Case of the Week 11/22/06

County: Wetzel
Client's Age: 78

Client's husband is applying for Nursing Home Medicaid, and NH is asking for financial information from client to complete the application. Client and husband, however, have been estraned and legally separated for over 30 years. Client was concerned about whether Medicaid Estate Recovery could apply to her home. We explained the federal right of spousal refusal in NH Medicaid law permits client to refuse to cooperate and therefore keep her home out of the consideration entirely.

Case of the Week 11/14/06

County: Upshur
Client's Age: 67

Client's deceased husband was a coal miner. She had been receiving Black Lung benefits but was notified they were being terminated. We located an experienced attorney to represent her in filing an appeal, and he successfully got her benefits restored.

Case of the Week 11/10/06

County: Brooke
Client's Age: 77

Client's SS benefits have been affected by an overpayment SSA levied under the fairly recently-enacted fugitive felony provisions. Though the underlying warrant was an error that C corrected as soon as SSA notified him of the problem, SSA charged C with a significant overpayment of benefits, and notified him they would stop his check for several months for the repayment. We counseled client to appeal for a hardship waiver, and helped him identify evidence and arguments to support each element of the waiver for use in his appeal.

Case of the Week 10/27/06

County: Jefferson
Client's Age: 70

Client recently moved into apartment, landlord has ignored her requests to make several repairs. Though most are minor or cosmetic, client had been assured before she moved in they would be fixed and now the client wished she had never taken the place. We reviewed her lease and determined that because it listed no start and end dates, she was actually a month-to-month tenant, and therefore could be released from any further obligation merely by giving 30 days notice that she was moving.

Case of the Week 10/19/06

County: Hardy
Age: 72

Client was being harrassed for collection of a debt. After reviewing her assets, income, and expenses she appears collection-proof, so we explained how to write a cease letter to stop the collections calls. Also we reassured her that the kind of income she gets enjoys federal protection from general creditors, and talked generally about how to prioritize her bills based on the different legal rights she has regarding each kind of expense.

Case of the Week 10/13/06

County: Logan
Age: 75

Our client's former landlord had refused to give her back her security deposit of almost $700, though our client left the apartment clean and undamaged. We wrote a letter to him on her behalf explaining that by law he cannot charge her for normal wear and tear, and he returned her deposit.

Google Accessible Search for visually impaired users

Google has launched a search engine that "identifies and prioritizes search results that are more easily usable by blind and visually impaired users," according to the FAQ. They don't give much description of the criteria they use to define accessibility, but do link to the W3C accessibility guidelines.

WV Legislature's LOCHHRA committee focuses on Aged & Disabled Waiver

The Legislative Oversight Committee on Health and Human Resources Accountability (LOCHHRA) has an interim meeting scheduled for next Wednesday, Sept. 13 at 10:00am in the House chambers. The agenda for the meeting is the Aged and Disabled Waiver program.

The following legislators are on the committee:
Senator Prezioso Chair
President Tomblin Nonvoting, Ex Officio
Senator Boley
Senator Caruth
Senator Hunter
Senator Sharpe
Senator Unger

Delegate Leach Chair
Speaker Kiss Nonvoting, Ex Officio
Delegate Hall
Delegate Hatfield
Delegate Michael
Delegate Perdue
Delegate Susman
Delegate Boggs Nonvoting
Delegate Border Nonvoting
Delegate Brown Nonvoting

Legislative interim meetings such as this one are open to the public.

Good website on Home & Community-based Medicaid Waivers

In searching for a copy of our current Aged and Disabled Waiver as approved by CMS (no luck yet), I discovered this website: www.hcbs.org/browse.php/state/188/West%20Virginia/

It's got a variety of interesting specific info on waivers state by state (everything from forms to reports and papers), as well as a variety of info that can help policy makers and advocates working toward more progressive and client-centered services through Medicaid waivers.

For the uninitiated, waivers are optional programs states can use to get federal Medicaid matching dollars to provide services beyond what is included in their state Medicaid plans. There are several different types of waivers available through CMS, and some states have very creative and progressive waivers in place. Unlike state plan services which are generally entitlements for any eligible applicant, the state may limit the number of eligible applicants the waiver will serve, so waitlists are a common problem on waivers.

