We fight for seniors to receive the benefits they need to live dignified, independent lives. NYLAG helped Margaret, an elderly woman with dementia, to restore her wrongfully denied home healthcare.
Margaret, an 83-year-old living with dementia, was referred to an attorney with the Evelyn Frank Legal Resources Program at NYLAG by a social worker in Queens. She had recently been approved for Medicaid but her social worker had hit roadblocks while attempting to enroll Margaret in a Medicaid Managed Long Term Care (MLTC) plan for the home care she needed. She was denied enrollment in the MLTC plan on grounds that she allegedly had some type of third party health insurance. This made no sense, since Margaret had only Medicaid and Medicare. After investigation, the attorney learned that Margaret’s enrollment in a Medicare Advantage Plan, which should have no impact on her eligibility for MLTC, was incorrectly “coded” in the computer as a different type of third party health insurance.
By the time the case came to the attorney’s attention, Margaret had only two days to enroll in the MLTC or else the home care she needed and expected would be delayed by several months. Generally such last minute enrollment is logistically impossible. The attorney had previously brought similar “coding” errors to top-level administrators of the State Department of Health and New York City Medicaid programs, and contacted these administrators about Margaret’s case as yet another example of the many errors that block vulnerable seniors from accessing vital home care services. Thanks to this advocacy, Margaret was enrolled in the MLTC one day later. The Evelyn Frank Legal Resources Program continues to address these and many other systemic problems with MLTC with state and local government officials.