Corazon
A few weeks ago, Asako Okuma, a social worker at AmericCare Adult Day Health Care Center in San Marcos, CA was referred to NSCLC’s Oakland office needing help for Corazon, a 72-year-old woman who is eligible for Medicare and Medicaid (Medi-Cal in California). Corazon, who has been visiting the center for nearly eight years, receives needed therapy, exercise and socialization at the center. She came close to losing all of that when a problem arose with her managed care plan.
Like many others in California, Corazon was recently required to join a Medicaid managed care plan to keep her Community-Based Adult Services (CBAS) benefits, which pay for her adult day care. Medicare beneficiaries that enroll in a Medicaid plan are supposed to be able to continue seeing their Medicare doctors, but this policy wasn’t working for Corazon.
Corazon needed heart surgery and her cardiologist, a Medicare provider, had set a date for the procedure. When her cardiologist learned that she was enrolled in a Medicaid managed care plan, he canceled the surgery, fearing that he would not get paid. According to Okuma, this caused Corazon who speaks limited English a great deal of anxiety – the last thing she needed given her heart condition. She was concerned that she would have to wait much longer to get the needed surgery or not get it at all if she could not find a new cardiologist willing to see her.
Okuma called the doctor’s office and then the managed care plan to see if the situation could be resolved. A plan customer service representative said nothing could be done, suggesting that Corazon disenroll from managed care if she wanted the surgery. Disenrolling from managed care would have meant losing her CBAS services.
NSCLC was able to help, using its connections to take the problem straight to senior leadership at the health plan. The plan was then able to convince the cardiologist to agree to accept payment from the plan. The surgery went ahead as planned. “It was life and death for Corazon,” Okuma said. “NSCLC is a great resource.”
Duane Kimmel
The story below is based on an article in Daily Report, an Atlanta Legal publication, entitled Federal Class Order Restores Homeless Vet’s Social Security and is printed with permission. Duane Kimmel is a member of the plaintiff class in Clark v. Astrue. NSCLC was counsel for plaintiffs in the case challenging the Social Security Administration’s practice of relying exclusively on outstanding probation and parole warrants as sufficient evidence for denying benefits to many seniors and people with disabilities. Proksauer, Rose LLP served as pro bono counsel and the Urban Justice Center also worked on the case. Approximately 140,000 people lost benefits and could recover $1 billion in back benefits as a result. To read the complete article requires a subscription to Daily Report.
Duane Kimmel was stuck. His Social Security disability payments had been cut off because of a decade-old warrant, but authorities had no interest in arresting him so that he could clear the warrant and restore his benefits. As a result, Kimmel lost his only source of income for five years and became homeless. He lived in the woods in Doraville and in Atlanta, Georgia shelters. An old back injury prevented him from working, and he didn’t seem to have any recourse. But his situation is about to change because of Clark v. Astrue and the help of Gwinnet Legal Aid ‘s Rachel Lazarus.
Kimmel, a 62-year-old Marine Corps veteran, was able to clear an outstanding warrant with the help of Gwinnet Legal Aid, part of the Atlanta Legal Aid Society, and the U.S. Department of Veterans Affairs. The warrant had been pending since 2000 because Kimmel failed to pay $850 in probation fees after he moved to Florida. Kimmel was on probation for a marijuana possession offense, but he didn’t know the warrant existed until his Social Security payments stopped in 2005.
The process wasn’t easy because police in Michigan, where the warrant was pending, didn’t want to arrest him when he tried to turn himself in. Kimmel had traveled to Oakland County, Mich., to take care of the warrant. He said the VA paid for the bus ticket because he couldn’t afford it.
When police wouldn’t take him away, Lazarus secured an agreement with Michigan law enforcement to arrest Kimmel in order to clear up his paperwork problem. Kimmel then entered into a 60-day drug rehab program for his probation violation, and when he returned to Georgia, he was able to have his Social Security benefits reinstated in 2010. His Social Security payments amount to $937 per month, which is enough for him to rent an apartment in Lawrenceville and get back on his feet. The pending payout will help him support himself for years to come.
Ida Williams
NSCLC is educating advocates, media, policymakers and others about the need to modernize the Supplemental Security Income (SSI) program by increasing the benefit amount and the amount of resources someone can have in order to meet unforeseen circumstances. To read more about modernizing SSI, click here.
