The Alaska Department of Senior and Disabilities Services is being criticized for finding hundreds of seniors ineligible for a Medicaid waiver program that pays the cost of their housing and nursing care. The department's director defends the denials. He says the individuals who were denied the C waiver option don’t meet Nursing Home Level of Care. There is an apparent gap between the state’s disability services and the people who need them.
In the last five years, there has been a rise in the number of people denied the Medicaid waiver after reassessment. Duane Mayes, Director of Senior Disabilities Services or SDS says the department wasn’t able to conduct its annual evaluations of waiver recipients’ eligibility up until several years ago because of a series of lawsuits.
“So literally for a period of seven to eight years we were unable to remove anybody that no longer met level of care from our waiver system.”
Mayes says the lawsuits were settled about three years ago and that made it possible to remove people from the program. In the last five years the department has carried out 8,253 reassessments for its waiver recipients in South Central Alaska. 30% received denials.
At Main Street Assisted Living in Homer the rate of denials is much higher. More than half of residents could lose their waivers next year.
Resident Marian Friedrich received one of the denials and she disapproves of the way her assessment was carried out.
“When they came and assessed me the woman who did the marking paid absolutely no attention to any mental or behavioral issues. She entirely skipped a whole half of the form as if it wasn’t important anymore. To me if you’re going to throw away half the form you better throw away the whole form.”
Holly Chipps has been a Certified Nurse’s Assistant for 30 years. She’s worked at Main Street Assisted Living for the past two years.
“It is a very vague list and vagueness connotes insincerity. To ask a resident can you take a spoon, put it in your bowl, and feed yourself is not a fair depiction. Can they go to the store? Can they cook their own meal? Can they determine what is good food and bad food, prepare it and then feed themselves? No they can’t. That’s why they’re here.”
Mayes, with the state, says the face to face interview isn’t the only research the state conducts to determine a person’s eligibility. They check the questionnaire against medical records and the ultimate decision is reviewed by a third party contractor. And lastly Applicants are also given a chance to appeal a denial. Still, Chipps is certain not a single one of her residents looking at losing their waiver can live by themselves.
So for now people like Friedrich have a couple of options. They can fight the system through appeals. Or if that doesn’t work, Mayes says the department has other services.
“There’s general relief, there’s personal care assistance services. We spend 100 plus million in personal care assistance services. We also have about 27 million dollars in grant services.
But these fallbacks might not be enough. Ruth Babcock, owner of Main Street Assisted Living, says ‘general relief’ is a temporary aid.
“General relief was originally setup to deal with people who did not have any resources and were younger and maybe were injured. [They] had a health issue [and] needed a place to get well for a few months maybe.”
The grant services are designed to help people before their health becomes so poor that they need round the clock care. And Personal Care Assistance doesn’t guarantee all the services that come with the waiver. Plus it is only available to people living in their own home.
Mayes says he’s heard the concerns that their continuum of care is not comprehensive enough. Partly for that reason, SDS is trying to bring two new waiver options online, one of which will serve seniors who aren’t eligible for Nursing Home Level of Care.
But it could take two years for those tools to come online. They won’t be around to help Marian Friedrich, and the seven other residents at Main Street Assisted Living who could lose the waiver in the next year.
Friedrich still has a ray of hope. Her lawyer found a problem in the paperwork she received from SDS so she’s clinging to that.