County: Taylor
Age: 72
Client contacted us because significant sum of money was taken from her account after she gave personal information out over the phone. The person soliciting her convinced her he was associated with her bank and was trying to update her informaiton. However, he was located in Peru with an outfit that scams people. Our client immediately filed a police report and contacted us. I explained what identity theft is, steps she can take to protect herself from further theft, and provided her with an ID Theft Affidavit to dispute the unauthorized withdraw from her account. Before she contacted us her bank was unwilling to get the money back or close her account. Armed with the ID Theft Affidavit, she got her account closed. Her bank also assured her that they are working to get her money back.
Monday, October 17, 2005
Tuesday, October 11, 2005
Case of the Week: 10/7/05
County: Wood
Age: 82
The client needed to know if her deed creates a right of survivorship with her daughter. I reviewed her deed and researched the relevant code provisions and case law. I explained that while West Virginia has done away with the assumption that joint tenancies create right of survivorship, her deed states that the relationship is as joint tenants and not as tenants in common. Arguably, this creates a right of survivorship.
Age: 82
The client needed to know if her deed creates a right of survivorship with her daughter. I reviewed her deed and researched the relevant code provisions and case law. I explained that while West Virginia has done away with the assumption that joint tenancies create right of survivorship, her deed states that the relationship is as joint tenants and not as tenants in common. Arguably, this creates a right of survivorship.
Wednesday, October 05, 2005
Case of the Week: 9/30/05
County: Jackson
Age: 61
Client contacted us regarding his rights to an undivided interest in property he inherited. The co-tenants have been removing hay from the property and he needed legal counsel. After researching the WV Code and case law, I explained that he may have a right to an accounting to see if the co-tenants have committed waste; however, for hay, co-tenants have lawful authority to remove. Also explained the client may ask the court to partition the property if the dispute persists.
Age: 61
Client contacted us regarding his rights to an undivided interest in property he inherited. The co-tenants have been removing hay from the property and he needed legal counsel. After researching the WV Code and case law, I explained that he may have a right to an accounting to see if the co-tenants have committed waste; however, for hay, co-tenants have lawful authority to remove. Also explained the client may ask the court to partition the property if the dispute persists.
Thursday, September 29, 2005
Case of the Week: 9/19/05
County: McDowell
Age: 66
Our client contracted to have various projects done on her home. The contractor failed to provide a new furnace as per the contract and to perform other tasks as promised. I reviewed the contract and explained that she is still within the statute of limitations to bring a cause of action against the contractor for breach of contract. If damages exceed $5,000, then she will need to file her claim in Circuit Court. However, if her damages are less than $5,000 she may file in the Magistrate Court without the assistance of a lawyer. Explained to the client how to bring a claim for damages under a breach of contract theory in Magistrate Court.
Age: 66
Our client contracted to have various projects done on her home. The contractor failed to provide a new furnace as per the contract and to perform other tasks as promised. I reviewed the contract and explained that she is still within the statute of limitations to bring a cause of action against the contractor for breach of contract. If damages exceed $5,000, then she will need to file her claim in Circuit Court. However, if her damages are less than $5,000 she may file in the Magistrate Court without the assistance of a lawyer. Explained to the client how to bring a claim for damages under a breach of contract theory in Magistrate Court.
Friday, September 09, 2005
Case of the Week: 9/5/05
County: Preston
Age: 61
Client received a charge on her credit card statement for MBNA's Privacy Assistance Program. She never activated this program. I contacted MBNA and requested that she be disenrolled from the program and refunded what she paid toward it. MBNA reviewed her account, disenrolled her from the program, and happily refunded her money.
Age: 61
Client received a charge on her credit card statement for MBNA's Privacy Assistance Program. She never activated this program. I contacted MBNA and requested that she be disenrolled from the program and refunded what she paid toward it. MBNA reviewed her account, disenrolled her from the program, and happily refunded her money.
Friday, September 02, 2005
Case of the Week: 8/19/05
County: Mineral
Age: 83
Our client had to leave her residence to live in an apartment complex that could meet her health needs. She was assured by management that since her move was due to medical necessity, she would not face any penalties. She provided the apartment management with the appropriate notice, including a letter from her physician stating she requires 24 hour assistance. However, after moving, she received a letter from the apartment management that she owed back rent, a penalty fee for early termination, and charges for repairs. I contacted the managing company and provided them with the letter she got from her doctor. The managing company reviewed her case, recognized their error, and dropped the charges for the early termination and back rent. The client recognizes the need to pay for the repairs.
