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July 2, 2016

I learned more about how Medicaid works this week: If you transfer to us from another adult day health care center because you have been ‘expelled’ from the other center (as one of our members was), then the social worker who has handled your case can do the transfer and we do not have to do anything and we will begin getting reimbursed for your care immediately.

If you transfer to us from another adult day health care center because you think we are better, more convenient to where you live, etc., then the other day center is supposed to discharge you, and we have to file a MAP 24 to ask for the transfer and wait for a prior authorization notice, which typically takes three months to process for those new to applying for home and community based services paid for with Medicaid dollars. Not sure how long the transfer process would take. I had no idea there was a difference in the transfer process depending on circumstances. Is it just me, or does that seem crazy to you, too? To me it seems that the process for a willful choice of transfer is discouraging free choice. It is a scary thing to be discharged and to have to wait on a prior authorization in the Medicaid system. Most organizations will not provide care without a prior authorization notice, and we won’t either in the future because we can’t pay our bills with good intentions. So if a son, daughter, spouse, needs care for their loved one so they can work or just take care of their own health, and they want to transfer to a better adult day health center, they risk losing their job or their health  because of a glitch in the system. How is that for free choice?

I also learned that the Federally mandated separation of the social worker from the organization where he or she works has not been implemented yet. Even though it was supposed to begin a year ago. Not sure why the delay. In other words, a social worker should work in the best interest of his or her client, not in the best interest of the organization where they work. But I guess that is not happening yet. ‘Buyer’ beware. Your social worker may not be acting in your best interest.


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