After much effort by lobbyist Brian Jogerst, earlier this month, Task Force members Emma Hemness, Mike Jorgensen, and David Jacoby, joined by attorney Angela Warren, met with DOEA and DCF representatives in Tallahassee. The goal of this meeting was to address problems and reestablish regular and ongoing communication with Florida department leaders. Our ultimate goal is to be able to work with DOEA and DCF to facilitate resolutions to long-term care challenges in our state. The head of the DOEA, his two top assistants, and a representative from DCF attended.

Delayed Level of Care Determinations.

Among the topics discussed were the pervasive Medicaid approval wait times caused by delayed level of care determinations. Before the meeting, examples of delays were provided to DOEA to analyze. Specifically, representatives of DOEA indicated that the failure of physicians to fill out the 3008 form correctly (specifically box “Y”) was causing many of the delay issues. It was relayed that the DOEA only notifies the party that submitted the 3008 form of any defect, which is rarely forwarded promptly to the Medicaid applicant. While the members of the Task Force who attended believe DOEA’s explanation oversimplified the issue, it was a good dialogue, and we hope just the beginning of a long-term working relationship.

Reestablishment of Ongoing Relationships with DOEA and DCF.

In addition to the level of care issue, Task Force members provided DOEA and DCF with numerous examples of systemic issues with the entire long-term care Medicaid application process. However, given the limitations of a 30 minute conference time, we believed the best outcome was to initially focus on reestablishing ongoing relationships with these Departments rather than attempting to address all systematic deficiencies.

At the Task Force’s request, the DOEA agreed to have ongoing quarterly meetings with members of the Task Force and to appear at future Continuing Education Programs. It is unclear at this time whether DCF will also, but we will keep Task Force members apprised. 

Before the DOEA or DCF will consider seriously addressing any systemic issues we are experiencing in the field, as suspected, they want specific case numbers for the individuals in which the problem was encountered. While many of us have experienced similar issues, we have not necessarily tracked and recorded them. There is also no clearinghouse where this information is stored and tabulated. To make real progress with DOEA and DCF, we must be able to provide specifics. Therefore, at the behest of our lobbyists, Brian Jogerst and Greg Black, the Task Force has developed a form created by Britton Swank and digitized and computerized by Jason Waddell, which is in its final stage of testing. The Task Force intends to have these forms circulated and available to all ELS and AFELA members very soon. These user-friendly forms will tabulate and keep the statistics for future use to monitor compliance and improvement in the Medicaid approval process. The Task Force requests that you and your staff regularly utilize these forms to track all problems and issues you are having with the Medicaid application process so that when Brian and Greg require examples to present to the Departments, we can readily access the data.

For those who deal with individuals with special needs, be aware that in the last year, advocates are seeing a rash of eligibility denials for the iBudget Medicaid Waiver, which are routinely upheld in fair hearings. The Agency for Persons with Disabilities (APD), which administers the iBudget Waiver, uses particularly rigid standards for individuals with autism or intellectual disabilities. Task Force member, Nancy Wright, has a pending case in the Fourth District Court of Appeal on a denial of eligibility under the category of autism. In this case, APD tried to undermine the determination by three separate clinicians that the client met APD’s definition of autism because, like many individuals with autism, the client also had a co-occurring mental illness diagnosis. The Disability Rights Florida organization has filed an amicus brief supporting the client. More information is forthcoming.

Nancy is also the plaintiff in an appeal to the First District Court of Appeal seeking to force AHCA to publish their fair hearing orders. AFELA and the Elder Law Section will be filing an amicus brief in this matter supporting this request.

The Task Force is working to identify and develop elder law attorneys for future leadership in our field. As the demographics of the United States continue to invert with top-heavy elderly populations, we suspect continued challenges for the elderly and disabled in navigating the various government programs. In this regard, the Task Force recognizes the need to continually bring new ideas and talent to champion causes for Florida’s elderly and disabled. The Task Force plans to increase community outreach to Florida law schools and encourage student participation by law students in upcoming CLE programs.

AFELA, through the leadership of its President, Heather Kirson, has developed and launched a Mentorship Program available to AFELA members. If you are interested in being a mentor or a mentee, please get in touch with Heather at hkirson@kirsonfuller.com