Fair Hearing

rosecoloredglasses

Hello everybody! I have a fair hearing coming up on November 7th for myself to be enrolled in the CDPAP program, and I am quite anxious about it. I applied for the CDPAP program last year as I can't work due to being a full time care giver for my mother, and while the state declared that we were eligible for it, my mother's insurance says that they won't pay me for being her care taker. So I filed for a fair hearing, problem is I'm not sure what "evidence" I'm supposed to submit to plead our case, and I don't have the money to hire a lawyer for this so it's just going to be me trying to explain everything. Has anyone else had this issue before and what stuff did you submit as "proof." It might be silly but I think that my mom just being diagnosed with something like Alzheimer's should be all the proof needed. There's no cure, she's not going to get better, she needs me 24/7. Any advice or suggestions would be heavily appreciated!

SusanB-dil

Could you maybe check if any lawyers may have a free consultation?

Of course, paperwork from the doctor stating diagnosis. Sorry I don't know much about this, either, but I hope it all works out for you.

M1

Each state has its own rules about who can qualify as a paid caregiver. If she lives with you, you may not qualify. You are entitled to a lawyer for these hearings (which are usually done by telephone), but the primary thing you need to know is what your state's rules are regarding a family caregiver and how are you going to argue that you qualify.

This information should be available on your states Medicaid website.

M1

I did a quick Google search, it looks from your earlier posts that you're in New York State. It looks like you cannot be a paid caregiver if you are a spouse or her legal representative (ie her poa) and she is unable to direct her own care). That's probably the issue.

rosecoloredglasses

https://alzconnected.org/discussion/comment/226544#Comment_226544

I don't have a POA for her yet, would that change anything? On the paperwork I received insurance claims that because she can move around physically it's not necessary for her to have at home care.

rosecoloredglasses

Thank you so much for your kind words, good vibes sent my way mean just as much haha!

M1

I hope you can work something out....I used to work for the Medicaid appeals review board in our state so am very familiar with the process. How much home help they will pay for is based on an assessment of her needs for assistance with activities of daily living like bathing, dressing, grooming, meal prep, toileting, etc. It's usually a pretty minimal amount, maxing out at 27 hours per week in most states- and then on top of that there are eligibility requirements about which family members can be the paid caregiver. Read the materials they send you for the hearing very carefully. Somewhere in it should be an appeals review that may be called a medical necessity review or something similar to that. It should lay out the reason for the denial, and that should help you decide how to argue your case.