Age: 83
Our client had to leave her residence to live in an apartment complex that could meet her health needs. She was assured by management that since her move was due to medical necessity, she would not face any penalties. She provided the apartment management with the appropriate notice, including a letter from her physician stating she requires 24 hour assistance. However, after moving, she received a letter from the apartment management that she owed back rent, a penalty fee for early termination, and charges for repairs. I contacted the managing company and provided them with the letter she got from her doctor. The managing company reviewed her case, recognized their error, and dropped the charges for the early termination and back rent. The client recognizes the need to pay for the repairs.
Case of the Week: 8/12/05
County: Morgan
Age: 70
Client contacted us after the DMV gave him notice to turn in his license plate. I reviewed the summons he recieved and researched the law. I explained that all motorists must maintain insurance and carry proof of insurance in West Virginia. I further explained that in his situation, under the West Virginia State Code, he will get his registration reinstated once he gets insurance and can show proof of insurance.
Age: 70
Client contacted us after the DMV gave him notice to turn in his license plate. I reviewed the summons he recieved and researched the law. I explained that all motorists must maintain insurance and carry proof of insurance in West Virginia. I further explained that in his situation, under the West Virginia State Code, he will get his registration reinstated once he gets insurance and can show proof of insurance.
Case of the Week: 7/29/05
County: Kanawha
Age: 74
Client contacted us regarding an overpayment Social Secuirty claims she recieved under Supplemental Security Insurance for failure to report changes in her income. After reviewing a letter from Social Security noting the overpayment and her financial situation, I determined that she might be qualified for a waiver; however, I explained to her that all participants have a duty to report changes in their income and resources. I explained how she should proceed with her request and provided her with an overpayment waiver form.
Age: 74
Client contacted us regarding an overpayment Social Secuirty claims she recieved under Supplemental Security Insurance for failure to report changes in her income. After reviewing a letter from Social Security noting the overpayment and her financial situation, I determined that she might be qualified for a waiver; however, I explained to her that all participants have a duty to report changes in their income and resources. I explained how she should proceed with her request and provided her with an overpayment waiver form.
Saturday, August 20, 2005
Aged & Disabled Waiver Frozen
According to an article in the Charleston Gazette on August 19th, the A/D waiver is frozen again. I received a phone call from a concerned provider on Tuesday that this appeared to be happening, though there had been no communications about it from waiver administrative staff to providers, waitlisted applicants, or advocacy organizations. As far as we know, there still has been no such communication to any of these interested parties regarding when the freeze will end, whether new applications are still being taken, how long the waitlisted people (some who have waited 6 months already) should expect to continue to wait, and how we can best help the vulnerable population at this time.
Advocates are presuming that the freeze was prompted by the administration's presumption that the program's waiver renewal application to CMS will be approved. As far as we know, it has not been approved yet, though again there has been no communication about it. The 5 yr renewal application included a drastic reduction of slots from current 5,400 to 3,900 in the first year and down to 3,450 in the second year. Perhaps administration will freeze the waiver for a year, since there are probably already over 3,900 active waiver slots being used now (I've been told but haven't been able to verify that there are approximately 4,000 on right now). If that's the approach they're taking, it would mean those folks who've already been on the waitlist for 6 months might have to be on the waitlist for a year and a half total.
Another unsettling figure I heard, but haven't been able to verify, is that only 5,200 slots were filled in FY04, 200 less than the 5,400 available according to the waiver approved by CMS. Why did the waiver renewal propose to cut this valuable program to serve 2,000 fewer people annually? Why has there been a 6 month waitlist, which is not a waitlist in the true sense of waiting for an available slot, but rather just a standard 6 month wait for every single applicant? Why didn't 200 more people who were waitlisted when slots were available get served in FY04? Money, of course. The state spends less money by serving fewer people total, and by making people wait so long some will die, get placed in a nursing home, or give up trying during that 6 months of sometimes desperate waiting. Though we can all understand that fiscal times are hard (though didn't we actually have both a total state budget surplus, and a Medicaid surplus last year?), and that to balance a budget without additional revenue you have to cut spending. But these are some of our state's neediest people, and for them this program means the difference between institutionalization, inadequate care, or at worst abuse and neglect, and getting to continue to live well at home. How can anyone say there's absolutely no other spending in our state budget, even in the state Medicaid budget, that can't be cut to save these services.
These cuts and freezes of the A/D waiver certainly take us backward in our state's efforts to uphold its obligation under the Olmstead doctrine to provide services in the most community-integrated setting reasonably possible. And the lack of open dialogue, or even one-way communication from the administrators of the program about what's happening, are harming these vulnerable West Virginians further. It is outrageous that people actually on the waitlist would have to learn about this freeze from the newspaper.
