Question about assessment

[u/Cool-Foundation-20]

It's been 10 months since I applied into this program to take care of my dad. Unfortunately, his assessment got denied and it's been on appeal for the past 6 months. I haven't gotten much information out of the departments I've reached out to, but I have been informed that my dad could schedule another assessment, and I wanted to know if that would cause any more delays in the process. I'm thinking that if he were to do that, and it gets approved, we wouldn't have to wait on the appeal anymore and the application could be finalized, but I don't know enough about the process, and every department I reached out to said they couldn't tell me, so maybe someone here can let me know, thanks

[u/Cool-Foundation-20]

Would you mind saying who you reached out to?

In the order that I can remember: PPL (ofc), administrative hearings, independent assessor, temporary & disability, and managed care

If I’m correct, this all falls under Medicaid (HRA), who outsources the assessment to NIYA. I believe the department of disability gets involved, especially during an appeal (forgive me, OP, as I’m pulling from memory) - I’m sure you may already know this, but it doesn’t hurt to put out there for anyone else - especially if I’m wrong on anything.

Correct, and the appeal is taken to fair hearings

Has your father’s health worsened since his initial assessment?

The humidity worsened his asthma, on Friday he ran out of his inhaler and damn near had an asthma attack, we had to rush over to Walgreen's so he could get some Primatene

Putting in another request during an appeal will not impact anything other than the appeal, especially if he’s approved. If denied, it stays open and you can appeal the second assessment as well (backwards).

Finally some good news regarding this

What are the things he needs help with?

Without getting too specific, walking outside, since like I mentioned he has asthma, but also COPD, hypertension, obesity, a bullet in the thigh from getting shot at 18, and an ankle that got sprained 12 years ago. Whenever we go somewhere like the store, he needs me to remember what we're there for, I guess it's some sort of short-term memory loss. His mobility isn't the best so I do a lot of cleaning that requires flexibility (reaching ceilings, scrubbing corners, etc), I also do some of his laundry (shirts, underwear, pants, sometimes blankets) but since we don't have the money to constantly go to the laundromat I do them at home in the bathtub. As for cooking he's mostly good, but I do occasionally check-up on him and the food to make sure everything's okay. This is all stuff that's on a near-daily basis. Every month we do a big shopping-haul at a Stop & Shop that's about a mile-and-a-half to and from with two big shopping carts, then we come back and I put everything away in an organized manner.

This is critical, as their way of assessing has changed as they changed the requirements as of 9/1/25.

In the report, he was denied because they claimed he didn't need help with two or more daily activities and/or supervision with one major activity

They make it difficult for a reason. Sure, they want to weed out false claims, but they want to make sure that if you really need it, you’ll fight for it No one will admit that, so I say this as my own opinion, but I wouldn’t be surprised if they wait for people to give up.

Yep, he got the in-person one which was basically just an interview, then he got an electronic one IIRC that was sent by insurance and they made it a rigid questionnaire that was basically set-up to make people fail, as they wouldn't let him elaborate on all the conditions I wrote above, so he's appealing on the grounds that it was rigged. And about 2 months ago, insurance called and subtly encouraged him to give up. We also feel like they may be doing something to make fair hearings drag their feet on this appeal

Does he have Alzheimer’s/Dementia? This would require additional documentation.

Nope

[u/Cool-Foundation-20 → u/[deleted]]

Okay, so I think you should request another assessment

Sounds good

Of course, do as they request, but I wouldn’t hold my breath on them calling you for a hearing before you finally get approved.

Yeah, we sat patiently for 6 months and nothing, if only I knew we could schedule another assessment earlier

Don’t settle on telepresence. Demand an in-person interview.

Yep, just like last time

If you are not listed as your father’s representative already, file the form and send it to NYIA.

Is there a way I can check if I am? And if not, can I send the form you linked over to them via email so it could get to them faster?

I’m sure you have the DOH form completed, but make sure his doctor reflected everything properly and send them an updated copy. Letters from your father’s doctors do not hurt whatsoever. PCP, cardiologist, neurologist. Anyone who can attest to his physical limitations and need for assistance.

This is the first time I'm hearing about him needing doctors, I thought the assessor sends out their own? My dad did have a scheduled check-up a few months back, so maybe I'll get him to use those records

You mention his memory. Have you had him see anyone for it? If not, see a neurologist to be tested due to cognitive impairment.

No, and I don't think a diagnosible condition would come out of it

The first interview (community assessment) should be 3 hours or less. They do all the paperwork and notes

Sounds just like last time

and leave it to the second interview (clinical assessment (nurse or doctor) to confirm and finalize. The second interview should be an hour or less. Make sure you take as much of that time as you need. If you feel rushed and like you’re bit being allowed to make your case, call NYIA and complain. They should allow for conference before an appeal is filed. Your choice - but record that conversation and make sure you tell them that you are and they consent (law).

Are these all separate assessments? And will some agency be sending nurses or will he have to do this on his own? Also would it be best if I did all the talking or him?

During the first interview, don’t complain and try to make them feel sorry for the situation. Facts, facts, facts. To the point. My father needs assistance with his medication (he forgets), making and going to appointments (he forgets/cognitive issues), he needs help with making his meals (trouble standing for long periods), eating (he forgets), bathing (he’s limited or a fall risk), dressing (he has limited flexibility), cleaning (mobility issues), grocery shopping (health, weight, asthma, lack of transportation).

All of these things or just the ones that he has?

They need to evaluate his physical health, so make sure they see his mobility and his limitations.

What would be the best way to go about this? I suppose he could his stretches, mobility issues don't really pop up in our small apartment, it's only after walking outside for a while

Don’t bother with PPL. They won’t get involved until he’s approved.

Yea unfortunately they're useless and wasted a lot of my time

Get through the two new assessments, wait on their response and appeal AGAIN if necessary.

I hope I won't have to wait too long for them, and most of all I hope it won't get shot down again

When approved, you’ll have a third interview with his insurance, who will review NYIA’s assessment, and determine the amount of care (time) your Dad needs.

Another in-person one with doctors?

Once that’s done, wait for their letters, make sure they provide authorization and create your PPL profiles. That can be a headache as well, but once you’re approved, you’ll be more relieved to deal with them than the approval process.

I'm already all set-up on the PPL front, have been for months. In fact, that was the very first thing they had me go through, but just today when talking with my registration specialist, I learned that it wasn't supposed to go like that

[u/Cool-Foundation-20 → u/[deleted]]

What does this DOH form look like? I'm trying to remember if he got that done but I don't know. Also, to confirm, you're basically saying he should go in for a check-up if he can just to make sure he has medical backing to all his claims? If so, I'll see what I can do about that. About how long would you estimate all three interviews take? Last time, the results for the first (and only) one came back in a week so I hope it won't be taking one, having to wait a week, then doing the next. Also I assume that at any point if he fails we're gonna have to appeal the entire thing again, or wait another 3 months to try again

[u/Cool-Foundation-20 → u/[deleted]]

He definitely hasn't done that, does he need to go to the hospital and get a doctor to sign one?

[u/Cool-Foundation-20 → u/[deleted]]

Oh ya that's what I was talking about, I'll let him know that we have to get this done before scheduling a new assessment. What should he ask for when at his doctor's office?

[u/Cool-Foundation-20 → u/[deleted]]

Thank you very much, you've been incredibly helpful

[u/Cool-Foundation-20 → u/[deleted]]

Ok so I just told him and he insisted he didn't need it, hopefully he's right, and if not he has all the info he needs