Naomi, a Senior Planning Services caseworker, related her experience in trying to obtain Medicaid coverage for an individual who had no family support and was homeless for a period of time. Additionally, he had poor memory and gathering necessary information changed a simple caseworker into an investigative detective. Ultimately, Naomi achieves the impossible: a Medicaid approval.

In mid April, Senior Planning Services retained a case from a nursing home for Gregory Slate who needed Medicaid coverage dating back to January. According to Medicaid guidelines, one may be able to obtain retroactive coverage three months back so long as at the time of the coverage request date the individual had met all the Medicaid guidelines. Being that Greg was homeless for a short time, we were under the assumption that he would meet the financial criteria . After speaking with the skilled nursing facility where Greg resided at, it was confirmed that Greg had also been clinically evaluated and that medically he had met the Medicaid requirements. Naomi understood that for Greg to remain eligible for retroactive coverage the application needed to be submitted before the end of April. This implied that Naomi had about two weeks to open the case with Medicaid and submit necessary information. There was just one problem: Greg could not recall where he banked and had no documents to establish identity or citizenship.

Naomi quickly filled out an application with the limited information and submitted it to Medicaid to open the file. Simultaneously, she sent out request letters to all the established banks in the area with the hopes that one of the banks was the one where Greg’s accounts were held. Sure enough, Naomi received a response and was able to obtain the five years of bank statements for Greg’s application. She also had to obtain a birth certificate for Greg to establish identity and citizenship, but once again, Greg’s memory fell short and he was unable to recall the name of his mother. With extensive research into the previous facilities that Greg had been at, Naomi was able to track down a distant family member who had the information necessary to request a birth certificate from vital statistics. There was much back and forth with the Department of Vital Statistics but eventually the birth certificate was received and a copy was sent to Medicaid.

Once the five years of bank statements had been received, Naomi carefully reviewed them. Greg was over the Medicaid asset limit due to his Social Security money accruing. Naomi reached out to the Medicaid case worker to explain the situation and ask for retroactive coverage despite the fact that he was over the resource limit. There are guidelines that the caseworkers can sometimes fall back on if an exception is needed. After much negotiation with the case worker at the Board of Social Services, Greg was approved for Medicaid with the retroactive coverage he needed to cover the nursing home bill.

Names have been changed to protect the privacy of those involved.