May 8, 2000

Administrative Adjudications Division
Rehearing Unit,
744 P Street,
MS 19-37
Sacramento, CA 95814
 

In recollection, I believe no action had been taken on my part informing IHSS (This would normally be the case worker, not the provider liaison.) of any change in status after completing all essential applications for assistance and the continuation of assistance as recently as June 29, 1999 (Evidence #1 - Statement of Facts for In-Home Supportive Services, State of California, Health and Welfare Agency, 76S654A SOC 310 (REV. 4/87 signed and dated 6/29/99).

As early as November 26, 1998 and through and up to the MEDS Computer glitch (around the first of July 1999) several State and Federal agencies, including the California Department of Health Service under the Health and Welfare Agency, were in direct contact with CareAmerica, as were the patient's COBRA administrators. As early as March 18, 1999, the plan's termination was announced.

In fact, one of the most important documents utilized by the Health and Welfare Agency in collecting this information, was the June 29, 1999 Statement of Facts for In-Home Supportive Services, administered by the County Case Worker, P. Knox, showed this patient not to have CareAmerica coverage. It was this missing information collected by IHSS under DPSS, in conjunction with Medi-Cal agents, which caused her five month loss of eligibility.

Clearly this change of coverage was generated internally by the MEDS Computer and inadvertently supported by the County, who seemed not aware of the disastrous loss of one of their intake patient's eligibility in one of their County administered programs. Though their defense is that their actions hurt no one, the truth is, their omission of action caused great loss of time, money and patient care, not to mention extreme stress to the family members individually and as a whole.

Combined with their knowledge of the extreme trauma of patient and family as well as the massive nature of the brain injury, the County's failure to respond in a timely fashion, without palpable reason, bears heavily on the promise of a rehearing.

So serious this inability of these relative government bodies to accurately communicate to each other, the patient was somehow, perhaps inadvertently reclassified as PCSP. This is only two weeks before her CareAmerica COBRA coverage would become terminated.

I believe that this is important to a rehearing, because it is the assertion of reclassification from IHSS to PCSP which is the structure and basis for this decision

I believe that the denial and dismissal of this claim was based upon administrative actions, which were implemented without regard for medical necessity at the time and without regard for the patient's future medical necessities or social service needs. I believe that these actions were done in haste through, though if not illegal, then by improper and immoral means, with the intent to save money (DSS ACL No. 93-30, May 10, 1993), without concern or commitment to the patient's needs or caregiver limitations.

Only in retrospect can one see, that in March 1999, the Department of Social Services, under the directive of Mr. Albert Seltzer, Department of Health Services attempted to coerce this patient's reclassification from IHSS to PCSP through a letter of intimidation on State letterhead (Form SOC 426 (1/93)) by warning that IHSS funds for this specific patient might be interrupted unless their desire to reclassify this patient is met within five calendar days! It is this classification which Judge Voelker has based his decision to deny and dismiss this claim.

At the time, I was afraid that my wife would lose all benefits, which would ultimately result in our financial ruin and eviction from our home. However, after reviewing this letter, as Constance's conservator, I felt that such reclassification, which offered her eligibility to the PCSP program, was not in her best interest.

On March 11, 1999, the day after receiving this letter, I contacted Constance's IHSS case worker, P. Knox, and told her that we had elected to remain under IHSS. On the following day, Friday, my son Justin informed me that someone, very nice, from the County had come to the door with documents to be signed, that anyone could sign, and my son signed them without knowing what they were about or their purpose. It is my belief that these were the documents reclassifying Constance against her wishes.

It is very hard to think that the State, under the County administrators, would sink this low to do something like this. But in retrospect, I believe it is very clear why the County did this. They knew the brain-injury severity of my wife's condition, and the potential long-term care commitment, especially upon discovering CareAmerica's termination of coverage on April 1, 1999, but pretended they did not know. They also knew that if they could move quickly enough, reclassification would deny her IHSS staff review, essentially freezing the patient's status under PCSP, without recourse (p30-757.1) and relieving them of additional budgetary expenditures; a position repeatedly echoed by IHSS representative Mr. Kam Bui, before Judge Voelker.

I think that it is indefensible to deliberately, hastily or without consent or due process, reclassify a patient, spiriting them away from the potential care they might need, and then ultimately be permitted to submit such actions before an Administrative Law judge as being both a legal and an appropriate defense in this matter.

By allowing this, thus forever denying the greater care options to a patient who cannot move and who cannot speak, who has been a devoted mother and hardworking citizen, especially when the reclassification option was not accepted for good reason by the patient's legal representative under the Laws of the State of California, is sufficient in itself to seek review, in the consideration and hope of a rehearing.

New evidence supporting the above is being compiled and prepared for rehearing.

Yours sincerely,

Joel E. Webb
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