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Case Studies Medicaid New York

NY – Retroactive Medicaid Coverage

Senior Planning Services was retained on 1/30/2014 by a skilled nursing facility to assist them with a case that was submitted to Westchester County back in 2013. It was an application for a young mother of two that was placed in nursing care due to an unfortunate accident at her job. The Medicaid Caseworker requested significant amounts of bank statements and verifications of cash withdrawals seen on the client’s bank statements. The nursing facility was unable to fulfill the demands of the county caseworker and therefore chose to hire Senior Planning Services to handle the case. Marcella, the Senior Planning Services Caseworker quickly resubmitted the case in full within a very short time period. Marcella was in touch with the Medicaid office weekly to oversee the progress of the case.

The Medicaid Caseworker had left for vacation for several weeks and after doing a thorough investigation, Marcella was informed that the case was forwarded to a new caseworker in the Medicaid conversion department. Marcella proceeded to contact the new caseworker who was thoroughly confused about the case and seemed to have not had the slightest clue about the case. It was getting frustrating, but Marcella was not giving up. She phoned the Medicaid caseworker’s supervisor who said that he was unable to locate the case and that it had been misplaced.
Marcella contacted the supervisor of the nursing home eligibility unit and confirmed that she would see to it that our client would receive retroactive Medicaid coverage dated back to April 2013. Marcella then resubmitted the Medicaid application in May 2014 with proof of prior submission. After working with the supervisor for several weeks, Marcella received the most wonderful piece of mail on 7/3/2014-the case was officially approved with coverage from April 2013!

The nursing home could not be more grateful for Senior Planning Services’ persistence in the process. The client’s husband was thrilled with the news and was delighted that he can now focus on raising his two children without the worries of paying exorbitant nursing home bills.