Advocates are presuming that the freeze was prompted by the administration's presumption that the program's waiver renewal application to CMS will be approved. As far as we know, it has not been approved yet, though again there has been no communication about it. The 5 yr renewal application included a drastic reduction of slots from current 5,400 to 3,900 in the first year and down to 3,450 in the second year. Perhaps administration will freeze the waiver for a year, since there are probably already over 3,900 active waiver slots being used now (I've been told but haven't been able to verify that there are approximately 4,000 on right now). If that's the approach they're taking, it would mean those folks who've already been on the waitlist for 6 months might have to be on the waitlist for a year and a half total.
Another unsettling figure I heard, but haven't been able to verify, is that only 5,200 slots were filled in FY04, 200 less than the 5,400 available according to the waiver approved by CMS. Why did the waiver renewal propose to cut this valuable program to serve 2,000 fewer people annually? Why has there been a 6 month waitlist, which is not a waitlist in the true sense of waiting for an available slot, but rather just a standard 6 month wait for every single applicant? Why didn't 200 more people who were waitlisted when slots were available get served in FY04? Money, of course. The state spends less money by serving fewer people total, and by making people wait so long some will die, get placed in a nursing home, or give up trying during that 6 months of sometimes desperate waiting. Though we can all understand that fiscal times are hard (though didn't we actually have both a total state budget surplus, and a Medicaid surplus last year?), and that to balance a budget without additional revenue you have to cut spending. But these are some of our state's neediest people, and for them this program means the difference between institutionalization, inadequate care, or at worst abuse and neglect, and getting to continue to live well at home. How can anyone say there's absolutely no other spending in our state budget, even in the state Medicaid budget, that can't be cut to save these services.
These cuts and freezes of the A/D waiver certainly take us backward in our state's efforts to uphold its obligation under the Olmstead doctrine to provide services in the most community-integrated setting reasonably possible. And the lack of open dialogue, or even one-way communication from the administrators of the program about what's happening, are harming these vulnerable West Virginians further. It is outrageous that people actually on the waitlist would have to learn about this freeze from the newspaper.
Friday, July 22, 2005
Case of the Week: 7/22/05
County: Wetzel
Age: 64
Client's Social Security was garnished for past due child support. Because his income is very low and my client is in poor health, I sent Child Protective Services a letter explaining that the garnishment creates an undue hardship for my client, who needs the income to keep up with medical expenses. After reviewing my client's case and his circumstances, Child Protective Services reduced the amount of garnishment to $20 per month.
Age: 64
Client's Social Security was garnished for past due child support. Because his income is very low and my client is in poor health, I sent Child Protective Services a letter explaining that the garnishment creates an undue hardship for my client, who needs the income to keep up with medical expenses. After reviewing my client's case and his circumstances, Child Protective Services reduced the amount of garnishment to $20 per month.
Thursday, July 14, 2005
Change in WV M'caid Estate Recovery Practice?
An article by Sarah Lueck appeared June 24, 2005 in the Pittsburgh Post-Gazette (apparently a reprint from the Wall Street Journal) about Medicaid Estate Recovery. Specifically the article focuses on how states are more aggressively pursuing estate recovery as one way to offset increasing Medicaid budgets. www.post-gazette.com/pg/05175/528036.stm
The article claims that "West Virginia has made a notable about-face" from our 2000 Attorney General's lawsuit challenging the recovery mandate and the practice of only pursuing recovery in estates valued at $50,000 or more, to now going after estates as small as $5,000.
Though federal and state law in West Virginia have permitted recovery in estates valued between $5,000 and $50,000, the state Medicaid entity (the Bureau of Medical Services) has maintained a practice of not pursuing estates under $50,000. The state contracts with a Boston-based firm to handle recoveries of $50,000+ estates. If the article is correct in its assertion that the practice is changing, seniors who benefit from long-term care Medicaid (either in a nursing home or through home-based services) whose estates are between $5,000 and $50,000 need to be aware of the increased likelihood of recovery against their estates.
AARP's Public Policy Institute recently released a report which studies estate recovery practices across the nation. An article about the report appears in the Sumemr 2005 issue of the West Virginia Elder Advocacy Quarterly, available online at www.seniorlegalaid.org/newsletter_detail.cfm?H=297&E=25
Senior West Virginians age 60 and over may speak to an attorney at West Virginia Senior Legal Aid about long-term care Medicaid eligibility, transfers of assets, estate recovery, and planning generally by calling 1-800-229-5068.
The article claims that "West Virginia has made a notable about-face" from our 2000 Attorney General's lawsuit challenging the recovery mandate and the practice of only pursuing recovery in estates valued at $50,000 or more, to now going after estates as small as $5,000.
