Help with Medicare and Medicaid Benefits: A Sometimes Overlooked But Critical Legal Aid Service
Kevin Golembiewski
I first learned about legal aid in law school. I learned that legal aid attorneys help people with housing issues, family law matters, and small-claims disputes. Not until several years later did I learn that they also help people access Medicare and Medicaid. Yet such help is critical to the health and well-being of millions of people.
Director, Disability Rights Florida and LSC Emerging Leaders Council Member
Medicare and Medicaid provide healthcare coverage to over 100 million Americans. Medicare provides coverage to those who are 65 and older and to certain people with disabilities, while Medicaid provides coverage to adults who have lower incomes, pregnant women, and children. The Social Security Administration administers Medicare, so those seeking Medicare benefits must contact the Administration. By contrast, those seeking Medicaid benefits must contact their State because state agencies administer Medicaid.
For countless Americans, navigating Medicare and Medicaid is a necessity. They rely on the programs to access medical equipment, community-based care, hospice care, life-saving surgeries, and more. Many people with disabilities, for example, rely on Medicaid not only for routine healthcare services but also for the supports that they need to live in the community with their family and friends. Under Medicaid’s waiver programs, people with disabilities who would otherwise require institutional care in a hospital, nursing home, or intermediate-care facility receive in-home nursing care, medical equipment, and other supports that allow them to live at home and contribute to their community.
But navigating Medicare and Medicaid is difficult. Even federal judges have trouble doing it. Judges have referred to the programs as “a byzantine tangle of federal statutes” and a “complex labyrinth of statutory and regulatory requirements.” As a result, a person challenging a denial of benefits faces a daunting task: she must try to make sense of the byzantine requirements, identify the precise basis for the denial, figure out how to appeal the denial, and then persist through the appeals process.
And each year, many people are denied benefits. According to one study, around 16% of the 71 million people who are on Medicaid lose their benefits at least once during their lifetime.
In other words, at any given time, millions of our neighbors, friends, and family members need help. They face the loss of benefits that are critical to their health and a regulatory scheme that is confusing to even federal judges.
So what can they do? Contact a legal-aid organization. Although many people might not know it, assistance with Medicare and Medicaid benefits is a bread-and-butter service for legal aid attorneys. Legal-aid organizations across the country specialize in Medicare and Medicaid, providing free assistance to people who are at risk of losing their benefits. They explain the ins-and-outs of the programs to clients, investigate denials, and navigate the appeals process. And they frequently get results. In 2015, for instance, Florida’s legal aid organizations helped clients recover over $70 million worth of Medicare and Medicaid benefits.
That is certainly a service that our communities should know about. Please spread the word.
