Alene, a 74 year old Brevard County native, worked her entire life. After retiring from her career in customer service, she found herself itching to get back to work. In her late 60s, she started a second career as a security guard. But at age 71, she started to experience severe pain and trouble walking.
And despite getting her hours restored, she still has gaps in services. And COVID-19 has made it worse. For example, during one period in May, Alene went without any home health care for 3 days. One can only imagine what those 3 days were like: only being able to wash half her body and not being able to change clothes. Yet in telling her story Alene does not sound angry. She talks about the challenges of the health aides and expresses concern about other seniors.
“That’s a concern to me. There are seniors out there whose services are being cut and they are just accepting the cut; they don’t know that they have rights to get those services reinstated or get some of their services back. Some plans will cut your services to the bone. My plan was ready to leave me alone 3 days a week. I wouldn’t have any help at all, I would just have to manage on my own. I worry there are other seniors out there who are being handled in this way”
Finally, in sharing her story with Florida Health Justice Project, Alene learned about her right to be provided with a gap plan. As explained in the Advocate's Guide to the Florida Long Term Care Medicaid Waiver, managed care plans much have a process for “immediately reporting any unplanned gaps in service delivery,” and they must prepare a “Service Gap Contingency and Back-up Plan,” informing the enrollee of resources available. This is a critical consumer protection. And, unlike a plan’s decision to deny, terminate or reduce a prescribed benefit (which triggers a written notice of the right to appeal), no one gets notices of gaps, or the right to appeal. “When my hours were cut from 35 to 14, I got a notice in the mail telling me of my right to appeal and to continue receiving services at the current level, pending the outcome of my appeal." Like many, Alene was not aware of her right to a gap plan “I thought I just had to put up with the fact that home health agencies sometimes can’t find health aides to come to my home for the full amount of time I need help, ” Alene related. “Since asking my case worker for a copy of my gap plan, I've had much less of a problem. I'm sharing my story to help others like me learn about their rights.”
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