Though federal and state law in West Virginia have permitted recovery in estates valued between $5,000 and $50,000, the state Medicaid entity (the Bureau of Medical Services) has maintained a practice of not pursuing estates under $50,000. The state contracts with a Boston-based firm to handle recoveries of $50,000+ estates. If the article is correct in its assertion that the practice is changing, seniors who benefit from long-term care Medicaid (either in a nursing home or through home-based services) whose estates are between $5,000 and $50,000 need to be aware of the increased likelihood of recovery against their estates.
AARP's Public Policy Institute recently released a report which studies estate recovery practices across the nation. An article about the report appears in the Sumemr 2005 issue of the West Virginia Elder Advocacy Quarterly, available online at www.seniorlegalaid.org/newsletter_detail.cfm?H=297&E=25
Senior West Virginians age 60 and over may speak to an attorney at West Virginia Senior Legal Aid about long-term care Medicaid eligibility, transfers of assets, estate recovery, and planning generally by calling 1-800-229-5068.
Tuesday, July 12, 2005
Finally Aging Gets A Commissioner
Gov. Joe Manchin announced yesterday that Sandra K. Vanin, Ed.D., Director of The Friday Clinic at West Virginia University’s Center for Excellence in Disabilities, has agreed to serve as Commissioner of the West Virginia Bureau of Senior Services, effective Aug. 1, 2005.
Monday, July 11, 2005
Medicaid Commission members named, and WV BMS Commissioner included
FOR IMMEDIATE RELEASE
Contact: HHS Press Office
Friday, July 8, 2005
(202) 690-6343
HHS SECRETARY NAMES MEDICAID ADVISORY COMMISSION MEMBERS
Former Tennessee Governor Named Chair; Former Maine Governor Named Vice-Chair
HHS Secretary Mike Leavitt today announced 13 voting members and 15 non-voting members of an advisory commission charged with identifying reforms necessary to stabilize and strengthen Medicaid.
Consisting of health policy leaders from both sides of the aisle, state health department officials, public policy organizations, individuals with disabilities and others with special expertise, the commission will submit its first report to Secretary Leavitt by Sept. 1. Through the FY 2006 budget agreement, the Department of Health and Human Services agreed to create this commission to develop proposals on the future of the Medicaid program.
"In Washington and state capitols across America, there is consensus that now is the time to reform and modernize Medicaid," Secretary Leavitt said. "I look forward to having a robust conversation in an open and bipartisan manner with the commission members. Together with Congress and the states, we will create a plan that will better help Medicaid fulfill its commitment to quality care in a way that is financially sustainable."
In addition, the Secretary is holding open two vacancies on the commission for current governors so that they may join after Sept. 1, 2005 when the commission focuses on the longer-term methods of modernizing the Medicaid program. The National Governors Association Center for Best Practices will serve as a working group tasked with informing the commission on the range of issues that will be considered.
Former Tennessee Governor Don Sundquist will chair the commission and former Maine Governor Angus King will serve as vice-chair. The commission members are:
* Nancy Atkins, commissioner for the Bureau for Medical Services, Department of Health and Human Resources, West Virginia
* Melanie Bella, vice president for policy, Center for Health Care Strategies, Inc.
* Gail Christopher, vice president for health, Women and Families at the Joint Center for Political and Economic Studies and director of the Joint Center Health Policy Institute
* Gwen Gillenwater, director for advocacy and public policy, National Council on Independent Living
* Robert Helms, resident scholar and director of health policy studies, American Enterprise Institute
* Kay James, former director of the U.S. Office of Personnel Management
* Troy Justesen, deputy assistant secretary for the office of special education and rehabilitative services, U.S. Department of Education
* Tony McCann, secretary of health and mental hygiene, Maryland
* Mike O'Grady, assistant secretary for planning and evaluation, U.S. Department of Health and Human Services
* Bill Shiebler, former president, Deutsche Bank
* Grace-Marie Turner, president, Galen Institute
In addition to the voting members, the commission will consist of the following non-voting members:
* James Anderson, president and CEO, Cincinnati Children's Hospital Medical Center, National Association of Children's Hospitals
* Julianne Beckett, director of national policy, Family Voices
* Carol Berkowitz, pediatrician, president of the American Academy of Pediatrics
* Maggie Brooks, county executive, Monroe County, New York
* Valerie Davidson, executive VP, Yukon-Kuskokwim Health Corporation
* Mark de Bruin, senior VP of pharmacy services, Rite Aid; chairman of the policy council, National Association of Chain Drug Stores
* John Kemp, CEO, Disability Service Providers of America
* Joseph Marshall, chairman and CEO, Temple University Health System, American Hospital Association
* John Monahan, president of state sponsored programs for WellPoint; Blue Cross/Blue Shield Association and America's Health Insurance Plans
* John Nelson, physician, immediate past-president of the American Medical Association
* Joseph J. Piccione, corporate director of mission integration, OSF Healthcare System
* John Rugge, CEO, Hudson Headwaters Health Network, National Association of Community Health Centers
* Douglas Struyk, president and CEO, Christian Health Care Center, American Health Care Association/National Center for Assisted Living and American Association of Homes and Services for the Aging
* Howard Weitz, cardiologist, Thomas Jefferson University
* Joy Johnson Wilson, director of health policy and federal affairs counsel, National Conference of State Legislators
The Medicaid commission must submit two reports to Secretary Leavitt. By Sept. 1, the commission will outline recommendations for Medicaid to achieve $10 billion in reductions in spending growth during the next five years as well as ways to begin meaningful long-term enhancements that can better serve beneficiaries. The commission, for its first report, also will consider potential performance goals for Medicaid as a basis of longer-term recommendations.
