Remember that each case is different… all of the variables in the persons history; medical condition and financial, needs to be evaluated prior to application.   

Is the person married or single?  This plays a huge difference in the rules.  Before you proceed with the ALTCS application, it is best to complete a prescreen to evaluate how the rules affect your case.   We can do a FREE pre-screen over the phone or you can check out the newest way to be guided through the ALTCS applicaiton- www. myaltcs.com!

We are pleased to continue to be a resource for you!

Please join us for our annual conference in beautiful Flagstaff Arizona -  CELEBRATING YOUR UNIQUE SPIRIT!!!

  Friday, May 7, 2010 8:30 AM – 2:00 PM

Federated Church 406 W. Aspen Avenue, Flagstaff, AZ

Cost: $20 — Make checks payable to NAGA

 TOPICS THAT WILL BE DISCUSSED:

Recognizing Sadness, Anxiety & Depression in Older Adults & What We Can Do — Mary Mareck, MSW

 Introduction to Tai Chi 

 What is Normal Aging? What is Dementia? — Dr. Marwan Sabbagh, Neurologist, Banner Health Care

Lunch provided by Simply Delicious….Raffles…..much more!

We would love to have you join us!  

Registration Deadline: April 28, 2009    For information, call Meg Leander at (928) 221-1600 or the Area Agency on Aging at (928) 213-5254 or         (877) 521-3500 

Christian Care Center, Phoenix

Classic Residence by Hyatt at Grayhawk, Scottsdale

Lingenfelter Center, Kingman

Sonora at Splendido, Tucson

WE ARE PROUD OF YOU AND THANK YOU FOR

YOUR COMMITMENT TO THE SENIORS OF ARIZONA!

I suppose it would be great if everyone could pay privately for all of their care, or find alternative benefits, such as the Wartime Pension through the VA to help out.  But, as I see it, it is important to remember that  few folks can pay privately for long-term care for very long.  Think of your parents or your own personal situation, if faced with a nursing home bill of over $5,000/month….How long could you pay privately?   Would you need help?

 Our state has devised a program that works, it covers care at the lowest level possible in the most cost effective setting.  Seems like this is the right thing to do.  We could be in a state that basically gives help to those only needing a nursing home at the highest cost to the state.  Instead, ALTCS provides services – not 24 hour – but certainly a lot of care, in their own home with a variety of home and community based services to help keep the member in the lowest level of care possible.  Then will also cover assisted living and group home care.   Nursing home care is a reality for some, but our state allowing members to get care in a lower cost setting makes sense for both the state and the member.

The program contractors ( insurance companies contracted by state to provide care)  are in a difficult spot, they must provide all needed care in a cost effective manner.  They are stewards of the State/Federal dollars.  They need to make sure there will be monies left for the next guy while at the same time keeping our members safe and well taken care of .  I’d say this is a good thing.   Is our system perfect?  No.  But since the majority of folks needing long term care…assisted living….home and community based services…do not have enough money to pay for  services for any length of time, I am glad we have this safety net here in Arizona.   I’m glad help is out there and I am proud that our system is working in a cost effective manner to make it work for both the state and the Arizona resident!

Wednesday, Dec 16th at 12:00-1:30pm

Hospice Family Care- 100 E. Sheldon Street- Prescott

RSVP to Ned Dagle, Hospice Family Care to reserve your spot. 928-541-1740

The document we get asked about the most is the MENTAL HEALTH  POWER OF ATTORNEY – Yes you need one!!!!!  Even in rare circumstances that you may need to be admitted to a Level One behavioral health center and need psychotropic medication – this is the only way your agent can admit you.   A medical Power attorney document in not enough in AZ. 

Free Form…vs…..Expensive Guardianship- the choice is yours!!!

Her husband is in the nursing home.   He has a room mate.  The two wives have become close as every day they visit their husbands and talk.   Mrs S, our client, moved her husband in almost the same time as Mrs H moved her husband in. Both did consultations with JacksonWhite, as both had too much to qualify for ALTCS yet did not have enough funds to pay privately for the $6000/month care their husbands were requiring.  Mrs S and Mrs H both had approximately the same amount of assets.  Mrs S decided to proceed and let JacksonWhite handle the application process and the preservation of funds.   Mrs H, decided that the flat fee from JacksonWhite was too expensive and decided to proceed with application on her own.   Mrs S, after giving me a huge hug, said that her husband had been approved with our help in less than three months, we were able to protect all remaining asset, do all the leg work, do all the necessary legal documentation to protect house AND she got a refund from the nursing home for the months her husband was “pending” ALTCS.  Sadly, Mrs H was still struggling.  She had been paying privately this whole time, has has such trouble getting all needed documents together and it looked like she was going to be denied ALTCS due to an issue that we had easily fixed for Mrs S.   She was distraught and overwhelmed and worse even, running through all of her savings to pay for care while she tirelessly worked on the ALTCS piece.  Now that Mrs S’s husband is approved for ALTCS she is now only paying $200 for share of cost she is able to relax and  be there for her husband while Mrs H is still floundering and having trouble.   Mrs S said to me…”my heart breaks for Mrs H, she should have just used your services and she would be all done, just like me”.

