Questions about Medicaid reimbursement lead to state policy amendments

  • Posted: Friday, March 29, 2013 11:56 p.m.
Rowan Social Services Director Donna Fayko, left, worked with Rodney Cress, veterans advocate,  to correct a flaw in the Medicaid reimbursement policy.
Rowan Social Services Director Donna Fayko, left, worked with Rodney Cress, veterans advocate, to correct a flaw in the Medicaid reimbursement policy.

Rodney Cress never expected that asking questions about a Medicaid reimbursement would lead to a state policy amendment systemwide.

Cress, who is a veterans advocate, worked with a person acting as a fiduciary agent who spent their own money to care for the spouse of a veteran living in a nursing home. A fiduciary agent essentially is the trustee who manages or protects a person’s property or money.

That person provided the Veterans Administration with receipts and the money was reimbursed. However, the problems began when the money was required to be placed into a bank account.

The Rowan County Department of Social Services, which administers the Medicaid program, wasn’t fully aware of a fiduciary agreement and the money was considered reserve for the veteran’s spouse, making them ineligible for Medicaid benefits. State Medicaid policy does not clearly define a fiduciary agreement as a legally binding agreement. The DSS staff may not know to request this fiduciary agreement as a legally binding agreement that makes certain money “unavailable” to the Medicaid applicant.

The veteran’s trustee may not know the significance of the fiduciary agreement and not tell DSS officials of its existence. If no one knows such an agreement exists, the applicant may be denied Medicaid, even if they are entitled to receive it.

For nearly a year, Cress worked to get answers until he brought his concerns to the attention of Rowan County Social Services Director Donna Fayko. Fayko presented the situation to the N.C. Division of Medical Assistance, which administers Medicaid at the state level. Officials reviewed the policy and realized some amendments needed to be made.

“No one did anything wrong. There was a gap in policy. We found there was clarification needed,” Fayko said.

The gap could be remedied by the trustee making it clear he or she is a fiduciary for a veteran or veteran’s spouse, she said.

Fayko began talks with a legislative liaison while Cress spoke with lawmakers, including Harry Warren, Carl Ford, Andrew Brock and Richard Burr.

Once it’s established, the money in the account is earmarked for the fiduciary, Cress said, then it’s not right to penalize the veteran or the veteran’s spouse.

“The system is needs to be improved and enhanced,” he said.

Since Cress began nearly a year ago with asking some crucial questions, the local social services office has committed to reviewing veterans cases during the re-certification process. Cress has made it his goal to help other veterans and their spouses in similar situations, so they understand the procedures.

“My life was saved by soldiers. I want to pay that back. If I can make it easier by cutting through that red tape, I will,” Cress said.

To contact Veteran Advocate Rodney Cress, email him at

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