Ida, who is 64 and a widow, lives alone in the northeastern part of Houston, Texas. She receives $694 a month, an amount that includes both Supplemental Security Income and Social Security payments. She has no savings and the Social Security Administration withholds money every month for an overpayment they say she owes. For years, Ida was a caregiver to her mother, her husband and also raised a family so she didn’t work outside the house very much. A diabetic, she is not in the best of health. Once she pays her utility bills, taxes, her phone, car insurance and a tithe to her church, there’s little left for new clothes or even for cleaning supplies. Because she has no extra income, Ida can’t keep up with the repairs needed to her house. The lights went out in her laundry room and she can’t afford to get it fixed. Her roof needs work as does her front porch and back door, but hiring a handyman, electrician or carpenter is well beyond her means. Ida doesn’t drive much because she can’t afford to. She receives meals on wheels so she doesn’t go hungry and she receives some help from her church and from a local nonprofit, but she sums up what life is like on a limited income in a few short sentences. “It’s hard some months. I’m just getting by.”
Thanks to Care for Elders and Neighborhood Centers of Houston, Texas for connecting us with Ida so she could share her story. If you know someone like Ida who receives SSI and whose story ought to be told, please contact Scott Parkin.
Ramon Gonzalez
Left to right: Reina Santana, caregiver and friend, Ramon Gonzalez, and Sandra Susse.
NSCLC was counsel for plaintiffs in Clark v. Astrue a nationwide class action challenging the Social Security Administration’s (SSA) practice of relying exclusively on outstanding probation and parole warrants as sufficient evidence for denying benefits to many seniors and people with disabilities. Approximately 140,000 people have lost benefits because of this policy in the 4.5 years covered by this case. SSA has issued a plan for implementing a federal judge’s order to restore Social Security and Supplemental Security Income (SSI) benefits retroactively to class members. Ramon Gonzalez is one of those people.
In 2006, Ramon Gonzalez was driving at night when his car broke down. He decided to walk on the side of the road to get help. A truck hit him twice from behind hurling him into the air and breaking his pelvis. Ever since, the former plumber has been disabled, unable to work and now spends most of his time in bed.
Ramon, who is now 50 years old, was found eligible for Social Security Disability Insurance in 2007 after the accident, but he has yet to get a penny. The problem is that in 2003 he was sentenced to probation and a fine. He left Florida for Kentucky and later Massachusetts for work, thinking he was done with his sentence, but he was wrong. This mistake came back to haunt him.
Unable to work or to get Social Security benefits, Ramon was able to get help to the tune of $150 every two weeks from the state. “It was living hell,” he said in describing trying to live on so little with medical bills and prescriptions on top of normal living expenses. He was forced to move twice because he couldn’t pay rent; a personal caregiver helps him but t here hasn’t been enough money to pay for his needs. “I wish nobody – not even my worst enemy – should have to go through what I went through.”
Ramon heard about free legal services and contacted Sandra Susse of Community Legal Aid in Springfield, MA. “I didn’t know where to turn,” he noted. “If it wasn’t for her [or programs like NSCLC], I don’t know what I’d have done.”
It turns out Ramon is a member of the plaintiff class in Clark. Sandra helped him apply for (SSI) which he is now receiving as a result of the court order requiring SSA to change its policy. Later this year, he should at last be able to receive Social Security, including retroactive payments, which should help greatly since most recently his truck broke down and he can’t afford to fix it.
Aileen Harper
Aileen Harper, executive director of the Los Angeles-based Center for Health Care Rights, says that NSCLC provides a unique and important role in making often complicated federal or state changes in laws or rules understandable for people. She said that when California changed the Adult Day Health Care program to the Community-Based Adult Services program, seniors and others needed help in understanding how the change affected their other Medicare or Medi-Cal benefits. In the education and training the Center does on a local level, people had many questions and concerns. Often, she says that government agencies do not communicate health policy change well for whatever reason and this change was no exception. “NSCLC’s support allowed us to clarify and answer questions in a meaningful way,” she noted. “They (NSCLC staff) have a practical, hands-on approach and they understand and pick up on the direct service component.”
Elaine Clark
The late Elaine Clark was the lead plaintiff in Clark v. Astrue. A federal court issued a final order (see above article) providing relief in the case, but too late to help her. NSCLC Directing Attorney Gerald McIntyre brought the case with Proskauer, Rose LLP and the Urban Justice Center of New York City.