The second report, due Dec. 31, 2006, will provide recommendations to help ensure the long-term sustainability of Medicaid. The proposals will address key issues such as:
*How to expand coverage to more Americans while still being fiscally responsible;
*Ways to provide long-term care to those who need it;
*A review of eligibility, benefits design, and delivery; and
*Improved quality of care, choice and beneficiary satisfaction.
A full copy of the commission's charter is available at http://www.cms.hhs.gov/faca/mc/default.asp.
Contact: HHS Press Office
Friday, July 8, 2005
(202) 690-6343
HHS SECRETARY NAMES MEDICAID ADVISORY COMMISSION MEMBERS
Former Tennessee Governor Named Chair; Former Maine Governor Named Vice-Chair
HHS Secretary Mike Leavitt today announced 13 voting members and 15 non-voting members of an advisory commission charged with identifying reforms necessary to stabilize and strengthen Medicaid.
Consisting of health policy leaders from both sides of the aisle, state health department officials, public policy organizations, individuals with disabilities and others with special expertise, the commission will submit its first report to Secretary Leavitt by Sept. 1. Through the FY 2006 budget agreement, the Department of Health and Human Services agreed to create this commission to develop proposals on the future of the Medicaid program.
"In Washington and state capitols across America, there is consensus that now is the time to reform and modernize Medicaid," Secretary Leavitt said. "I look forward to having a robust conversation in an open and bipartisan manner with the commission members. Together with Congress and the states, we will create a plan that will better help Medicaid fulfill its commitment to quality care in a way that is financially sustainable."
In addition, the Secretary is holding open two vacancies on the commission for current governors so that they may join after Sept. 1, 2005 when the commission focuses on the longer-term methods of modernizing the Medicaid program. The National Governors Association Center for Best Practices will serve as a working group tasked with informing the commission on the range of issues that will be considered.
Former Tennessee Governor Don Sundquist will chair the commission and former Maine Governor Angus King will serve as vice-chair. The commission members are:
* Nancy Atkins, commissioner for the Bureau for Medical Services, Department of Health and Human Resources, West Virginia
* Melanie Bella, vice president for policy, Center for Health Care Strategies, Inc.
* Gail Christopher, vice president for health, Women and Families at the Joint Center for Political and Economic Studies and director of the Joint Center Health Policy Institute
* Gwen Gillenwater, director for advocacy and public policy, National Council on Independent Living
* Robert Helms, resident scholar and director of health policy studies, American Enterprise Institute
* Kay James, former director of the U.S. Office of Personnel Management
* Troy Justesen, deputy assistant secretary for the office of special education and rehabilitative services, U.S. Department of Education
* Tony McCann, secretary of health and mental hygiene, Maryland
* Mike O'Grady, assistant secretary for planning and evaluation, U.S. Department of Health and Human Services
* Bill Shiebler, former president, Deutsche Bank
* Grace-Marie Turner, president, Galen Institute
In addition to the voting members, the commission will consist of the following non-voting members:
* James Anderson, president and CEO, Cincinnati Children's Hospital Medical Center, National Association of Children's Hospitals
* Julianne Beckett, director of national policy, Family Voices
* Carol Berkowitz, pediatrician, president of the American Academy of Pediatrics
* Maggie Brooks, county executive, Monroe County, New York
* Valerie Davidson, executive VP, Yukon-Kuskokwim Health Corporation
* Mark de Bruin, senior VP of pharmacy services, Rite Aid; chairman of the policy council, National Association of Chain Drug Stores
* John Kemp, CEO, Disability Service Providers of America
* Joseph Marshall, chairman and CEO, Temple University Health System, American Hospital Association
* John Monahan, president of state sponsored programs for WellPoint; Blue Cross/Blue Shield Association and America's Health Insurance Plans
* John Nelson, physician, immediate past-president of the American Medical Association
* Joseph J. Piccione, corporate director of mission integration, OSF Healthcare System
* John Rugge, CEO, Hudson Headwaters Health Network, National Association of Community Health Centers
* Douglas Struyk, president and CEO, Christian Health Care Center, American Health Care Association/National Center for Assisted Living and American Association of Homes and Services for the Aging
* Howard Weitz, cardiologist, Thomas Jefferson University
* Joy Johnson Wilson, director of health policy and federal affairs counsel, National Conference of State Legislators
The Medicaid commission must submit two reports to Secretary Leavitt. By Sept. 1, the commission will outline recommendations for Medicaid to achieve $10 billion in reductions in spending growth during the next five years as well as ways to begin meaningful long-term enhancements that can better serve beneficiaries. The commission, for its first report, also will consider potential performance goals for Medicaid as a basis of longer-term recommendations.