Case of the Week: 8/18/06

County: Barbour
Age: 85

Our client had moved into senior housing with her husband 25 years ago and have been in the same unit that entire time. The unit is handicapped accessible. When my client moved in, she and her husband signed a document acknowledging that the unit is for handicapped residents and agreed to move out should someone with disabilities need the unit. Since that time, both the client and her husband have developed disabilities. They received a notice from management that a resident who uses a wheelchair requested that unit. I sent management a letter explaining that my client and her husband are both disabled under their definition of disability. Working with their attorney, I was able to keep my client in her unit. Management found another suitable handicapped accessible unit for the other resident.

Case of the Week: 7/7/06

County: Ohio
Age: 76

Our client had to leave her apartment due to medical reasons. She had paid her rent to the end of the lease agreement and the landlord agreed to return her security deposit. Our client waited for months without seeing the deposit. The landlord claimed she sent the deposit out and that there was probably a delay with the hospital mail. However, my client received her deposits from her electric and cable companys. I sent the landlord a letter demanding she remit my client's deposit of $139. Two days after the landlord got my letter, the deposit was delivered to our client via UPS.

Case of the Week: 6/23/2006

County: Randolph
Age: 80

Our client contacted us after he had returned a vacuum cleaner he ordered from a TV advertisement. Although he was promised a refund, the New York based company never made good on it's promise. C contacted the West Virginia Attorney General; however, the company was not cooperative and there was little the Attorney General could do. I sent the company on a letter on the client's behalf threatening legal action based on Consumer Protection Law should they fail to remit C a full refund. With the threat of legal action, the company quickly refunded my client his $276.70. My client is grateful for all the help he received from both the Attorney General and West Virginia Senior Legal Aid.

Case of the Week: 6/5/2006

County: Boone
Age: 70

Our client contacted us after she received a letter from Citi Bank claiming that a payment of $6588.60 was return due to insufficient funds. The payment was made by Discover in October of 2005 as a balance transfer. She recieved the letter from Citi Bank nearly 4 months after the balance transfer. After several failed attempts to work with Citi Bank she contacted us. I sent a letter of dispute on her behalf asking that Citi Bank conduct an investigation of the charges. After two billing cycles my client received a statement from Citi bank crediting her all the charges, including late fees and finance fees, leaving her with a zero balance.

Case of the Week: 5/26/06

County: Marion
Age: 74

Our client contacted us after having visited a dentist for a bridge. The dentist had begun the process of getting her a bridge. A mold of her mouth was already made and she was wearing temporaries. Unfortunately, her dentist passed away. The client made several, unsuccessful attempts to contact the dentist office regarding her bridge work. Since she was having trouble and she needed her bridge, she contacted us. I sent the office a letter asking that they give her the bridge, so that she can go to another dentist to have the work completed. I gave a deadline of May 22. The office contacted our client on May 22 and offered to have another dentist complete the bridgework at no extra charge.

Case of the Week: 5/26/06

County: Marion
Age: 74

Our client contacted us after having visited a dentist for a bridge. The dentist had begun the process of getting her a bridge. A mold of her mouth was already made and she was wearing temporaries. Unfortunately, her dentist passed away. The client made several, unsuccessful attempts to contact the dentist office regarding her bridge work. Since she was having trouble and she needed her bridge, she contacted us. I sent the office a letter asking that they give her the bridge, so that she can go to another dentist to have the work completed. I gave a deadline of May 22. The office contacted our client on May 22 and offered to have another dentist complete the bridgework at no extra charge.

Case of the Week: 5/19/06

County: Mon
Age: 87

This client contacted after he had contracted with a construction company to replace his screen door. In the process of replacing the screen door, the frame and main door were damaged. Our client could barely use the door. I sent the construction company a letter requesting that they repair the damage they caused. 10 days later, the construction company went back to the client's home and repaired the damage. Our client is happy. He paid a total of $1266 for the job and is now satisfied with the results.

