Why Don't These Homeless People on Medicaid just Reach out to the Abundant Legal Resources in the Community & File a Medicaid Appeal to get the level of Intensive Case Management Services they need?
Well, I'm glad you asked:
Colorado Legal Services handles Medicaid eligibility appeals as resources allow, and DOES NOT handle Medicaid service appeals;
Disability Law Colorado (formerly The Legal Center for People with Disabilities and Older People) on rare, rare occasions has taken a Medicaid appeal AND such appeals are NOT within its priorities. (parenthetically, there has been some talk in Congress of creating a Medicaid Protection & Advocacy Program -- AND there is NOT one yet)
One reason (not the only reason) why there is such a paucity of advocates/attorneys is ironically the VERY SAME REASON for the problem in the first place ---these cases SUCK TIME:
To even understand these cases one winds up doing a lot of case management ( who has time for that, right?)
And if you don't have any support staff (think Orchid) or not as much as you need (think CLS & Disability Law Colorado) -- you can see the problem.
But that's the problem for the State too, isn't it?
AND HOW TIME CONSUMING CAN THESE MATTERS REALLY BE? Well, the sky's the limit:
Honestly, from my perspective, the #1 reason (& there are many, many others) it is so time consuming is that the systems one is dealing with are multiple, complex, underfunded, and dysfunctional and too complex even for the people administering them.
Those systems would typically be: Medicaid, Housing, Social Security, Community Mental Health Centers, Behavioral Health Organizations, Etc.
Of course, most administrators would say they couldn't possibly be expected to master all the systems above.
AND we're expecting someone who is homeless to do that?
"OF COURSE NOT!" --THE STATE SAYS TRIUMPHANTLY "WE HAVE INTENSIVE CASE MANAGEMENT"
Let's just say that really hasn't worked out for my guy.
AND when these services are NOT reliable or in the quantity needed that not only hurts people who are homeless on Medicaid --- it creates many cautionary tales to keep people in Mental Institutes and Nursing Homes.
How many of us routinely have had our clients (whether @ the Institute or the Nursing Home) told something like, "Well, Honey I know what that law says but I been here a long time AND it just don't work the way they say it does."
I don't just mean that staff including doctors would discourage the person. If they have the power, the doctors themselves sometimes will NOT give the person permission to leave because they don't trust the Medicaid system to provide the services it is legally obligated to provide. (see these services really are critical and they really do have to be adequately funded which they are not)
Is it a BAD PEOPLE PROBLEM? From my perspective, these things rarely are.
IS IT A HORRIBLE SYSTEMS PROBLEM THAT IS GOING TO COST SOME VERY SIGNIFICANT DOLLARS TO FIX AND NOBODY'S QUITE SURE HOW TO DO THAT?
Yes, I think that is it --- EXACTLY!
"Doc, I think with these services our guy would do very well in the community. Would you consider making that placement recommendation?"
"Well, Val I've never really seen Medicaid provide those kind of services before."
"Doc, I'll admit they are not often provided in this particular way or quantity AND the regulations provide for them right here -- See."
"I bet I could call somebody at HCPF and get this all straightened out."
"You know Val we all wish the system worked better than it does, AND I have to deal with the reality as I know it."