The second report, due Dec. 31, 2006, will provide recommendations to help ensure the long-term sustainability of Medicaid. The proposals will address key issues such as:
*How to expand coverage to more Americans while still being fiscally responsible;
*Ways to provide long-term care to those who need it;
*A review of eligibility, benefits design, and delivery; and
*Improved quality of care, choice and beneficiary satisfaction.
A full copy of the commission's charter is available at http://www.cms.hhs.gov/faca/mc/default.asp.
Friday, July 01, 2005
case of the Week: 7/01/2005
My client is an 89-year-old resident of Monongalia County. She needed a DPOA in order for her son to manage her finances. Since she is housebound, low income, and time is of the essence, I was able to advise her about DPOAs, discuss the powers she wanted to include, and draft a DPOA for her.
Thursday, June 16, 2005
Aged and Disabled Waiver Renewal: The good, the bad, & the ugly
The Aged and Disabled Medicaid Waiver (A/D Waiver) program provides in-home Medicaid-funded services to low-income West Virginians who need help with activities of daily living. To qualify medically, the participant must have at least 5 "deficits" according to the Pre-Admission Screening, needing the same level of care required for Medicaid-covered nursing home admission. The program has 5,400 slots or participants, and there has been a 6 month waitlist in place for over a year. Basically this program helps people stay living at home and avoid having to move to a nursing home by providing help with activities of daily living, ie. walking, bathing, dressing, eating, toileting, as well as instrumental activites of daily living, ie. meal preparation, house work, and shopping. This program is one of the important pieces of the Olmstead puzzle, how the state discharges its duty to support community-based living.
The A/D Waiver is up for 5 year renewal through the Centers for Medicare and Medicaid Services (CMS). The renewal application includes some significant changes, both positive and negative, as well as some missed opportunities for change in leaving certain areas as is.
The Good
The self-directed option that is being funded through a Robert Wood Johnson grant will enable participants to take control over their own services. The option to self-direct will be entirely voluntary, only approximately 10% of participants are expected to try it, and participants can choose to go back to the traditional model any time. In a nutshell, the self-directed option will allow a participant to take a budget (which will be determined by the amount of $ the participant's level of service would have cost under the traditional model, minus a small adminstrative fee), and create a service plan within that budget designed to suit the participant's service needs. Self-directed participants will become the employers for individuals they choose to hire to serve their needs, or can contract with existing providers for staff. They can hire their spouses, family, and friends, if they choose. They can choose to bank some of the monthly budget to save up for home modifications, assistive technology, or other items they need. They won't just get the cash, approved costs will be paid through a fiscal intermediary.
This option will not only empower those participants to take control of their own lives, it can help address the serious staffing shortage that has plagued the program for years. This is the best part of the Waiver renewal changes, and I hope this program is so successful that we start incorporating the best aspects of consumer direction into all areas of Medicaid in West Virginia.
The Bad
The Waiver still has a 6 month waitlist, and still has no triage or prioritization to allow needier people to get on the program quicker. I know this is a contentious issue, especially for those who do not have the highest need, and therefore would not be prioritized. I think a priority system can address those folks, for example by having a person become a priority once he or she has been on the waitlist for a specified length of time. At any rate, we have had the heartbreak of telling a senior with Lou Gehrig's disease, who came home to West Virginia to die, that she had to wait at least 6 months for waiver services, though her prognosis gave her less than 6 months to leave. We missed a great opportunity to deeply help this woman, and her slot would have been available for the next person in less than the waitlist period anyway. Other states have prioritization that works, we could do it, too.