Case of the Week: 5/5/06

County: Cabell
Age: 64

Our client received a notice from Social Security that she received an overpayment in Supplemental Security Income (SSI) payments and would have to repay a total of $3494. I researched her issue and reviewed her legal position. I explained that she could request a waiver of the overpayment. We discussed possible arguments and strategies. After requesting the waiver, she was happy to learn that Social Security granted it. She is relieved that she does not have to pay back the $3494.

Case of the Week: 4/28/06

County: Jefferson
Age: 80

The client contacted us because she kept receiving bills from Sears for an account she never authorized. Her account balance was $181.98. I sent a letter of di spute on the client's behalf with an ID Theft Affidavit. Sears responded by refunding out client the money she did pay toward the bill and her account balance is zero. I advised her to close the account and be careful with her identification information.

Case of the Week: 4/21/06

County: Marion
Age: 71

Our client called us after she learned that her plan provider for Medicare Part D would not cover one of her prescriptions. Although the provided wanted to switch to a generic drug, her doctor advised her that this would be detrimental to her health. I explained that she and her doctor can submit a request for an exception since the doctor does not feel she can switch. If the plan refuses then she can appeal. The client had her doctor send a request for an exception and the plan decided to cover her prescription.

Case of the Week: 3/20/06

County: Wood
Age: 87

Our client contacted us after she received a statement in the mail from Capital One with charges for privacy protection. She recalls having been solicited by Capital One via telephone. My client is elderly and hard of hearing. She never wanted the card, but she was signed up anyway with privacy protection after the initial solicitation. I sent a letter disputing the charges and requesting her account be closed since she never authorized the card in the first place. My client received confirmation that her balance with Capital One is now zero and the account has been closed.

Case of the Week: 3/10/06

County: Taylor
Age: 74

Our client received a letter from a collector regarding her student loan from 20 years ago. My client had limited information regarding the loan. I contacted the collection company and learned that the loan is federally insured. I explained to our client that although her Social Security benefits may be garnished, she can exempt up to $750 per month from garnishment. Since my client receives $700 per month, she can exempt the entire amount.

Case of the Week: 3/3/06

County: Wayne
Age: 71

This client contacted us after receiving a hospital bill in the amount of $3000 for services that should have been covered under his Medicare Part B. I contacted the billing office of the hospital and explained that my client is covered under Medicare Part B and, therefore, the hospital must file a claim through Medicare. After gathering my client's Medicare information the hospital filed its claim. Medicare covered most of the balance. My client can be billed for only $450 for co-pays and deductibles.

Changes in Aged and Disabled Waiver getting plenty of press

West Virginia Public Radio broadcast a 3 part series on West Virginia Morning about changes in the medical assessment and reassessment for the Aged and Disabled Medicaid Waiver program (ADW). Kate Long interviewed waiver beneficiaries, waiver service providers, administrators, and advocates, including your truly. Her story focused on the tragic human impact of the recent changes that have made the program harder to get on and stay on. Kate's piece delved into the changes brought about by the new PAS 2005's stricter criteria as well as the state contracting with WVMI to complete PAS's. She also highlighted several elderly individuals who have suffered because of these changes.

In yesterday's Sunday Gazette-Mail there was an excellent article by Scott Finn in the same vein. Scott's piece focuses on the stories of a few waiver clients who are very sick, and yet are being taken off the program.

This waiver has been underfunded for at least the 10 years I've been working with these clients. It still is, and now that there is a large national movement to reduce the costs of Medicaid, I'm afraid the very needy people who benefit from this waiver are among the targeted.

Case of the Weekd: 2/17/05

County: Jefferson
Age: 65

This client contacted us after her received a notice to garnish his Social Security for child support. The original order was issued 30 years ago in another state. He also informed me that up until three years ago his taxes were being off-set to pay for the past due support. After reviewing his notice and the law, I was able to advise him that although Social Secuirty benefits can be garnished for support orders, West Virginia law provides a 10 years statute of limitations on judgements. Moreover, the statute of limitations is not tolled by tax offsets or moving to a different jurisdiction. My client can protect his benefit .

WVA legal director position vacant; WVA now handling ADW appeals

I recently learned that Tom Gillooly is no longer the legal director for The West Virginia Advocates (WVA), the federally designated protection and advocacy provider for West Virginians with disabilities. The organization is accepting applications through March 1, 2006, and the position was advertised in the Sunday Gazette-Mail this week.

