NCA Success Story: The Power of Persistence

In November of last year, an individual and their spouse were referred to National Care Advisors in crisis. This individual was disabled and wheelchair bound. Their spouse had been serving as their full-time caregiver for multiple years and had been receiving caregiver wages by their state’s Department of Health and Human Services agency (DHHS) through the individual’s long-term care (LTC) waiver. However, in June of 2024, the individual’s Medicaid coverage lapsed and attempts to have it reinstated were unsuccessful, leaving the individual and their spouse in a critical and vulnerable situation.

Once assigned to this new client’s case, NCA’s nurse consultant, Trish, immediately jumped into action. She began advocating for their Medicaid application, making multiple calls to the DHHS office to ensure that their application was successful. On January 2, 2025, the client’s Medicaid was fully activated.

This left the challenge of reinstating the spouse’s caregiver wages and securing retroactive payment for the wages lost during the lapse. The reinstatement of the client’s Medicaid inaccurately classified them as a new member, assigning them to a new case manager and altering the waiver’s service model. This led to a different company overseeing case management. Because the new case manager was not overseeing their care during the retroactive pay period, they were unable to process the retroactive payment.

Trish acquired the name of the Administrator for the CFI Medicaid Waiver Services Program and began advocating for the correction of the Medicaid eligibility date. When her calls went unanswered, she located the administrator’s email and sent multiple messages to push for the necessary corrections. 

After persistent follow-ups, the eligibility date was successfully corrected, eliminating any gap in coverage. When faced with resistance regarding the approval of retroactive pay, Trish provided detailed documentation of all communications, including the individuals she had previously spoken with and proof of the forms submitted as requested. 

When the administrator stopped responding to emails and did not provide updates regarding the retroactive payments, Trish took the initiative to research the contact information for the original company responsible for wage payments. She reached out to them directly and was able to clarify their process and the necessary steps for approving the retroactive payments.

In just one final phone call, Trish confirmed they had everything needed to initiate the payment process. The client was informed that they could submit the timecards for the lapsed period, and that those retroactive payments, totaling $35,000, would be approved immediately as a lump sum payment.

This success story could not be a better example of the power of persistence. Through a knowledge-based, confident approach, NCA’s Nurse Consultant, Trish was able to successfully advocate on behalf of this client and their spouse, ensuring that their Medicaid coverage was reinstated and that their spouse would receive all caregiver wages to which they were entitled.

Unfortunately, situations like this are far too common. For individuals with complex care needs, public benefits like Medicaid and LTC waiver services are often indispensable in maintaining their health and well-being. That’s why at National Care Advisors, our nurse consultants specialize in helping clients and their families, as well as their financial managers and trustees, understand the laws and regulations specific to these benefits programs. Our Registered Nurse Consultants have extensive experience working with local, state and federal agencies as well as private insurance companies to secure, preserve access to and maximize benefits. There is often an immediate and significant return on investment as a result of the income and costs that are covered by third party benefits.

Unsure about what third party benefits you, your loved one or your client are eligible for? Have you been denied or lost access to benefits? Do you know the value of benefits and that all benefits have been maximized? Contact us today to discuss how National Care Advisors can help you evaluate your unique circumstances and ensure you are receiving and maximizing all available benefits!