The Ugly
Though many providers who are just learning about the self-directed option are very worried about the impact it will have on their bottom line, the more worrisome aspect of the renewal application for them is the significant reduction in slots. While self-direction might move as many as 540 participants off provider roles (though many will doubtlessly still choose to contract with providers for services), by the 2d year the program proposes to cut 2,000 slots.
As an advocate for seniors and people with disabilities this is deeply disturbing to me. This is absolutely going backwards in our Olmstead efforts. This program helps people leave nursing homes to live back in the community, helps people in the community stay home longer, and is already so underfunded that we have a 6 month waitlist and very low maximum levels of service provided. Generally participants get 25 hours of services or less per week on the program, not even enough to allow a family caregiver to continue to work a full-time paying job in addition to caring for a person with a disability.
Though states may apply for changes before the expiration of their waivers (5 years in this case), renewal time is the best chance to try to progress. I think the reduction in slots on this waiver proposal is not outweighed by the improvement the self-directed option will bring, and overall the new proposed version of the waiver is worse for West Virginia rather than better.
The A/D Waiver is up for 5 year renewal through the Centers for Medicare and Medicaid Services (CMS). The renewal application includes some significant changes, both positive and negative, as well as some missed opportunities for change in leaving certain areas as is.
The Good
The self-directed option that is being funded through a Robert Wood Johnson grant will enable participants to take control over their own services. The option to self-direct will be entirely voluntary, only approximately 10% of participants are expected to try it, and participants can choose to go back to the traditional model any time. In a nutshell, the self-directed option will allow a participant to take a budget (which will be determined by the amount of $ the participant's level of service would have cost under the traditional model, minus a small adminstrative fee), and create a service plan within that budget designed to suit the participant's service needs. Self-directed participants will become the employers for individuals they choose to hire to serve their needs, or can contract with existing providers for staff. They can hire their spouses, family, and friends, if they choose. They can choose to bank some of the monthly budget to save up for home modifications, assistive technology, or other items they need. They won't just get the cash, approved costs will be paid through a fiscal intermediary.
This option will not only empower those participants to take control of their own lives, it can help address the serious staffing shortage that has plagued the program for years. This is the best part of the Waiver renewal changes, and I hope this program is so successful that we start incorporating the best aspects of consumer direction into all areas of Medicaid in West Virginia.
The Bad
The Waiver still has a 6 month waitlist, and still has no triage or prioritization to allow needier people to get on the program quicker. I know this is a contentious issue, especially for those who do not have the highest need, and therefore would not be prioritized. I think a priority system can address those folks, for example by having a person become a priority once he or she has been on the waitlist for a specified length of time. At any rate, we have had the heartbreak of telling a senior with Lou Gehrig's disease, who came home to West Virginia to die, that she had to wait at least 6 months for waiver services, though her prognosis gave her less than 6 months to leave. We missed a great opportunity to deeply help this woman, and her slot would have been available for the next person in less than the waitlist period anyway. Other states have prioritization that works, we could do it, too.
The Ugly
Though many providers who are just learning about the self-directed option are very worried about the impact it will have on their bottom line, the more worrisome aspect of the renewal application for them is the significant reduction in slots. While self-direction might move as many as 540 participants off provider roles (though many will doubtlessly still choose to contract with providers for services), by the 2d year the program proposes to cut 2,000 slots.
As an advocate for seniors and people with disabilities this is deeply disturbing to me. This is absolutely going backwards in our Olmstead efforts. This program helps people leave nursing homes to live back in the community, helps people in the community stay home longer, and is already so underfunded that we have a 6 month waitlist and very low maximum levels of service provided. Generally participants get 25 hours of services or less per week on the program, not even enough to allow a family caregiver to continue to work a full-time paying job in addition to caring for a person with a disability.
Though states may apply for changes before the expiration of their waivers (5 years in this case), renewal time is the best chance to try to progress. I think the reduction in slots on this waiver proposal is not outweighed by the improvement the self-directed option will bring, and overall the new proposed version of the waiver is worse for West Virginia rather than better.
Friday, May 13, 2005
Case of the Week: 5/9/2005
County: Randolph
Age: 68
Client was contacted by the Department of Labor regarding an overpayment of Blacklung benefits to her deceased father. The Department of Labor was holding the client responsible as executor of her father's estate. I contacted the claims examiner on my client's behalf and explained that to the best of my client's knowledge the deceased left nothing in his estate. Moreover, the overpayments were never used for my client's benefit. Her father passed away at a nursing home with no assets. As a result, the estate was never probated. The claims examiner investigated the estate of the client's father and notified me that the debt will be written-off as uncollectable. Our client will no longer be held responsible for her father's overpayment.