Elaine Clark began receiving Social Security Disability Insurance in 1996 when she was diagnosed with end-stage renal disease. She also had several other serious medical conditions for which she was receiving treatment. In January of that year, retroactive to January 2005, the Social Security Administration unlawfully stopped paying her benefits based on an outstanding warrant. The warrant was issued because she was in alleged violation of a condition of probation. Although there never had was a finding she violated her probation, SSA ended her benefits ended anyway. The SSA based their action on finding her name a national crime database that they used to throw Ms. Clark and thousands of others off the rolls. At the time, Ms. Clark was living in senior housing and, because she no longer had income and could not pay rent, the owners sought to evict her and offered to move her to a homeless shelter. Before she could be evicted, however, Ms. Clark passed away in a hospital. Her daughter and son who survive her soon stand to share a modest retroactive benefit.
Rhon Koch
A resident of Michigan, Rhon Koch is a long-time advocate for the rights of those with disabilities. She believes that the interests of consumers should not be forgotten as states propose new models of care for dual eligibles.
Ms. Koch, who is dually eligible for both Medicare and Medicaid and living with a disability, participated as a consumer representative in a workgroup looking at her state’s proposal to integrate the financing and delivery of Medicare and Medicaid services. On each of the working groups there was one consumer representative. The rest of the 35 on each were consisted of insurance industry, provider and government officials.
“You’re doing a wonderful job,” she said in reference to the NSCLC briefs. She said she appreciated in particular how they recognize the need to address the concerns of the frail elderly and people with disabilities. She added that the recommendations in NSCLC’s briefs “need to be addressed in these models” and she advocated for several of them at the meeting. Copies of the briefs were handed out at workgroup meetings.
Sadly, the recommendations she pushed for were not in the proposal the state submitted to the federal Centers for Medicare and Medicaid Services. However, she said that others at the workgroup meeting she attended approached her and voiced support for the issues she brought up. Ms. Koch expects that they will be revisited.
Brian Lindberg
NSCLC Provides an Open Window of Knowledge
“Without NSCLC and its partnership with organizations like NAELA (National Academy of Elder Law Attorneys) many older, low-income people would lack a voice in Washington DC,” says Brian Lindberg, NAELA’s voice in DC and executive director of the Consumer Coalition for Quality Health Care. He feels that NSCLC provides an “open window of knowledge” for the public and other organizations that want to inform themselves about legal issues affecting the elderly. Lindberg, who has partnered with NSCLC to protect legal services programs under the Older Americans Act and preserved eligibility rights for older people in Medicaid, feels that NSCLC is an effective advocate for the elderly poor because of its focus on analyzing legal issues in-depth, advocating with government agencies and using its litigation expertise. Before becoming a policy advisor and the executive director of the CCQHC, Brian Lindberg spent 10 years on the Senate and House aging committees. He also is legislative and regulatory advisor for several national legal and aging groups such as the National Association of State Long-Term Care Ombudsman Programs.
A Heartfelt Thank You from Eskaton ADHC
The center is located in the northeastern part of Sacramento County, California. Some 50 family, participants and staff from Eskaton ADHC of Carmichael California personally signed a thank you card addressed to Deputy Director Kevin Prindiville for NSCLC’s work to save the state’s adult day health care program. Along with the handwritten signatures, there was a simple note: “Thank you for your work on the ADHC settlement. We are all so happy!”
Eskaton’s adult day health care is an innovative program designed to assist both participants and caregivers by supporting the independence and socialization of participants during the daytime hours. Participants attend from two to five days per week, giving caregivers much needed “time-off” and enabling them to pursue a career or personal interests. Billie’s daughter, for example, was not going to be able to hold down her job and care for Billie at home if the center closed. Billie attends 5 days a week and would have required skilled nursing placement, effectively breaking up their family, without ADHC.
According to Administrator, Jill Yungling, without this unique program, many other participants would otherwise face premature entrance into a long-term care facility.
Humboldt Senior Resource Center on Saving California’s ADHC Program
It is hard to adequately express my gratitude for the work that NSCLC did to preserve the Adult Day Health Care (ADHC) program in California. If it wasn’t for your efforts, our ADHC participants might have had to move into skilled nursing facilities unnecessarily. They are now able to remain in their own homes and receive the support services of our ADHC program. On behalf of all our participants, their families and our staff, thank you for helping us. Our participants are now able to remain in the community with the support they need to maintain their dignity and self determination. Their families are able to continue to work and receive respite care for their loved ones; and our staff are employed and supporting their families. Thank you for all your hard work.
