Chapter 2 (April 2020)
In the midst of the COVID crisis, Therese’s bureaucratic nightmare with her Medicaid Long-Term Care managed care plan (“the plan”) entered a new chapter.
But now, in the midst of the COVID crisis, Therese is in a new bureaucratic nightmare. The plan told the sisters they needed to get a new prescription with a “clinical diagnosis to support 40 hours a week of skilled nursing care.” Back and forth the prescription went between the health plan and Therese’s doctor, who dutifully supplied all of the requested information, each time it was requested. Still, Kathleen stopped getting paid at the end of March. When Therese called the plan, desperate to fix the problem, she got confusing and conflicting information. For example, on April 6, the plan incorrectly said the Rx needed to be filed with Medicare. The plan corrected their mistake but on April 14, told Therese they never received it.
On April 17, after not receiving RN wages for over three weeks, Kathleen told the Health Justice Stories Project, “We’re a close and loving family. Of course, I’m not going to let my sister Therese die or go into a nursing home; but we need my skilled nursing wages to pay the bills.”
And Therese, in spite of her profound physical challenges said, “ I feel blessed. I have my sister here to take care of me.” But these two articulate and resourceful sisters are worried--and not just about themselves. Together they wonder how other people who are so severely disabled, including those who also have dementia, can survive these bureaucratic nightmares. ”I’m very troubled about what people are going through who do not have family with the skills to take care of them,” Kathleen asked. “Are they just dying?”
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