For 50 years, Carmen S. has called her first floor Brooklyn apartment home. Filled with mementos of family and friends in New York and Puerto Rico, the welcoming décor reflects her life as an active member of her neighborhood and community.
Now 78, and suffering from severe osteoporosis, Carmen remains independent and in her home with the aid of a home health care attendant, who for the last several years has helped her cook and clean, pick up groceries or medications, get in and out of the bath safely, and perform other activities.
That assistance was threatened in May 2015, when Carmen got a letter from her Medicaid-mananged insurance plan stating that the 25 hours of weekly care she received would be cut to just 12. “It felt fatal,” she said of the news. “I thought, ‘How will I manage?’ So many things I can’t do. Cooking on my own, I sometimes burn myself.”
Worried and looking for help, Carmen reached out to the Independent Consumer Advocacy Network (ICAN), which assists people in New York’s managed care plans who get long-term care services. Said Rosalina Gonzalez, an ICAN Counselor, “I spoke with Carmen and helped her file an appeal to challenge the insurer’s decision. I also called her doctor’s office to get a letter explaining that she had a history of falls and needed care every day.”
When the insurer denied the appeal, ICAN stepped in to help Carmen request a fair hearing with New York State. Rosalina headed to Brooklyn to personally document Carmen’s need for daily assistance and obtained copies of the insurer’s own assessments showing Carmen’s condition had not improved.
Armed with information, ICAN contacted Carmen’s health plan and convinced them to restore the full 25 hours of weekly home care, without a hearing.
“When I got the notice that the hours were restored, I didn’t believe it at first,” said Carmen. “I was so grateful! It’s so important for people to have a place like ICAN to go to for help.”