In part one of our report looking at different aspects of the State's Medicaid system, we discussed what appears to be a successful transition away from fee-for-service payments to managed long-term care. However, as Medicaid beneficiaries shift to managed care there's a growing need for professional help to navigate the system—especially for those who just miss the threshold for Medicaid coverage. NY1's Erin Billups filed the following report.
On a fixed income, it became increasingly more difficult for Helen Rose to the pay her ever-increasing rent and medical bills, and manage her chronic obstructive pulmonary disease.
"It was harder and harder to get to the doctor. I was falling, and I didn't know what to do about it. It just looked very grim," Helen Rose says.
Ineligible for Medicaid coverage, much of the burden fell on her daughter Sarah's shoulders.
"Every day was a crisis, knowing that if I wasn't there to take care of her, she didn't get any care; and I was working four jobs, I was paying two rents," Sarah Rose says.
They discovered Helen was likely eligible for a Medicaid Spend Down, which grants coverage to the elderly and/or disabled with incomes exceeding Medicaid limits, if they're spending that excess income on medical bills.
Figuring out how to successfully apply was a daunting task, though.
"I got the Medicaid application. It was, like, written in hieroglyphics. I thought, I have advanced degrees from the finest universities on the planet, and I can't make sense of this," Sarah Rose says.
The Roses eventually found help at the Lenox Hill Neighborhood House, who, along with the New York Lawyers for Public Interest's pro bono attorneys, walked them through joining a pooled supplemental needs trust.
"A trust is not only a place to store your wealth for the next generation, but it's to stabilize someone's current situation," says Mia Kandel, Lenox Hill Neighborhood House's Health and Wellness Initiatives Director.
Rose put her excess income into the trust, which then pays her living expenses.
As a result, federal law then allows Medicaid to cover the full bill for her for medical care.
She was then able to move into an assisted living facility.
"I know that my bills are always going to be paid, and Sarah doesn't have to worry," Helen Rose says.
Sarah is worrying less—relieved, she says, that they were finally able to access the state's robust Medicaid safety net.
"You get to a point where the cost of your care is so much more expensive than anything you could have planned for. Getting old is the crisis," Sarah Rose says.
The program has helped about 100 people going through the same crisis, but they need more lawyers to volunteer to address the growing need.
"This is not just a place for very high income people. Being a part of volunteerism and helping people stay in their homes who are low and moderate income means that this is a richer city," says Marnie Berk, Pro Bono Director at New York Lawyers for Public Interest.