denied ([[:Image:2008-06-05 Medicaid denied.web.png|denial letter]]; [[:Image:2008-06-05 Medicaid denied - back.web.png|back of page]] with instructions for requesting a hearing)
Basically, they're claiming we didn't send them the stuff we sent them.
** Basically, they're claiming we didn't send them the stuff we sent them. The ''real reason'' for the denial (and for the irrelevance of many of the questions asked by the Medicaid office, below), however, is that we should have been applying via NC Health Choice for Children, not Medicaid; see [[htyp:Medicaid/NC|here]].
 
** Does anyone know '''what document''' is being referred to by "The state regulations regarding this action are found in <u>2000 / 2300</u>"?
Does anyone know '''what document''' is being referred to by "The state regulations regarding this action are found in <u>2000 / 2300</u>"?
* '''2008-06-11''': We (re-)apply for Medicaid via [[htyp:NC Health Choice for Children|NC Health Choice for Children]]  and are expecting a response within 45 days, i.e. by approximately July 25.
==Earlier Paperwork==
* '''2008-07-15''': Yolanda contacts the Department of Social Services to ask about the application's status. The caseworker assigned to the application is Alicia Turner; Yolanda speaks with Alicia and finds out that DSS sent us a request for further documentation on June 13, which we definitely did not receive.
This was the earlier request for paperwork, which came in the mail back in March:
* '''2008-07-16''': We put together some documents and send them to Yolanda. Since we weren't able to find documents ''exactly'' matching their requests, we ask Yolanda to please check with Alicia to make sure that the documents were adequate.
 
* '''2008-07-23''': Yolanda confirms that she "called and left several messages" for Alicia Turner, but has heard nothing back.
{|
* '''2008-08-01''': Our second application is denied ([[:Image:2008-08-01 Josh NCHC denial.web.png|denial letter]]) with the claim that we had "not provided the information to establish eligibility".
|-
* '''2008-08-04''': Terry Ames of [[htyp:The Durham Center|The Durham Center]] calls the Department of Social Services to ask about the "missing documentation" they claim we didn't give them, and leaves a voicemail message for Ms. Turner's supervisor.
| Click thumbnail below for larger image:
* '''2008-08-07''': Terry receives a call from Sherry Rodgers, caseworker supervisor, who says we have to '''re-apply a third time'''. We plan to [[:Image:2008-06-05 Medicaid denied - back.web.png|request a hearing]] instead, as we still don't know what documentation is missing.
 
* '''2008-08-30''': Josh's Medicaid approval arrived in the mail. After writing a letter directly to the Medicaid folks, I was finally able to get everything straightened out and provide them with the one missing piece of documentation. (There's more to this, but this is all the updating I have time for at the moment.)
[[Image:2008-03-14 Josh Medicaid request for information.web.png|300px]]
* '''2009-06''': Upon renewal, the Medicaid was switched to [[htyp:NC Health Choice|NC Health Choice]], which apparently does not cover the foster home we had lined up for him. There is much more to this story and I've just been too busy to even start setting it down.
 
* '''2009-07''': In late July, we found out that if we get a physician to sign a [http://info.dhhs.state.nc.us/olm/forms/dma/dma-5045.pdf DMA-5045] stating that Josh needs out-of-home care lasting more than 12 months, then Medicaid will look only at ''Josh's'' income ($0) rather than Sandy's -- and he should thus definitely qualify for Medicaid indefinitely.
|
* '''2009-08-07''' Got the DMA-5045 filled out this morning, as well as the FL-2 form and medical records it requires; now I just need to finish filling out the application, scan everything for our records, and send it in. Tomorrow's mail, perhaps?
 
* '''2009-09-18''' One Medicaid application (submitted with a filled-out DMA-5045), three emails, at least one or two phone calls, and then a further week or two of waiting -- and we received [[:File:2009-09-18 Josh Medicaid acceptance.png|Josh's Medicaid acceptance]] in today's mail.
Basically, it asked for the following:
* FL-2 completed by doctor - '''done''' (note: it's a triplicate carbonless-copy form not available online)
* Proof of income for <u>Josh</u> for the months of <u>Jan</u> - '''Josh is a nonverbal autistic minor with no income'''
* Bank account numbers or statement(s) showing balance for the months of <u>Jan for Josh</u> - '''We were told to substitute one of Sandy's bank statements, since Josh has no bank accounts'''
* Bank Consent form / Release of Information forms signed by <u>Josh</u> - '''Josh has no bank accounts'''
* Life insurance policies or the name of the insurance companies and policy numbers for <u>Josh</u> - '''Josh has no insurance'''
* Apply for Social Security Disability for <u>Josh 1 800 772 1213</u> - '''we applied for this in Feb. 2007, and submitted proof that we had applied'''
* Health insurance card or the name of the company and policy number - '''Josh has no insurance'''
* Proof of Citizenship and identity for <u>Josh</u> - '''we included a copy of his birth certificate'''
* Proof of State Residence for <u>Josh</u> - '''we included copies of two items addressed to Josh'''
 
