Fort Collins resident needs help with Medicaid

[Andi Brunson-Williams]

Hello Mr. Kefalas, 

My name is Andi Brunson-Williams. My family resides in District 1 of Fort Collins, Colorado (near City Park). I first would like to extend my gratitude to you personally for all of your work in government for our town and our state. I'm including a photo I took of you, myself, and my husband Nick at a Trans Day of Remembrance in March of 2023. I have a few others from other parades and marches and local events. Your presence at local events means the absolute world to your community. I can see your dedication to others and making the world a better place!

 

We are a family of 5 living in Fort Collins CO. We have been here since 2005. My husband Nick and I have been married for 23 years, we have three kids ages 20, 17, and 9. We are active in our community volunteering for SPLASH, our child's school, and local gifting communities. We have been struggling financially for most of our adult lives due to my inability to work due to multiple diagnosed disabilities. Due to my health and our children's varied diagnoses and needs, health insurance is one of our greatest needs. We have been helped by family and friends and food banks and other organizations to get by, but for our health needs Medicaid has been our primary source of insurance for years. 

I am currently dealing with an issue with Medicaid that I was hoping I could gain some clarity on or get some help with and I am unsure if it's within the scope of something you could assist with. We had received the standard recertification/update information mail from Medicaid at the end of March. (We get those about every 6 months.) My husband Nick had submitted all the information required and then followed up with a phone call (which is not required or asked of by the Medicaid office but we have learned it's best to be diligent so mistakes don't happen). Nick spoke with someone over the phone (it still takes hours to reach someone by phone) to confirm they received the info and entered it all correctly 

Last week on April 22nd I received a phone call from an upcoming MRI appointment (on May 2nd) that I did not have Medicaid starting May 1st, 2024 and would I like to cancel that appointment or update insurance. So I called Medicaid and was able to get through. The person told me that Medicaid had made a clerical error in regards to my husbands income. The person I spoke to said they accidentally doubled his income (due to an recent one time bonus he received that the Medicaid office submitted as repeating quarterly income). She informed me they would remedy that clerical mistake and send the info to our case worker/technician who would let us know, but that we shouldn't loose Medicaid health insurance. She verified our income and stated to me that we still qualify and our technician would confirm with us as soon as possible. 

We had my husband's HR resent income information on Friday 4/26th, this was not required or asked of us but we wanted to do what we could to ensure the office had all the correct info so there would be no loss of coverage. Monday, April 29th (yesterday) Nick called again to follow up. The person on the phone said they had the information, it all looked good and we would not loose Medicaid health insurance and our case worker/technician would be in contact to confirm. 

At 5:39 pm last night (April 29th) we got a text (though we didn't see it until this morning) from a technician, that my husband, myself and my eldest kiddo (20) would loose Medicaid tomorrow May 1st.  Our youngest two kids (ages 17, and 9 ) still qualify for Medicaid. We spent 2 hours on the phone with a technician/case worker today. What was revealed through that conversation was we have been on Transitional Medicaid since last May (2023) though we were never notified (which their own records confirmed we were not notified of our switch to transitional Medicaid, nor were we informed that we would loose coverage).  Not one of the numerous people we have spoken with over the last year said anything, nor did any of the three people we spoke to within the last three weeks, nor did they inform us we were loosing coverage starting May 1st, 2024. I was told by our technician that many of the employees there do not have access to see that we were going to loose Medicaid beginning May 1st, nor could they see that we are/were on transitional Medicaid nor does everyone in the office know or understand what transitional Medicaid is. I asked him "how are we suppose to know what that is, or even know we are on transitional Medicaid if the people we speak to do not know?" and was told they usually send one letter informing us at least of the information that we are now on transitional Medicaid when they switch us to transitional Medicaid May of 2023. That communication did not happen per their own record check. We were only informed today that we are losing coverage tomorrow. I am wondering what the legal responsibilities are of Medicaid to inform people that they are losing insurance? 

I am disabled, I have a surgery coming up in June that I would have scheduled sooner or found other insurance had I been aware we would not have Medicaid.  Now I may not be able to have this surgery. This is not only a significant hardship but a life threatening obstacle that has been caused by Medicaid. We do qualify for Health First, as we are low income, and my husband applied to that today but the process takes 30 days. I also may qualify for WAD (working and disabled) but that process once you apply takes two months to obtain. And I may qualify for SSI but that takes years and having a lawyer in order to obtain. Paying for insurance while we still don't make even close to a sustainable wage for Larimer county is a hardship; but as a disabled person, not having insurance is life threatening. Being informed only the day before we loose Medicaid seems to be a huge error and one I would hope would qualify us for an extension in order to obtain insurance coverage. 

I would like to understand the responsibility of Medicaid to inform consumers in a timely manner so they can have other insurance especially when we do qualify for other low income insurance but they all take 30 days or more to obtain. And I'd like to know if you can help us so we don't have a lapse in insurance due to an error or oversight from the Medicaid office. In no way do I blame the employees there who are overworked, underpaid, and undertrained but this should not happen to anyone, especially when we as consumers are diligent and trying hard to ensure this doesn't happen. We have spent a culminative 20 hours on this (that is unpaid labor) in the last 3 weeks and we still were not given accurate information and so will not have insurance for, at minimum, the month of April or until our applications are processed for other low income insurance. 

We are going through a process called "escalation" with Medicaid to try and get answers and resolve this error, and we will pursue CDR (county dispute resolution) if needed that may result in a fair hearing. I'm happy to provide information, as I learn it, to educate you about these processes if you would like. It is new to me but I am determined to get answers. I of course would like to not loose insurance and thus risking my health and my life, but I also do not want to see this happen to other people. 

Please let me know if you can provide any assistance in this timely issue. 

Thank you for your time and consideration.

Andi Brunson-Williams

nickbruns...@gmail.com

teilees...@yahoo.com

(970)213-2854

(620) 388-5940

[John Kefalas]

Hello Andi,

Thank you for your kind words and for reaching out to explain your Medicaid situation. I will forward your concerns and inquiry to our LC Human Services Director, Heather O'Hayre, and our Benefits and Community Support Division Manager, Vanessa Fewell, and request that they follow up with you accordingly and in a timely manner, which I know they will do. I am hoping that this matter can be addressed. 

	John Kefalas County Commissioner, District 1
	Commissioners' Office 200 W Oak St | 2nd Floor PO Box 1190, Fort Collins, CO 80522-1190 W: (970) 498-7001 Cell:  (720) 254-7598 jkef...@larimer.org | www.larimer.org

[Andi Brunson-Williams]

Thank you John! I hope you have a wonderful rest of your week and weekend! 

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