Josh/Medicaid

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In chronological order:

  • 2008-02-12: We have the first meeting with Josh's case manager at Community Partnerships, Yolanda, in order to put together his Personal Care Plan. She also gives us a Medicaid application to fill out.
  • 2008-02-15: We belatedly start filling out the Medicaid application but question whether it is the right one, noting that it says "Application for Adult Medicaid" at the top and Josh isn't an adult.
  • 2008-02-18: We are told that it is in fact the correct form, and Medicaid will let us know if it is not. We ask some follow-up questions about this, because some of the questions on the form don't really make sense: "when we fill out Page 10 of 18 ("Tell us about you"), is it asking about Sandy or Josh? If it's asking about Sandy, why does it want to know all these things about her and not about Josh? It certainly sounds like they're asking about an adult, but why do they want all this information about Sandy and practically no information at all about Josh?" Lacking an immediate response, we make some guesses, finish the application, and send it to Yolanda, who submits it the next day.
  • 2008-03-14: The Medicaid office requests some additional paperwork
  • 2008-06-05: Our first application is denied (denial letter; back of page with instructions for requesting a hearing)
    • Basically, they're claiming we didn't send them the stuff we sent them. The real reason for the denial (and for the irrelevance of many of the questions asked by the Medicaid office, below), however, is that we should have been applying via NC Health Choice for Children, not Medicaid; see here.
    • Does anyone know what document is being referred to by "The state regulations regarding this action are found in 2000 / 2300"?
  • 2008-06-11: We (re-)apply for Medicaid via NC Health Choice for Children and are expecting a response within 45 days, i.e. by approximately July 25.
  • 2008-07-15: Yolanda contacts the Department of Social Services to ask about the application's status. The caseworker assigned to the application is Alicia Turner; Yolanda speaks with Alicia and finds out that DSS sent us a request for further documentation on June 13, which we definitely did not receive.
  • 2008-07-16: We put together some documents and send them to Yolanda. Since we weren't able to find documents exactly matching their requests, we ask Yolanda to please check with Alicia to make sure that the documents were adequate.
  • 2008-07-23: Yolanda confirms that she "called and left several messages" for Alicia Turner, but has heard nothing back.
  • 2008-08-01: Our second application is denied (denial letter) with the claim that we had "not provided the information to establish eligibility".
  • 2008-08-04: Terry Ames of The Durham Center calls the Department of Social Services to ask about the "missing documentation" they claim we didn't give them, and leaves a voicemail message for Ms. Turner's supervisor.
  • 2008-08-07: Terry receives a call from Sherry Rodgers, caseworker supervisor, who says we have to re-apply a third time. We plan to request a hearing instead, as we still don't know what documentation is missing.
  • 2008-08-30: Josh's Medicaid approval arrived in the mail. After writing a letter directly to the Medicaid folks, I was finally able to get everything straightened out and provide them with the one missing piece of documentation. (There's more to this, but this is all the updating I have time for at the moment.)
  • 2009-06: Upon renewal, the Medicaid was switched to NC Health Choice, which apparently does not cover the foster home we had lined up for him. There is much more to this story and I've just been too busy to even start setting it down.
  • 2009-07: In late July, we found out that if we get a physician to sign a DMA-5045 stating that Josh needs out-of-home care lasting more than 12 months, then Medicaid will look only at Josh's income ($0) rather than Sandy's -- and he should thus definitely qualify for Medicaid indefinitely.
  • 2009-08-07 Got the DMA-5045 filled out this morning, as well as the FL-2 form and medical records it requires; now I just need to finish filling out the application, scan everything for our records, and send it in. Tomorrow's mail, perhaps?
  • 2009-09-18 One Medicaid application (submitted with a filled-out DMA-5045), three emails, at least one or two phone calls, and then a further week or two of waiting -- and we received Josh's Medicaid acceptance in today's mail.