OCLA Low-Income Legal Assistance for Medicaid Clients in Community-Based Care Settings

Last week, WHCA representatives, including Lauri St. Ours, EVP of Government Relations and Communications, and Carin Marney, Ballard Spahr, met with representatives from the Office of Civil & Legal Aid (OCLA), the state agency that administers the statewide Legal Counsel for Long-Term Care (LTC) Program through contacts with legal service providers, to provide legal assistance to Medicaid-eligible adults living in residential long-term care settings including assisted living. OCLA’s long-term care legal services program launched in January.

Here’s a quick summary of the meeting:

OCLA Program Update

• The program is intended to be resident-focused while also responding to broader system issues affecting housing stability and care access.
• OCLA anticipates a July 1 process change that will place greater emphasis on addressing issues before discharge notices are issued.
• Eligibility criteria may be adjusted to allow earlier intervention and address problems upstream, though attorney capacity and funding remain limiting factors.

Appeals and Discharge Trends

• OCLA is gathering data regarding which appeal pathways residents are utilizing.
• Most discharge-related matters appear to proceed through the Office of Administrative Hearings (OAH).
• Participants reported few, if any, cases advancing to unlawful detainer actions.
• Additional data from OCLA is expected by the end of July.

Nonpayment and Medicaid Eligibility Concerns

• Nonpayment remains the most common reason cited in discharge notices.
• “Needs cannot be met” is the second most common reason.
• Participants discussed challenges arising from:
  • Medicaid eligibility delays.
  • Delayed application submissions.
  • Lack of a back-payment mechanism for assisted living providers.
  • Financial exploitation by family members or others controlling resident assets.
• OCLA noted that many nonpayment situations involve residents who could qualify for Medicaid but whose applications are delayed by responsible parties.

Guardianship, Representative Payees, and Financial Exploitation

• Guardians and representative payees were identified as frequent contributors to payment-related issues.
• Participants discussed the need for earlier identification of guardianship concerns during pre-discharge timelines.
• OCLA acknowledged limited discussion to date regarding representative payees and agreed to provide additional information.
• Strengthening collaboration between OCLA and the Office of Public Guardianship was identified as a priority.

Adult Protective Services (APS) Coordination

• Providers reported inconsistent APS responses when financial exploitation is suspected.
• Concerns were raised about lengthy investigations and a lack of communication back to facilities.
• OCLA agreed to explore improved coordination with APS and include these concerns in future follow-up discussions.

Capacity and Outreach

• OCLA did not seek additional state operating budget funding during the most recent budget cycle.
• Current funding levels are sufficient, but OCLA is closely monitoring attorney demand and intake volume.
• The agency plans to increase outreach efforts over the next year to improve awareness of available legal services.

Key Takeaway for Providers

The discussion reinforced that nonpayment issues are often symptoms of larger systemic challenges, including Medicaid eligibility delays, financial exploitation, guardianship problems, and representative payee issues. OCLA’s planned shift toward earlier intervention before discharge notices are issued may create opportunities to resolve these issues before they escalate into appeals or housing instability.

Resources:

Legal Counsel for Long-Term Care | Office of Civil Legal Aid