Clarice Hausch, the Executive Director, would not go into detail about why Tom was no longer with the organization, but she did tell me that he did some great work for them during his tenure at WVA.

And good news for folks whose medical eligibility is being denied or reduced for Aged and Disabled Waiver (ADW) services, Clarice said WVA is looking to take some of those cases for legal representation. Particularly, she explained, their funding streams which support assisting people with physical disabilities and/or some mental illness are not yet exhausted.

Legal Aid of West Virginia has been handling many ADW appeals, so hopefully these two entities will coordinate and collaborate to efficiently get the best representation possible for these important cases. As soon as I know more details about who is taking which kinds of cases, I will post them here, so we can all make good referrals.

Case of the Week: 2/10/06

County: Mon
Age: 67

Our client contacted us because he was in an auto accident. Because he did not have insurance, he was being pursued by the other motorist's insurance company. Our client also has an 80 percent loss of hearing that made it very difficult for him to work anything out with the company. I contacted the company on his behalf and negotiated a settlement which saved my client $704 off the origianl claim.

Case of the Week: 2/3/06

County: Berkeley
Age: 71

This client contacted us because his apartment complex is getting foreclosed upon. Because his rent was subsidized, he would face an increase in rent once the sale was final. To avoid this, he found another, affordable place to live. Given that his is a month to month tenant, generally he would have to give 30 days notice before terminating the tenancy, but given the seriousness of this situation, my client wanted to move right away. I contacted the manager and explained the client's situation and she agreed to waive the 30 day notice and also agreed to return my client's security deposit.

First look at 2006 WV Legislation and seniors; and it's not "HIPPA," it's "HIPAA"

You'll be the smartest one on your block if you learn that the infamous HIPAA (with 2 A's, one P) is actually the Health Information Portability and Accountability Act. Not HIPPA.

And back to things that really matter, our state legislature is now in its annual 2 month regular session. The state Bureau of Senior Services kindly publishes a weekly legislative roundup of the status of bills affecting seniors. From that large list I cooked down a few to keep an eye on:

Many about healthcare, including:

• requiring itemized statements of services billed for Medicaid recipients (SB 79, HB 2318)
• a good samaritan-type law waiving liability for physicians providing services to indigent people (SB 82)
• requiring health insurance policies to cover acupuncture (SB 104. 190)
• creating an Alzheimer's Caregiver Assistance Program (SB 109) and establishing an Alzheimer's Disease Registry (SB 112)
• authorizing dispensing and delivery of drugs to remote health clinics (SB 143)
• establishing the WV Fair Share Health Care Act allowing the state to offset healthcare costs from large employers who spend too little on employee health bene's (SB 147)
• permitting physicians to issue "do not resuscitate" orders on patients who lack healthcare decisionmaking capacity and for whom CPR would not be effective (SB 161, HB 4022)
• exempting from the Medicaid preferred drug list certain anti-psychotic drugs for certain high-risk patients (HB 2406)
• making in-home care available on a sliding fee scale for seniors age 65+ (HB 2324)
• requiring Alzheimer's training for certain personnel of longterm care facilities and adult day care facilities (HB 2649)
• establishes information sharing between pharmacies to prevent multiple prescriptions abuse (HB 2768)
• prohibiting pharmacists from refusing to fill prescriptions without valid reason (HB 2807)
• creates voluntary state income tax check-off to develop pharmaceutical assistance program for WV seniors (HB 3265)
  

Some particularly about nursing homes:

• adds "nursing homes" to the list of facilities whose certain unlicensed staff are authorized to administer drug (HB 2138)
• permits electronic monitoring of nursing home residents by themselves or their representatives (HB 2272)
• creates quality assurance program for nursing homes (HB 2281)
• requiring specific staffing levels in nursing homes and providing penalties for non-compliance (HB 2360)
  

Some about consumer issues, including:

• creating a physician's lien on injury awards and settlements (SB 48)
  
