On April 24, I received a letter from New York City that informed me that on May 1, my home care would be discontinued because I never returned my application for recertification of Medicaid, which pays for my home care. Just to clarify: I have Medicare for my doctors, hospitalization and drug coverage. I clarify this because recently, a friend confused the two. When I said that I intended to change primary doctors, she asked "Is there another doctor in the neighborhood?" I told her that was a strange question; did she think my internist was the only doctor in Central Queens? She replied "I mean a doctor who takes Medicaid", and I was stunned. Not only is my neighborhood #1 in Medicaid claims in all of New York state, and a doctor who didn't accept Medicaid could never survive in Rego Park, but didn't she realize that I am on permanent disability after a 30-year work history and therefore eligible for Medicare? Anyway, what necessitates my Medicaid coverage is the fact that I need home care. Just thought I would clarify that Medicaid is not my primary health care coverage.
So I still panicked when I heard that my home care was in jeopardy. However, if I applied for a "fair hearing", my Medicaid home care would be continued without a gap in service. If my fair hearing wasn't ruled in my favor, I would have to pay back my home care charges from May 1 until my fair hearing judgement. The issue at hand was that I never received a recertification package, and I thought maybe that the entire procedure had changed because the city agency [CASA] was supposed to be dissolved this year. Also, this exact thing happened last year and my former case worker -- Jose Perez [retired since last July] was always on top of things and called me even before I got the letter from the city, to tell me "Heads up.....you will be getting a threatening letter from the city. If you fill out the application which I will bring to you tomorrow and return it to me at the end of the week, I will bring your case up to date" Mr. Perez came to my apartment the next day, Tuesday, and I took Access-a-Ride to the CASA office in Long Island City on Friday. A week later I received notification that my case was up to date.
So this time, I called my new case worker and assumed he could do the same service for me. Instead, he insisted that my case was fine until October of 2013. And finally, after going back and forth with the new case worker, I received a notice in early June that my fair hearing was scheduled for June 14 at 1:30 pm. I called my case worker again who informed me "I found out that your case is not okay. I am going to attach the form in an email". When I advised him that the attachment was corrupted and I could not print it [what else could go wrong?], he offered to come to my apartment on Tuesday, June 11 with the form, which he did. When he arrived at my apartment, he said that he spoke to some lady in his office who "was in charge of fair hearings" [whatever the hell that means] and this fair hearing guru advised me that I should fill out the recertification form, get the [50+ pages] of documentation together, and bring it with me to the hearing. I was then assured that everything would be all right.
Well, a lot this expert of fair hearings knew. I spent all day Tuesday, Wednesday and Thursday getting together my documentation, which is not an easy task for me. I needed to scan some of my documents and it is not easy for me to do that in my new wheelchair that doesn't have seat elevation. Every lift of my printer lid and every stretch across my desk is fatiguing for me. I find that after I do two or three pages, I have to rest and I am ready for a nap. Needless to say, my knee pain [a whole other epic saga] was at its peak at that time, and I found myself popping the maximum dose of pain meds [OTC because my internist refused to give me a prescription -- another epic saga]. I found out that even over-the-counter pain relief can put me to sleep and cause inconvenient stomach issues. Moreover, I had to tilt back my wheelchair every hour or so and put my feet up on the recliner at the whole opposite end of the room from my desk, when my left leg started to hurt too much. So I had to get together all my documents and take naps and breaks in between. And my room is so cluttered that my wheelchair doesn't pull up to my file cabinet comfortably [anyone want to invent a wheelchair-accessible file cabinet?].
So what is already a daunting task becomes even more daunting for a person in my condition. Nevertheless, I felt I was well prepared for my hearing. How wrong I was! When I entered the hearing room, there was a judge and a lady [Ms. Pettiford] from the city agency who sends out the recertification forms. I said I never received it and I had it ready for them, and really naively believed they would say "Thank you, Ms. Cohen, thank you for coming and we will take your recertification."
That's not what happened. What happened was something like this:
Judge: Do you usually have a problem with your mail delivery?
me: [stunned] Well, there is a lady named Esther Cohen on the other side of the building, and
sometimes I get her mail. [true and I was surprised I was able to answer so quickly]
Judge: What apartment does she live in?
me: You know, I don't know, because she sent a young girl once to pick up her mail and when I
asked her apartment number, she would not tell me, and the doorman has no idea who she
is, and when I give her mail back to the mailman, he says there is no Esther Cohen in the
Judge: Then how did you know she exists and how did you find her?
me: I looked her up online and found a phone number and I called her.
Judge: Have you complained to the post office?
Judge: Have you complained to the landlord? After all, you must have missed other important
I say that I have to think she is illegally living in the building and I had no desire to
get anybody in trouble.
Anyway, to make a long story short, Ms. Pettiford presented a thick pile of documentation with a mailing history of documentation from her office to my home. She was a well-dressed and well-spoken woman and I have to say she was mighty scary. I told the judge that I got very little "snail mail", that most of my bills came by email. Suddenly, the judge asked for my apartment number and I said it was A11, and she then asked if I was in the habit of putting my apartment number on forms and anywhere I was asked for my address. I said that I made it my point to do that. Just to prove I was telling the truth, the judge asked me to produce a piece of mail or a form I had filled out with the apartment number, which I did. She then asked me to produce a piece of mail I had received with an apartment number, which I did. She thn looked at the mailing history provided by Ms. Pettiford and remarked that my apartment number appeared different ways; sometimes not at all, sometimes correctly, sometimes as 11A and sometimes as apartment 11. In the end, she requested that Ms. Pettiford correct my apartment number in my records. I was informed that Albany would let me know of their decision. On the way out, both Ms. Pettiford and the judge asked if I was okay. I said I was okay but would feel a lot better if Albany ruled in my favor. The judge then whispered to me that she felt the judgement would be favorable.
On June 21, a week after my hearing, I heard from Albany that my judgement was favorable and I should submit my recertification as soon as possible. Upon further inspection, I noticed that I was missing one of the statements of the year's worth of NYSARC pooled-income trust monthly statements I am required to submit. I requested it from NYSARC and had to wait a week for that. But I am finally ready to overnight my whole recertification package to my case worker at CASA.
In retrospect, I do remember that my former caseworker never seemed to get my apartment number correct. Every time he visited me, I had to correct him on that piece of information, as well as other pieces of information. And the NYSARC statement that I was missing? I wish I knew if I misfiled it or never received it as a result of my old mail-lady retiring after almost the whole 27 years I have been living here, or did it go to Esther Cohen? This gives me a heads-up to keep on top of my statements and make sure I receive them all, and be on the alert if I am still around in January of 2014 to chase down my recertification application if I don't receive it by mid-January. It was a big wakeup call for me to keep on top of everything much better than I have,
And once again, I pose this question: If all this can happen to a person as independent and with total intact cognizance and intelligence as I am, what must elderly and confused people go through? I am very proud of myself getting through all this, all alone with no family involvement, and facing this judge alone with my iPad to communicate. I have a father who is no longer able to drive out of his immediate neighborhood and suffering from early dementia, and a sister who has three children, a husband and a full-time job. The only friend I have who helps me in these things, was not available to go to the hearing with me. All I had was myself.
Until 2004, I was an independent and active woman -- a former airline sales exec and then a high school educator. Then my body kept betraying me. I was finally diagnosed with ALS/Lou Gehrig's Disease -- confined to a wheelchair and unable to speak. With life at a slower pace, I learned to live a more conscious and mindful life -- buying, eating and other choices. I listen instead of talking, and I observe instead of running and rushing.
Friday, July 5, 2013
Fair Hearing in Brooklyn
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