I have a cousin who lives in Illinois. She has MS and hs been placed on Medicaid after a lifetime of working. She has brain lesions and has ...

Question

I have a cousin who lives in Illinois. She has MS and hs been placed on Medicaid after a lifetime of working. She has brain lesions and has been MISplaced in a psychiatric hospital. She needs skilled nursing. Does Medicaid have an ombudsman or is there some placement dispute organization that advocated for patients in Illinois? Where should her sister go to have this addressed?

Answer

Nobody will deal with the sister without the sister's having legal authority, and with the cousin being an adult the relationship is not enough on its own especially when it comes to Medicaid. That program is really just a payer program; it makes NO medical decisions. All it does is decide if a particular health care option is covered, and if so, will pay for it up to various limits similar to any "insurance" program.

The cousin is clearly an adult, and if she is decisional, she is the only person who can make decisions. If the cousin is NOT decisional, it all depends on who her legal guardian is. It could be a public guardian that the hospital got appointed to make decisions, which is most likely the case, or possibly another family member or third party has a health care power of attorney.

The sister should start by contacting the hospital and finding out whether there is a guardian or power of attorney. If the cousin was admitted as decisional but is now NOT decisional, the sister may be able to intercede but there is a court process.