Dear Readers,

Below are copies of letters I sent to a writer at our local paper. I just found out that we will never be reimbursed for the care we have given two members of our health club who were receiving care from other places, paid for with Medicaid dollars before coming to us. I also just found out that our claim for charges for the past 13 days of attendance here by another member of our health club, whose attendance since October has been paid by Medicaid dollars, has been denied by the Medicaid system. Please read:

“Hello Tom,

Do you know if anyone at the Herald Leader would be interested in doing a story on how Medicaid did not reimburse us for caring for two Medicaid eligible members of our club? One came from a nursing home where her care was being paid for with Medicaid dollars. Her daughter found her there and took her out to care for her mother in her home (the mother has severe dementia).

The other member was at another adult day center here in town and her attendance there was being paid for with Medicaid dollars but the other day center discharged her instead of transferring her here and I could not figure out how to get her back into the system. When we finally got her reassessed, there was a series of unfortunate events (she contracted a UTI, the daughter had carpel tunnel surgery, the son in law fell and broke his shoulder) and she was taken by her family to a nursing home after a hospital stay.

The care we provided amounts to more than $12,000 that we will never see. Our claims were denied by Medicaid because we did not have “Prior Authorization”. In other words, the families are expected to pay out of pocket or care for their loved ones themselves (which is akin to being in jail) while waiting and working for “Prior Authorization”, a long and convoluted process. These are low income people who cannot pay for care out of pocket.

I would love to give free care if we could afford it. But we are new and have many unpaid bills. In fact, we are about to be evicted for non payment of our rent. We have till next Friday to come up with $15,300.”

“Hello again Tom,

I just finished billing Medicaid for another member who has been with us since October, and was transferred here from another adult day center in town. We have been getting paid as I have billed, until today. The system tells me that today’s claim of 896.43 for 13 full days of service has been denied. This bill includes breakfast, lunch, an afternoon snack and a medical staff that gives medical attention all the while he is here.

The Medicaid system tells me that the member’s available income information is not on file for the month of service. The member has been extremely demented for several years and has been Medicaid eligible for a long time. How could his income have changed? The Medicaid system is putting us out of business. I already told you about not being paid for two other Medicaid eligible members.

Here is what I see for us baby boomers: Zombie Apocalypse. Families are not going to go to the trouble to take full care of people who can’t take care of themselves, if they do even have families. The government is going to go broke if we all end up in nursing homes.

I designed our health club for seniors as a solution to all the woes of our current care giving system for caring for those who need care. Unfortunately, it is unsustainable with our current reimbursement system for home and community based services.”