Dave's Story

Dave* is a 64-year-old man who has been diagnosed with severe mental health impairments and physical impairments; his only income is from SSI, less than $800 a month.  He lives on his own, but his brother helps him with much of his paperwork and correspondence.  Dave’s Medicaid expired a couple of years ago and he designated his brother as his authorized representative to help him apply again for Medicaid.  His application was denied because he did not participate in a mandatory assessment. Dave did not understand the notice of the assessment, and his brother was not sent a copy of the notice. When Dave’s brother tried to request a hearing, he was not allowed to do so because the form designating him as Dave’s authorized representative had been lost.

Dave and his brother contacted LAWO for assistance.  LAWO represented Dave in his state hearing. The attorney argued that Dave’s Medicaid application should be reopened since the agency knew that his mental health impairments made it difficult for him to understand correspondence from the agency. The attorney also argued that a copy of the notice of the assessment should have been sent to his brother, who was his authorized representative. 

During the hearing, the State verified that Dave’s brother was his authorized representative.

The hearing officer decided that Dave’s Medicaid application should be reopened and that his brother should be notified of any assessment appointments.  Within a few weeks, Dave was scheduled for his assessment and approved for Medicaid.  With Medicaid he is now able to get his medications and see his doctors when he needs to, which he is very grateful for.

*This client’s name was changed to protect his privacy.