A Senior About to Lose Medicaid Benefits From PHLP’s Quick & Creative Advocacy
Linda’s approaching 60th birthday should have been a cause for celebration. Instead, as she lay in a nursing home recuperating from a dangerous bout of pneumonia, she received an unpleasant early birthday present: a termination letter from Medicaid. When Linda turned 60, she would begin receiving Social Security survivor benefits on behalf of her late husband, making her “income-ineligible” for Medicaid.
One year earlier, PHLP had helped Linda get coverage as part of the Medicaid expansion to address her numerous health problems, including bipolar disorder and diabetes. Prior to that, she had been uninsured for over seven years since her husband’s death. Now, with less than ten days to go until Linda’s Medicaid was terminated and she became uninsured again, her daughter Jennifer called PHLP for help.
PHLP staff helped Jennifer file a timely appeal to continue Linda’s Medicaid benefits. Meanwhile, given Linda’s profoundly poor health, PHLP realized she was also a good candidate for the Aging Waiver, which allows older adults to receive skilled care and personal care assistance in their homes instead of going into a nursing home. PHLP staff connected Jennifer with the enrollment broker to begin the lengthy waiver application process.
In spite of her pending appeal, Linda’s Medicaid was cut off at the end of the month, leaving her without coverage and stalling her application for the Aging Waiver. PHLP staff immediately contacted the local County Assistance Office to correct the due process violation and to offer a creative solution: resolve the pending appeal by enrolling Linda in the Medical Assistance for Workers with Disabilities (MAWD) program. Although MAWD has a modest work requirement, this requirement is flexible: even though Linda was extremely ill, she could meet the work requirement by babysitting her granddaughter just once a week, as long as she was being paid. More importantly, having MAWD would ensure Linda had medical coverage even if she wasn’t approved for the Aging Waiver. The county office accepted this proposal, and quickly got Linda enrolled in MAWD.
Thanks to the quick and creative advocacy by PHLP staff, the lapse in Linda’s coverage lasted only a few days. Linda is still waiting to hear if she has been approved for the Aging Waiver. In the meantime, having secure coverage through MAWD will allow Linda to focus on more important things during her 60th year: staying well and spending time with her granddaughter.