• creating an Insurance Advocacy Unit within the state Attorney General's Office (SB 140)
• requiring consumer notification of negative credit ratings (SB 185)
• eliminating the 90-day mandatory reinstatement of lapsed auto insurance policies (SB 198)
• prohibiting non-renewal of auto and property insuance policies (SB 203)
• exempting seniors age 65+ from having to pay the fees associated with redemption of property from tax sale within 2 years (HB 2097)
  
• requiring hospitals to disclose their infection rates (HB 2180)
• making the senior discount at campgrounds and parks year-round (HB 2300)
• requiring grab bars to be installed in all hotel and motel baths and showers (HB 2312)
• reducing the statute of limitation on consumers filing actions regarding revolving credit against creditors pursuant to the Consumer Protection Act (CPA) from 4 years to 1 year (HB 3113)
• eliminating the probate of uncontested small estates (HB 3221)
• increasing the amount of the homestead tax exemption from $20,000 to $50,000 (HJR 1) or from $20,000 to $40,000 (HJR 06, and 19)

Some about abuse, neglect, and protection issues:

• requiring Adult Protective Services to complete a face-to-face interview with an adult reported to be abused or neglected within 14 days of the report, and within 72 hours if imminent danger or serious physical abuse is alleged in the report (HB 2048)
• adding identity theft to the list of crimes for which victims can get victims compensation funds awarded (HB 2049)
• creating a program to reprogram and distribute (HB 2067, 2842)

And one that defies normal categorization: raising the age for which one may request to be excused from jury duty from 65 to 70 (HB 2013).

And this is just the beginning of the session, so there will likely be more bills affecting seniors in the next weeks.

Case of the Week: 1/9/06

County: Grant
Age: 64

This client contacted us because his administrative hearing with the Department of Motor Vehicles has been postponed. Our client was pulled over for drinking and driving. His attorney was able to get a favorable outcome in the criminal case since our client was not under the influence of alcohol; however, his administrative case to determine wether his driving privileges should be suspended has not happened yet because the arresting officer is currently serving in Iraq. Our client wanted to know his due process and administrative due process rights. I researched the issue for him and explained that although the WV Supreme Court has stated a driver's license is a property interest within the protection of the WV Due Process Clause, the commissioner under the Code of State Rules may postpone a hearing upon his own motion for good cause. Since the arresting officer, who is crucial to the hearing, will not be available, then the commission has the authority to postpone. Also, since our client still has his driving privileges, he is not being harmed by the delay. Our client is low income and the research we provided is quite valuable to him as it would have cost quite a bit to have a private attorney do the same research.

Coal Company Retirees, M'care Part D, UMWA update

This is a followup to my post last week in this blog about coal retirees getting threatened with losing their company healthcare benefits if they didn't enroll in a Medicare Part D plan by December 31, 2005.

According to Brian Sampson in the President's office at the United Mine Workers Union (UMWA), all the coal companies the UMWA deals with nationwide took the 28% government incentive to keep all their current retiree drug benefits in place except these four: Peabody, Consol, Arch, and Bluestone. These four companies instead demanded each of their retirees (and their dependants) enroll in a Part D plan or lose all retiree health coverage by December 31, 2005.

UMWA quickly went into negotiations with these four companies to advocate the position that the collective bargaining agreements in place guaranteed these retirees their existing benefits, and they could not be forced to enroll in a Part D plan to keep what they already had a right to. UMWA, however, did send letters to their member retirees recommending that they go ahead and enroll while the union continued to dispute the actions of the companies.

According to a press release from UMWA issued December 29, 2005, the companies have all agreed not to take away the health benefits of those who have not enrolled in drug plans while the dispute is resolved. According to Brian, all four companies have also agreed that they will provide wraparound coverage at the levels they provided before. This means that retirees would not have to pay any more out of pocket than they did before. Hopefully they would each have two prescription cards, one from the Part D provider they chose, and one from the company's provider which would cover deductibles and copays beyond the out-of-pocket limits they had before. If the companies require burdensome paperwork or other hoops for retirees to jump through to get the wraparound coverage, this will be an important issue for advocacy.

Also according to Brian all sides have agreed to expedite the issue, and if they cannot come to an agreement it will go through the Resolution of Dispute (ROD) process of collective bargaining, to be decided by a board of trustees. If the UMWA is not satisfied with that decision, they may take it to the next level which is arbitration. Brian expects that the resolution will be final before May 15, 2006, since all sides know that the federal legislation creating Part D imposes penalties on current beneficiaries who enroll after that date.