* We were told that in the absence of any employment, Sandy could provide a copy of her most recent bank statement as evidence of income
* We were told that the  
* How can we get copies of a life insurance policy for someone with no life insurance?
* We applied for social security disability for Josh, but he didn't qualify because Sandy has too much money in her emergency stash (we probably wouldn't have been able to get the mortgage if she hadn't had them, but they won't count the debt on the mortgage against the emergency stash)
|}
'''General note''': nobody has any business requiring Josh to sign anything, as he is nonverbal and wouldn't understand what he is signing.

Latest revision as of 17:28, 7 April 2010

In chronological order:

  • 2008-02-12: We have the first meeting with Josh's case manager at Community Partnerships, Yolanda, in order to put together his Personal Care Plan. She also gives us a Medicaid application to fill out.
  • 2008-02-15: We belatedly start filling out the Medicaid application but question whether it is the right one, noting that it says "Application for Adult Medicaid" at the top and Josh isn't an adult.
  • 2008-02-18: We are told that it is in fact the correct form, and Medicaid will let us know if it is not. We ask some follow-up questions about this, because some of the questions on the form don't really make sense: "when we fill out Page 10 of 18 ("Tell us about you"), is it asking about Sandy or Josh? If it's asking about Sandy, why does it want to know all these things about her and not about Josh? It certainly sounds like they're asking about an adult, but why do they want all this information about Sandy and practically no information at all about Josh?" Lacking an immediate response, we make some guesses, finish the application, and send it to Yolanda, who submits it the next day.
  • 2008-03-14: The Medicaid office requests some additional paperwork
  • 2008-06-05: Our first application is denied (denial letter; back of page with instructions for requesting a hearing)
    • Basically, they're claiming we didn't send them the stuff we sent them. The real reason for the denial (and for the irrelevance of many of the questions asked by the Medicaid office, below), however, is that we should have been applying via NC Health Choice for Children, not Medicaid; see here.
    • Does anyone know what document is being referred to by "The state regulations regarding this action are found in 2000 / 2300"?
  • 2008-06-11: We (re-)apply for Medicaid via NC Health Choice for Children and are expecting a response within 45 days, i.e. by approximately July 25.
  • 2008-07-15: Yolanda contacts the Department of Social Services to ask about the application's status. The caseworker assigned to the application is Alicia Turner; Yolanda speaks with Alicia and finds out that DSS sent us a request for further documentation on June 13, which we definitely did not receive.
  • 2008-07-16: We put together some documents and send them to Yolanda. Since we weren't able to find documents exactly matching their requests, we ask Yolanda to please check with Alicia to make sure that the documents were adequate.
  • 2008-07-23: Yolanda confirms that she "called and left several messages" for Alicia Turner, but has heard nothing back.
  • 2008-08-01: Our second application is denied (denial letter) with the claim that we had "not provided the information to establish eligibility".
  • 2008-08-04: Terry Ames of The Durham Center calls the Department of Social Services to ask about the "missing documentation" they claim we didn't give them, and leaves a voicemail message for Ms. Turner's supervisor.
  • 2008-08-07: Terry receives a call from Sherry Rodgers, caseworker supervisor, who says we have to re-apply a third time. We plan to request a hearing instead, as we still don't know what documentation is missing.
  • 2008-08-30: Josh's Medicaid approval arrived in the mail. After writing a letter directly to the Medicaid folks, I was finally able to get everything straightened out and provide them with the one missing piece of documentation. (There's more to this, but this is all the updating I have time for at the moment.)
  • 2009-06: Upon renewal, the Medicaid was switched to NC Health Choice, which apparently does not cover the foster home we had lined up for him. There is much more to this story and I've just been too busy to even start setting it down.
  • 2009-07: In late July, we found out that if we get a physician to sign a DMA-5045 stating that Josh needs out-of-home care lasting more than 12 months, then Medicaid will look only at Josh's income ($0) rather than Sandy's -- and he should thus definitely qualify for Medicaid indefinitely.
  • 2009-08-07 Got the DMA-5045 filled out this morning, as well as the FL-2 form and medical records it requires; now I just need to finish filling out the application, scan everything for our records, and send it in. Tomorrow's mail, perhaps?
  • 2009-09-18 One Medicaid application (submitted with a filled-out DMA-5045), three emails, at least one or two phone calls, and then a further week or two of waiting -- and we received Josh's Medicaid acceptance in today's mail.