It is true that legal fees are expensive, but so important to weigh the potential loss if application is done incorrectly or denied.    There is certainly something to be said for getting it done right the first time and having peace of mind knowing the application and eligibility issues are all being dealt with correctly.  Mrs S thanked me over and over and whispered to me…”hiring JacksonWhite was the smartest money I have ever spent”…..

If your loved one is in a group home or you are a social worker referring to group home – beware. If the group home is an ALTCS approved home- this means they agree to accept their contracted rate for payment for care under ALTCS. They CAN NOT ask the family to pay more in order for the client to be in the facility under ALTCS.

Please see our latest addition of the Senior News – there is an article about Medicaid Fraud – it will explain Double Dipping and rules against it.

If the group home does not like their reimbursement provided by the Program Contractor or feel that it does not pay enough, the group home can either renegotiate their contract to better reflect their costs or decide to NOT take ALTCS clients.   Please do not be misled,  group homes that agree to take ALTCS recipients are agreeing to allow them to stay for their room and board amount, plus the difference of their contracted rate paid by the ALTCS program.   It is not the families responsibility to pay extra…. ONLY if the client is paying for something outside of the contract terms ( i.e.; private room) can they pay extra.  It CAN NOT be a condition of admittance.

For those Social Workers referring to group homes, please do your clients a favor and check into this before you refer – dont let your clients be misled.  It may be that another type of setting may be better financially – and ethically – for the client.

Check out our newsletter or call JacksonWhite if you need more information!!!

APPEAL – APPEAL – APPEAL!!

The eligibility hearing is an administrative process designed to ensure a fair and impartial review of an adverse action that is appealed. Adverse action is any action taken to deny or discontinue eligibility, a delay in an eligibility determination, an increase in the share of cost, or a reduction in services.  A customer is entitled to a hearing for any adverse action resulting from eligibility decisions. 

Eligibility hearings are heard by an Administrative Law Judge (ALJ) at the Office of Administrative Hearings (OAH). The hearings are held at 1400 West Washington in Phoenix, Arizona.  Customers or their representatives may contact OAH at (602) 542-9826 or toll free at (877) 203-0226 if they have any questions or concerns. You may also check out the OAH website at www.azoah.com.

Approximately 75% of all eligibility hearings requested are resolved prior to the scheduled hearing. For this reason, it is very important not to delay in appealing the denial.  You have only 45 days after the date of the decision to file the appeal.  On the 46^th day, you lose the right to appeal. Once the appeal is noted, the Eligibility worker will arrange for this “Pre-Hearing Discussion”. It is at this time that you can question the eligibility worker and substantiate your claim. This is very a very informal discussion. Do not be intimidated! If the application is still denied and you still want to appeal, you will continue on to the hearing with the Administrative Law Judge.  You do not need to have an attorney – but if you wish to seek counsel prior to this hearing you can call JacksonWhite to discuss your options

You may request a hearing by:

1.      Completing and submitting the request for hearing section found on the back of the Notice of Action; please see the attached sample of letter. It is important to submit this appeal request timely. This can also be faxed to the ALTCS office

2.      Submitting a written request that contains at least the complainant’s name, the eligibility action on which the hearing request is based, and the reason for the hearing request; or

3.      Calling the eligibility office and requesting a hearing, and then following up by submitting a written request.

Be an advocate for yourself.  If you question the reason for denial, please feel free to call JacksonWhite Elder Law for a pre-screen. This pre-screen will help determine your appeal rights and validity of denial issue.  This pre-screen process may  be well worth your time. Remember that the application is held “open” during the appeal process so that the retroactive coverage may still apply.

DON’T GET DISCOURAGED- IF YOU FEEL YOU NEED THESE BENEFITS KEEP TRYING!

http://www.uiowa.edu/~socialwk/NursingHomeResource/index.html

I got on the listserv and already am getting wonderful information from social services directors and geriatric social workers from across the nation!  Great find Paige!!