So at this point we at WVSLA agree that it is probably best for these retirees who have not yet enrolled to go ahead and do so. Humana is the company with the lowest premiums in West Virginia, and though UMWA does not endorse the company, they suggest their members who haven't chosen yet to consider enrolling in Humana to at least get enrolled in something. If the companies do provide wraparound coverage it won't much matter what the Part D plan covers since the companies will make up the difference, so low premiums will suit most retirees best.

Because of the agreements reached so far, retirees should not be experiencing coverage lapses. Consol retirees who are having problems with coverage at the pharmacy can contact Consol's retiree call center at 1-877-240-0139. Retirees from Peabody, Arch, and Bluestone who are experiencing coverage problems can contact the union at (304) 346-0342.

Coal Company Retirees and Medicare Prescription Drug Plan Enrollment

Just before the end of 2005 a panic developed among many Medicare-eligible coal company retirees. They got letters saying that they (and their spouses and dependents) would lose all their retiree healthcare benefits if they did not enroll in a Medicare prescription drug plan by December 31, 2005. These retirees have typically had excellent healthcare coverage, including some of the best prescription drug coverage of any retirement plans available in West Virginia. Some have paid no more than $50 out of pocket per year for drugs, even if they got thousands of dollars worth of prescriptions each year.

What about those retirees who are very sick and whose lives depend on costly medical care? What about those retirees who couldn't read or understand their letter (perhaps because of illiteracy, macular degeneration, mental incapacity, low education, etc.)? What about those retirees who never got the letter? What about the covered spouses and children of these retirees who never saw any such letter?

Even for those retirees and dependants who understood, there are literally 57 different drug plans available, each with different premiums, copayments, deductibles, and formularies. How could they possibly digest all that and make a good choice? The only real way to compare 57 different plans is through Medicare.gov's interactive Plan Finder database. How many of these retirees are computer-savvy enough to go through that process? Even if you can type and navigate the website, try typing "hydrochlorothiazide" or "metronidazole" without errors. And all this under the deadline of the busiest time of the year for many, the holiday season, with plenty of snow and cold to contend with.

Then those retirees who were also members of the United Mine Workers of America (UMWA) got letters saying that, though the union disagreed with the coal companies that they could take away retiree health coverage for failure to enroll in a drug plan, the union was recommending that affected retirees go ahead and comply by enrolling while they advocated their position.

For those who got the letters, understood them, and needed help choosing and enrolling in a plan, there was very limited help available. The process of choosing a plan can be time consuming, even using the interactive web-based Plan Finder. This is especially true for folks who take numerous prescription drugs. The toll-free numbers for Medicare, many of the drug companies, and other helping agencies were virtually impossible to get through on during those last weeks of December. One Morgantown senior said she finally hung up after being on hold with Humana (one of the popular and cheaper plan providers) with 1 hour and 40 minutes, hoping to enroll to keep from losing her benefits. Another had a surgery scheduled for January 5, 2006. Even if she could get her healthcare reinstated after successfully enrolling, if it couldn't be done in a week, she would have to bear the huge costs of a surgery because of the lapse in coverage.

At the last possible minute, in the Gazette-Mail on Saturday, December 31, 2005, Cecil Roberts of the UMWA is quoted as saying that retirees from Peabody, Consol, Arch, and Bluestone will not lose their coverage if they have not enrolled in a drug plan by December 31, 2005.

And yet this morning we have reports of covered retirees going to pick up their monthly prescriptions at the same pharmacies they've gone to for years and being told suddenly that they have been "red-flagged," and no longer have any drug coverage at all. Even some who have successfully enrolled in plans, but have not yet gotten their cards and coverage info.

Some of these prescriptions are a matter of life and death. Imagine the impact that all this confusion and threats of having no more coverage can have on a sick elderly retiree.

We are currently attempting to verify the quotes in the article, and to find out if there is still some deadline for these Medicare-eligible retirees to get enrolled in a plan to preserve all their retiree health coverage. As soon as we have more detail and confirmation, we will post it here.

Happy new year.