Joanne Conzelmann, MSW, Director of Adult Day health and Alzheimer’s Services, Humboldt Senior Resource Center
Ellen Mendoza
Ellen Mendoza
Tony Gonzales was a full-blood Apache from New Mexico, growing up in an orphanage and with his mother, until he dropped out of high school. He made his way to California and fell into a criminal life. In 1988 he was sentenced to Federal prison for seven years, and when he was released, he finally made his break with crime, went to school and become employed first as a welder and then as a drafter. He started drawing retirement benefits, however, a warrant was found from 1965, from his first run-in with the law for “joy-riding.” “The record was so old, no one knew it existed,” said Attorney Ellen Mendoza of Legal Aid Services of Oregon. “He had gone from being a bad guy to a good guy and then got a kick in the gut.” Thanks to NSCLC’s Directing Attorney Gerald McIntyre and Gonzales’s participation as a plaintiff in Clark v. Astrue, Gonzales was eventually reinstated. Mendoza added that her organization relies on a national organization like NSCLC for cutting edge information on cases like that of Gonzales and how to take appropriate action on behalf of their clients.
Megan Wall
Megan Wall, St. John’s County Legal Aid
Back Up Centers Are Extremely Important – St. John’s County Legal Aid Managing Attorney Megan Wall, a branch of Jacksonville Area Legal Aid, regularly taps National Senior Citizens Law Center’s Eric Carlson for help with clients who experience legal problems, especially those related to long term care. In Florida, for example, nursing homes were routinely asking clients for third party signatures, a violation of federal nursing home law. But, most advocates and judges in the state did not know that. She asked Carlson to do a two-day training and subsequently the practice has been curbed substantially. “Back up centers like NSCLC are extremely important to us in the field,” Wall said. “It’s important to have ground troops, but you need someone who is expert and responds quickly to your questions. Thank goodness for NSCLC.”
Eva Shiffrin
Staff Attorney Eva Shiffrin of Disability Rights Wisconsin has called on NSCLC’s Georgia Burke and Kevin Prindiville for help with Medicare Part D issues. “NSCLC is the premier source of how Part D works for people who are eligible for the low-income subsidy,” she noted. “I get the information I need very quickly and NSCLC does the research so I don’t have to.” Shiffrin said that at one time Part D plans were messing up on complaint tracking and drug companies were not following guidelines. NSCLC was not only able to tell me that this was a trend not an isolated incident, they also developed a system to track complaints and ensure that plans were accountable for errors. And, NSCLC is a persistent and effective leader in efforts to coordinate Medicare Part D and state Medicaid programs to avoid dangerous and unfair gaps in drug coverage for our most vulnerable low income beneficiaries. “NSCLC has the connections with CMS (the Centers for Medicare and Medicaid Services) to figure out things that we can’t.”
Harry Cota
Source: California Disability Community Action Network http://www.cdcan.info/node/233
Harry Cota, the lead plaintiff in a federal lawsuit against the Department of Health Care Services that blocked cuts in 2009 to Adult Day Health Care as violations under the federal Americans with Disabilities Act (ADA), passed away in March, after a battle with cancer. The case was originally filed as Lillie Brantley et. al v. David Maxwell-Jolly but later changed to Harry Cota et. al v. Maxwell-Jolly, and now renamed Darling v. Douglas. The lawsuit was filed in federal court in the Northern District of California on behalf of Adult Day Health Care participants by Disability Rights California, the National Senior Citizens Law Center, AARP Foundation Litigation, the National Health Law Program and the law firm of Morrison & Foerster LLP. The state continues its efforts to eliminate the program. Mr. Cota fought for this until the end of his life.
Joelen Gates
Joelen Gates
Joelen Gates, legal aid attorney at Connecticut Legal Services, helps low-income individuals with nursing home issues, including nursing home discharge cases. Recently, a client required total parenteral nutrition (TPN) which means that in order for her to receive adequate nutrition, she needed an IV line. The nursing home told her that they did not provide this type of care. Joelen sought advice from NSCLC. She was then able to cite rules in the Code of Federal Regulations which showed that the nursing home must provide TPN. On behalf of her client, Joelen won a decision in March 2010 that required the nursing home to provide the service. “NSCLC knows the law inside and out in their specialties,” said Joelen. “They have a broad perspective on what is happening in other states that makes our cases stronger.”