Age: 68
Client was contacted by the Department of Labor regarding an overpayment of Blacklung benefits to her deceased father. The Department of Labor was holding the client responsible as executor of her father's estate. I contacted the claims examiner on my client's behalf and explained that to the best of my client's knowledge the deceased left nothing in his estate. Moreover, the overpayments were never used for my client's benefit. Her father passed away at a nursing home with no assets. As a result, the estate was never probated. The claims examiner investigated the estate of the client's father and notified me that the debt will be written-off as uncollectable. Our client will no longer be held responsible for her father's overpayment.
Wednesday, May 04, 2005
Case of the Week: 5/02/2005
County: Randolph
Age: 67
My client was contacted by a collection agency for a past due debt of approximately $800. Over half of the debt is for charges from 10 years ago. I contacted the collection agency on my client's behalf and informed them that the West Virginia Statue of Limitations bars collection of a debt that is 10 years or older, unless there is an acknowledgement with a new promise to pay. My client made no such acknowledgement. As a result, the majority of the debt was forgiven. My client can settle the account with less than $50.
Age: 67
My client was contacted by a collection agency for a past due debt of approximately $800. Over half of the debt is for charges from 10 years ago. I contacted the collection agency on my client's behalf and informed them that the West Virginia Statue of Limitations bars collection of a debt that is 10 years or older, unless there is an acknowledgement with a new promise to pay. My client made no such acknowledgement. As a result, the majority of the debt was forgiven. My client can settle the account with less than $50.
Monday, April 18, 2005
Social Security beneficiaries who owe back federal taxes may be subject to 15% levy
An IRS policy that has permited the IRS to levy against federal employees and federal pensioners will be expanded as of July 2005. The expansion is expected to affect 90,000 additional taxpayers, specifically Social Security beneficiaries. The policy subjects the taxpayers to a 15% flat offset payment of federal back taxes from their Social Security benefits.
The Taxpayer Advocate Services for West Virginia can be reached at 304-420-8695, and the National Taxpayer Advocate toll free number is 1-877-777-4778, both services are free.
The Taxpayer Advocate Services for West Virginia can be reached at 304-420-8695, and the National Taxpayer Advocate toll free number is 1-877-777-4778, both services are free.
Case of the Week: 4/18/2005
County: Mingo
Age: 83
This 83-year-old gentleman from Mingo County contacted West Virginia Senior Legal Aid after he discovered his credit card had charged him for a service for four months that he never asked for or authorized. He tried to work with the credit card company, but with limited success. One his behalf, I wrote the credit card company a letter requesting that my client be disenrolled in the service and refunded the four months he was charged for the service. My client informs me that the credit card company has disenrolled him and he will be receiving a refund for the four months he was charged.
Age: 83
This 83-year-old gentleman from Mingo County contacted West Virginia Senior Legal Aid after he discovered his credit card had charged him for a service for four months that he never asked for or authorized. He tried to work with the credit card company, but with limited success. One his behalf, I wrote the credit card company a letter requesting that my client be disenrolled in the service and refunded the four months he was charged for the service. My client informs me that the credit card company has disenrolled him and he will be receiving a refund for the four months he was charged.
Friday, April 15, 2005
Case of the Week: 4/12/05
County: Randolph
Age: 65
Our client is an elderly lady who contacted us regarding a collection notice she received for a debt she does not believe she owes. I reviewed the notice, which fails to state the creditor on whose behalf they are collecting. The collection company, holding itself out as an attorney's office, has also contacted her threatening to sue if she does not pay. They have also threatened that if she does not pay she will owe 10 times more than she currenly owes. I explained that the company may be in violation of Consumer Protection Laws. I forwarded her a complaint form for the West Virginia Attorney General's office. I also explained her right to send the collection company a cease letter. I also evaluated her case and informed her that the likelihood of the company actually suing is slim since the debt is very small and the company is out of state. It would cost more for the company to hire an attorney and pursue the debt.
Age: 65
Our client is an elderly lady who contacted us regarding a collection notice she received for a debt she does not believe she owes. I reviewed the notice, which fails to state the creditor on whose behalf they are collecting. The collection company, holding itself out as an attorney's office, has also contacted her threatening to sue if she does not pay. They have also threatened that if she does not pay she will owe 10 times more than she currenly owes. I explained that the company may be in violation of Consumer Protection Laws. I forwarded her a complaint form for the West Virginia Attorney General's office. I also explained her right to send the collection company a cease letter. I also evaluated her case and informed her that the likelihood of the company actually suing is slim since the debt is very small and the company is out of state. It would cost more for the company to hire an attorney and pursue the debt.
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