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Lindsey Holden, EBS in Portage County, assisted a client in obtaining QMB. The client's spouse received an inheritance that caused her to lose SSI, Medicaid, and QMB. However, the main portion of the inheritance was real property in the spouse's name, only. This meant that the client could be eligible for MAPP, but because she did not qualify for premium-free Part A, she would be responsible for Part A and Part B premiums without QMB. The client's spouse intended to sell the property eventually, but was hesitant to do so that quickly. When Lindsey explained that she could become QMB eligible if the property was listed for sale, they contacted a realtor (a relative) who listed the property for them. Lindsey was able to show IM that the property was unavailable under MEH 16.2.2 , and with assertive follow-through, the client's QMB was processed.
11/30/2023
Story #128
Brittany Boyer, EBS of Marathon and Wood counties, recently helped a client obtain FoodShare, MAPP, and SLMB benefits. The client met all eligibility requirements, however, he was having difficulty providing verifications for his Veterans pension and his child support obligation from another state. Brittany assisted the client to the extent she was able, but ran against roadblocks both with the VA and with the out-of-state court. Brittany wrote a letter to IM citing that it must help a client with hard-to-obtain verifications, and cannot deny a benefit when information is difficult to prove (MEH 20.5). IM agreed with Brittany's letter and awarded the benefits to the client.
9/29/2023
Story #110
Michelle Fellom, EBS in Chippewa County, recently helped a married couple avoid losing MAPP eligibility due to difficulties providing verification related to life insurance policies. Income Maintenance records were still showing their policies as available assets even though the policies had been cancelled years ago. With no home internet access and no family to help out, the couple was struggling to provide verification acceptable to the Consortium. Michelle tried calling the insurance company with the customers on the line, but the company refused to issue anything in writing to confirm the status of the policies. After a failed attempt at a four-way call with Consortium staff and the insurance company, Michelle eventually succeeded at getting the customers, the Consortium, and the insurance company on the line at the same time. With the verification requirement finally satisfied, the couple got to breathe a sigh of relief that their MAPP coverage would continue uninterrupted.
8/31/2023
Story #99
Mikayla Sorge, EBS of Wood County, helped a client keep his Medicare Savings Program benefit. During the Public Health Emergency, the client had been receiving MAPP and QMB. During the PHE, he had cashed out a pension and reported it to IM timely. During the PHE unwinding, he received notice that his renewal was scheduled for May 2024. This meant that he should continue to receive MAPP and QMB through this time. However, the client received a notice that due to his pension, he was now only eligible for SLMB+, and because a person cannot have SLMB+ and MAPP at the same time, he would need to choose one or the other. This was incorrect, however, because his benefits should remain unchanged until his renewal date. Mikayla contacted IM and was able to resolve the issue quickly without needing to escalate it with the ForwardHealth Partners Inbox.
7/27/2023
Story #97
Kenton Zink, EBS in Dane County, recently met with a farmer who had lost QMB eligibility and had fallen behind on Medicare premiums. He had also received confusing letters telling him that he had lost BadgerCare coverage even though he continued to be eligible under Public Health Emergency rules. Amidst all the concern and confusion over his health insurance coverage, the client had been delaying reconstructive oral surgery to help repair damage from cancer treatments. Kenton worked with the Medicaid Buy-In Analyst to reestablish premium payments through the Medicare Savings Programs, helped reassure the client that his BadgerCare coverage remained in place so he could proceed with reconstructive care, and helped the client get approved for MAPP so that he will have reliable secondary coverage when his BadgerCare eligibility ends.
2/28/2023
Story #63
Kenton Zink, EBS in Dane County, helped a client get nursing home care covered by Medicaid. The client was covered by MAPP when she went into the nursing home. She initially elected hospice benefits but later revoked the hospice election when her condition improved. She then returned to full benefit coverage under MAPP. However, rather than bill Medicaid for the remainder of her stay, the nursing home billed the client directly, threatened collections, and even pursued her family members for payment. When questioned why the claim had not been submitted to Medicaid, it turned out that the nursing home billing office mistakenly thought that it was not allowed to bill Medicaid due to specific procedural requirements. Medicaid requires a nursing home to submit a level of care request when a resident revokes a hospice election and continues to reside in the nursing home. The billing staff thought that a level of care request could only be submitted for a person enrolled in long-term care Medicaid. With some advocacy from Kenton, the nursing home agreed to submit the claim to MAPP and the entire stay was covered, saving the client from more than $30,000 of debt.
Monetary Impact = $30,000
11/30/2022
Story #41
Emily Berry, EBS in Price County, helped a client understand benefits she already had but was not using! The client came to Emily at the recommendation of her doctor to apply for SSDI after receiving a diagnosis of Stage 4 Chronic Kidney disease. The client thought she was receiving Social Security Retirement benefits and nothing more. After conducting a thorough investigation, it turned out the client was actually already receiving SSDI from a previous illness, as well as MAPP. Her kidney disease was caused by the treatment of her previous illness. The client had no recollection of her disability determination and had never received her ForwardHealth card. This is a great example of how EBS help individuals who are overwhelmed with health crises and have fallen through the cracks of the systems.
7/28/2022
Story #19