Judson Esty-Kendall
Judson Esty-Kendall
Judson Esty-Kendall, attorney at Pine Tree Legal Assistance, helps low-income individuals in Maine’s Penobscot, Piscataquis, Hancock, and Waldo counties. Esty-Kendall finds NSCLC to be extremely helpful in addressing the Supplemental Security Income (SSI) issues he encounters. A client came to Pine Tree for assistance after his SSI benefits were suspended because of a Florida arrest warrant. The client had not been informed of a court date or the charge. Even though he returned to Florida to visit his father, the Social Security Administration (SSA) classified him as a “fleeing felon.” Esty-Kendall appealed the SSI suspension and received a favorable decision from an administrative law judge. However, SSA overruled that decision, prompting Kendall to take the case to the U.S. District Court in Portland, ME. With NSCLC’s counsel, he crafted his argument. The District Court ruled that Esty-Kendall’s client had the right to a hearing. SSA restored his benefits and paid him back benefits for the 1.5 year period in which benefits were withheld. From 2009-10, Pine Tree (which serves all ages) handled some 6,000 total cases, about 20 percent of which were extended representations and about 80 percent of which were relatively brief office assistance. Visit Pine Tree Legal.
Lavender Seniors
Lavender Seniors provides important services and a caring community to LGBT elders
Dan Ashbrook, Director of Lavender Seniors of the East Bay in California, says that NSCLC has provided great value to his organization through its expertise and work on legal issues that affect LGBT seniors. “We have had NSCLC provide educational discussions for our LGBT seniors in the areas of long-term care,” Ashbrook said. “The work of NSCLC increases the capacity of LGBT aging advocates such as Lavender Seniors to advance the mission of improving the lives of LGBT elders with research, education, and advocacy from a legal perspective.” Lavender Seniors of San Leandro, CA provides social support services and a vibrant caring community of LGBT older adults. Its programs foster a sense of belonging for all LGBT older adults particularly those who are isolated, vulnerable, disabled and at risk. It also participates in local, statewide, and national advocacy efforts for the betterment of the LGBT and mainstream older adult community.
BayLegal
BayLegal offers legal help to many low income older adults in the Bay Area.
Bay Area Legal Aid (BayLegal) often helps older adults who have been wrongfully denied Social Security benefits. As a result of the successful NSCLC-led Martinez v Astrue class action lawsuit, BayLegal and many other legal services organizations across the country are able to help those who may have been part of that class. Through the Martinez case, “NSCLC helped a lot of people without benefits,” said Steve Weiss, BayLegal’s Regional SSI Advocacy Coordinator. ”It is important to have a valuable and well-qualified support center in place [like NSCLC] and there is no one else that is more triumphal in Social Security that I can think of.”
Fran Chervenak
Fran Chervenak, senior attorney at the Pennsylvania Health Law Project (PHLP) in Pittsburgh, PA, works closely with national health advocates to address health policy changes. On behalf of her clients, she often raises issues for systemic advocacy with the Center for Medicare and Medicaid Services (CMS). Recently, CMS approved a PA Medicare Advantage Plan that started a Special Needs Plan for dual eligible beneficiaries. Medicare law requires the plan to enroll all dual eligibles or a discrete subset of that population. In this particular case, the plan did neither. Fran and PHLP tried to engage CMS and have them revoke the plan but were unable to resolve the issue. “NSCLC took the lead and talked to Medicare,” said Fran. With NSCLC’s advocacy and dialogue with CMS, the plan was revoked.
Cheryl Lucado
Anne Hurley, an attorney working on the Long Term Care Assistance Project at the Legal Aid Bureau in Baltimore, MD, turns to NSCLC for advice when she faces a problematic legal issue. Many of Anne’s clients are threatened with eviction from a nursing home. When she needs support for her clients, Anne often contacts NSCLC. She also values the national perspective NSCLC offers and information on what is happening in other states. Recently, a nursing home threatened to discharge Cheryl Lucado, a 60-year-old quadriplegic female. The nursing home claimed that it could not meet Cheryl’s needs, despite providing care for her the past 25 years. Cheryl, who has persevered all those years on a ventilator, believed she would die if evicted. With NSCLC’s counsel on how to approach the case, Anne won a motion for summary judgment in Cheryl’s favor, allowing Cheryl to remain in her home.
