HEALTH CARE

HEALTH CARE ADVOCACY UNIT


 Helping You Navigate Your Health Insurance Issues

CELJ’s Health Care Advocacy Unit offers help in a variety of issues concerning private insurance, Medicare, Medicaid and Managed Long Term Care. CELJ’s attorneys and paralegals can provide advice and counsel, advocate on your behalf and appeal plan decisions. Some of the matters that we assist with include:

  • Improving quality of care in skilled nursing facilities or homes

  • Transitioning from a nursing or rehab facility back to your home

  • Increasing the amount or type of health care you can get in your home

  • Appealing denials or decreases in coverage

We are available to help people 60 years old and older, as well as certified disabled individuals in Erie, Niagara, Orleans, Genesee, Wyoming, Chautauqua, Cattaraugus and Allegany counties. To find out if you qualify for assistance, you can contact our intake line at 716-853-3087 or use the form at the bottom of this page.

New York has recently changed the way it manages Long Term Care for Medicaid recipients. All persons over age 65 who need 120 days or more of nursing-home level care must join a Managed Long Term Care Plan. The plan will handle all Medicaid coverage and determine how much and what types of services you need. You have the right to appeal decisions made by the plan, including decisions about how much care you receive in your home, the types of services you are approved to receive, and your ability to live safely at home. We assist with answering your questions about Medicaid Managed Long Term Care and appealing decisions when necessary.

Common questions

LONG TERM CARE RESIDENT ADVOCACY


 Our legal staff is here to assist with:

  • Nursing home and adult care facility discharges and evictions

  • Explaining your nursing home or adult care facility resident rights

  • Execution of Advance Planning (Powers of Attorney/Health Care Proxy) documents for residents in nursing home or adult care facilities located in Erie County who are at 200% of the poverty level

  • Educational presentations on a wide variety of topics including nursing home or assisted living resident rights

  • For direct resident advocacy, see Long-Term Care Ombudsman Program below

 THE LONG TERM CARE OMBUDSMAN PROGRAM

 The Long Term Care Ombudsman Program (LTCOP) serves as an effective advocate and resource for older adults and persons with disabilities who live in nursing homes, assisted living, and other licensed adult care homes. Mandated under the Older Americans Act, the New York LTCOP oversees 15 regional LTCOPs.

People Inc. hosts the Region 15 program and serves Cattaraugus, Chautauqua, Erie, and Niagara Counties. We are proud to partner with People Inc. as the program's legal liaison, “in-house” legal support, for the program and volunteers. If you or a loved one would benefit from the support of our ombudsman program, contact us!

Interested in becoming an Ombudsman volunteer? Ombudsmen provide compassion and problem-solving skills as they investigate concerns brought by or on behalf of residents, and work to improve the quality of care and quality of life for residents. In order to become an ombudsman, volunteers need to go through a free certification course hosted by People Inc. For more information, please contact Susan Fenster, Coordinator, NYS Region 15 Long Term Care Ombudsman Program, at 716-817-9222.

The ombudsmen in the program are professionally trained and certified volunteer advocates. These advocates investigate and resolve complaints made by or on behalf of residents; promote the development of resident and family councils; and inform government agencies, providers and the general public about issues and concerns impacting residents of long-term care facilities with a goal of effecting systems-level change.

Common questions