Health Care Advocacy Unit

Helping You Navigate Your Health Insurance Issues 

There have been many changes in the health care landscape for older and disabled New Yorkers. CELJ’s Health Care Advocacy Unit offers help in a variety of issues concerning private insurance, Medicare, Medicaid and Managed Long Term Care. CELJ’s attorneys and paralegals can provide advice and counsel, advocate on your behalf and appeal plan decisions.

Some of the matters that we assist with include:

  • Improving quality of care in skilled nursing facilities or homes
  • Transitioning from a nursing or rehab facility back to your home
  • Increasing the amount or type of health care you can get in your home
  • Appealing denials or decreases in coverage

We are available to help people 60 years old and older, as well as certified disabled individuals in Erie, Niagara, Orleans, Genesee, Wyoming, Chautauqua, Cattaraugus and Allegany counties. To find out if you qualify for assistance, you can contact our intake line at 716-853-3087. To download our unit’s brochure, click here.

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Stay In The Community With Quality Care

Skilled Advocacy

Compassionate Service

Fair Medical Coverage Decisions

FAQs

New York has recently changed the way it manages Long Term Care for Medicaid recipients. All persons over age 65 who need 120 days or more of nursing-home level care must join a Managed Long Term Care Plan. The plan will handle all Medicaid coverage and determine how much and what types of services you need. You have the right to appeal decisions made by the plan, including decisions about how much care you receive in your home, the types of services you are approved to receive, and your ability to live safely at home. We assist with answering your questions about Medicaid Managed Long Term Care and appealing decisions when necessary.

How can I get the care that I need to stay in my home?

Many older and disabled individuals want to stay in their homes or apartments, but need help and skilled nursing care to safely remain at home. A Medicaid Managed Long Term Care Plan can provide these services to you in your home if you qualify. CELJ helps its clients understand the benefits of Medicaid Managed Long Term Care, and will work with your Managed Long Term Care Plan to help ensure you receive the quality care you need to stay in the community.

I have Medicare. Why am I receiving a bill?

Having Medicare does not always mean that Medicare will pay for all claims or hospital stays. Unfortunately, many Medicare recipients do find themselves facing large health care bills despite having coverage. This often happens after receiving inpatient rehabilitation in a skilled nursing facility, or after an ambulance transport. You have the right to appeal claim denials. Our attorneys can review your medical bills to ensure that you received proper coverage, and can represent you throughout the appeals process where appropriate. If you believe that a claim has been wrongly denied, you can contact our office to see if you qualify for assistance.

My spouse is in a nursing home, but I still live at home – why do I have to give our income to the nursing home if we have Medicaid coverage?

Medicaid can help cover the high costs of nursing home care, but if you make more than the monthly income limit, you will have to contribute towards the cost of your care. Spousal budgeting for Medicaid is very complex and varies based on individual circumstances. We help our clients make informed decisions about how to budget their income and resources to make sure the spouse living in the community has enough money to maintain their home, while also ensuring that the spouse living in a nursing home has everything they need as well. If you disagree with any determination made by the Department of Social Services regarding your Medicaid coverage or budgeting, contact our office to see if you qualify for assistance.

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