A Q&A with Neysha Birdsong, Area Director for SE Pennsylvania, JEVS Care at Home

Most people who apply for no-cost home care through Pennsylvania’s Community Health Choices (CHC) waiver program are approved. But those who are denied should not assume that the decision is final. While some applicants can be denied for medical or financial reasons, others may be denied because of how they completed the application. In those cases, resubmitting the application might lead to receiving approval.  

Wondering how to appeal and reapply? Our JEVS Care at Home (JCAH) Area Director, Neysha Birdsong knows what to do after receiving a denial letter. With extensive experience helping families navigate the CHC waiver application process, she shares the step-by-step process that applicants should follow if their initial waiver applications are denied.    

 

Q: What’s the first thing someone should do if they applied for home care through the Community Health Choices (CHC) waiver and were denied? 

A: The first step is to read your denial letter carefully. It will tell you why you were denied. From there, you can figure out how to appeal. Every county handles appeals a little differently, so it’s not a one-size-fits-all process. Make sure you don’t miss your appeal deadline, and start collecting the evidence you’ll need to support your case. 

Q: What kind of evidence do people need to appeal a denial? 

A: It depends on why you were denied. 

  • If you were denied for medical reasons: You’ll need a note from your doctor. It should include your diagnosis, your medical history, and notes from your chart explaining why you need help. For example, your doctor might note that your medications make you drowsy, so you need someone to check on you during the day. 
  • If you were denied for financial reasons: You’ll need five years of bank statements, Social Security or SSI award letters, and documentation for anything like prepaid funeral plans or life insurance policies. 

Q: How many people actually get denied? 

A: There’s no exact percentage, but roughly 10 to 20% of applicants are denied the first time around. 

Q: Can someone be denied because they made a mistake answering one or more questions—maybe because they were unsure how to answer? 

A: Yes. One common mistake involves life insurance. The application asks if you have a policy worth more than $10,000. Many people say yes because their policy pays out $20,000 when they pass away. But the current cash value of that policy — what it’s worth right now — is usually much lower than the payout amount. Once the real documentation is reviewed, many people are approved after reapplying. 

Q: Are there other questions that tend to trip people up? 

A: Yes — income questions are the trickiest. People sometimes list one source of income, like SSI, and forget to mention a pension or other income. Be as honest and complete as possible. Even if you don’t qualify for the waiver, your local area office on aging—like Philadelphia Corporation for Aging — has other programs that can help you, sometimes even at higher income levels or with a small deductible. 

Another issue is that a lot of seniors don’t want to admit they need help, so they downplay their limitations. Answer every question honestly. If you can’t stand for long periods, say so. If you overstate how much help you get from family or friends, that can actually work against you. Community support is valuable, but it won’t help you in an emergency, so be realistic about who can truly be there for you. 

Finally, don’t worry if your home is in need of repairs. There are programs that can help with home modifications, and needing those repairs won’t disqualify you. 

Q: What programs help with home modifications? 

A: A few options include: 

  • The Medicaid HCBS Waiver, through the Office of Long-Term Living (OLTL) 
  • The PA Options Program, for people age 60 and over 
  • Keystone: if they are your Managed Care Organization, you can contact their division for home modifications and homelessness prevention. They can also help with housing applications for buildings associated with Keystone. 

Q: What additional advice do you have for someone who’s just been denied? 

A: Reapply and go through the appeal process. Reach out to your state representative or an agency like ours if you need help. You don’t have to do this alone. Keep a good relationship with your doctors, go to your appointments, and make sure your medical records stay up to date. That documentation is what makes the biggest difference in getting approved. 

JEVS Care at Home is Here to Help 

If you have questions about applying or reapplying for the CHC waiver, our team members can answer your questions and help steer you through the process. Get no-cost assistance today!