What a mess Medicaid has become

In 33 years as a lawyer, I’ve had to deal with all kinds of government agencies. It comes with the territory.

At various times I’ve wrestled with the IRS, child support enforcement, Social Security, the ABC board, various boards of professional licensing, and so many different state child protective agencies I can’t even count (that was when I did interstate adoptions). I’ve been involved with everything from the local Zoning Board of Examiners and Appeals, up to the federal Benefits Review Board in Washington D.C. I’ve grappled, haggled, pleaded and fought with the APOC, OAH, DOJ, INS and BPOE.

Wait a minute, that last one might be the Elks Club. I’ll have to check on that.

Up until a few years ago, if you asked me what the easiest government agency to deal with was, I would have said the Alaska Medicaid Division. But these days, if you ask me what the worst agency is to deal with, I would be saying it is the Alaska Medicaid Division.

What happened in the last, approximately, six years to turn such a good agency into such a bad one? It used to be that if I wasn’t sure how to handle a Medicaid matter, I could shoot an e-mail over to one of the folks who work there, and I would get a clear, concise answer within a day or two. If that person couldn’t answer my question, they would at least forward the e-mail to someone who could. They had a helpful attitude which was a joy to work with.

Let me give you an example of how far things went downhill. A few years back, Mrs. McGillicuddy applies for long-term care Medicaid, in the hopes that she can stay in her own a home instead of moving into assisted living. All she needs is for the agency to provide some part-time help, doing chores and such that she is not physically able to do anymore, a few hours a week.

So Mrs. McGillicuddy files her Medicaid application. Within a few weeks, she gets a letter back which says her application is “pended” (which means it isn’t really rejected, just held in suspense) until she does several things. The letter tells her that she needs a Miller Trust, that she has a bit too much in one of her accounts, and that she needs to provide bank statements for the last few months. Now she has a checklist of what she needs to do, and when she gets it all done a few weeks later, she submits it to Medicaid and gets approved. Nice and easy.

Fast-forward to the present. Mrs. McGillicuddy files her application. She waits around for two months. Then she gets a letter saying that the application was flat-out denied. The only reason given is that she needs a Miller Trust. So she gets together with a lawyer and gets a Miller Trust, and then has to fill out a whole new application and re-submit it.

Another month goes by, and she gets another rejection letter, telling her about having too much in that one account. So she fixes that problem and again has to file a whole new application. And then she gets another letter about needing the bank statements. If she gets that taken care of, she might qualify. On the other hand, six or eight months has gone by, in which she was not able to get coverage, and in the meantime she has probably given up in frustration.

Am I about to tell you that the best way to handle this is to go through a lawyer who deals with Medicaid regularly? That can definitely help, but is not always a complete solution. The Alaska Medicaid agency drives these lawyers up the wall.

People often assume that government agencies don’t like lawyers. Actually, for the most part, the opposite is true. It is a lot easier for a government worker to deal with an experienced attorney, especially one who knows how things are done in that particular agency. The caseworker doesn’t have to waste a lot of time dealing with the wrong forms being filed, or requests for discretion in situations where the caseworker doesn’t have the authority to exercise discretion, or administrative appeals which waste everyone’s time and have no chance of prevailing anyway. With an experienced attorney, they can get right to the point.

But with Alaska Medicaid, even the attorneys who deal with the agency regularly, are constantly guessing. The agency won’t always answer questions. If there is a change in the procedures or interpretations, the attorneys usually find out only because one of them has something rejected and passes the word around to the others.

In fact, it’s embarrassing to be a Medicaid lawyer in Alaska. You regularly end up looking, in the eyes of your clients, as if you don’t know what you are doing.

For example: There are various types of trusts that are needed for certain Medicaid situations, particularly special needs trusts and Miller trusts. Of course, it doesn’t make sense for a lawyer to create every one of these specialized trusts from scratch, so they have templates which they modify for that particular client. And then after the trust is finalized, signed by the client, registered with the court, and so forth, they have to submit it to Medicaid for approval.

And periodically, the same wording which has been approved for years, will be rejected because somebody at Medicaid decided to interpret some traditional language to mean something other than what it was always understood to mean. So they have to scramble and fix language which was always acceptable before.

Why has Medicaid gone from being such a helpful, user-friendly agency to being such a pain in the buttox? I don’t know for sure, I can only speculate.

(By saying it that way, I make it a matter of opinion, not a statement of fact, so if I’m wrong they can’t sue me for defamation. See, I told you I’ve been a lawyer for a long time.)

Almost two-thirds of the cost of the Medicaid program is paid by the federal government. That means that the more people in this state that qualify for Medicaid, the more federal money comes into the state and feeds into the local economy. Conceivably the attitude a few years back was that this is a good thing, so we ought to help people get qualified for Medicaid. But then the Alaska economy took a hit with the drop in oil prices, and the attitude changed. Now the one-third the State had to pay started to look like a lot of money. So (and again, I am only speculating here) the attitude became that we ought to make it as difficult as possible for people to qualify, so the state budget is not strained.

Could be, could be. The reasons for it are pure guesswork on my part. But Medicaid being a particularly difficult agency to deal with? That’s a fact that I’ll stand by.

Kenneth Kirk is an Anchorage estate planning lawyer. Nothing in this article should be taken as legal advice for a specific situation; for specific advice you should consult a professional who can take all the facts into account. And that’s definitely not just an opinion.

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