You too could be a winner.

I spent the last few weeks going through boxes of documents, photos and papers in the basement looking for my fathers social security number. I used to have about seven death certificates for him - he died in 2002 - but for some reason I can find nothing now. I finally found an IRS document regarding my parents last joint claim that has an "ID number" that looks like a social security number, and isn't Mom's, so must be his, right?

This is all because now that Mom's in nursing care and almost through the money she got from selling her home, we are putting together something called a "Miller Trust." This trust is designed for people, like my mother, whose retirement income is steady, but not enough to cover the enormous cost of nursing care. The trust pays the care it can cover, and the rest is then covered by Medicaid. This is a good thing because it means Mom's expenses can be covered by her estate and not be passed on to her survivors.

Because Dad served with the Marines in Korea (his last message to me from his death bed was an ironic "semper fi!") Mom is eligible for support from the Veteran's Administration for part of the cost of her nursing care. After negotiating one of the least caller friendly voice mail systems I've encountered since Social Security, I got to Phyllis at the Commission for Veteran's Affairs. (The system is amazing. It says they're open, but no one answers. It give you an employee directory - not much help to a new caller - but no description of what anyone does. Phyllis called me back at one point and left me a message which did not include her extension number, so I had to go to the directory one more time. I couldn't help thinking that if I was a vet with PTSD I might have been tempted to save myself the trouble, hang up, and do something drastic.)

Phyllis was pretty helpful once she understood what I'm up to. People warm up to the only surviving son trying to provide for his dear mother who is in the last stages of an incurable progressive disease, and they should, dammit! After agreeing to send me the paperwork I needed, she hesitated and asked "Do you know how much time you have until she. . . passes?" I told her that Mom was under Hospice care, which implies a "window" of about six months. We agreed that it's really impossible to predict another person's demise, and that she could last quite a bit longer, really. Phyllis said that the thing is, it takes about nine months to go through the funding process. Once she's determined to be eligible, Mom can receive funding retroactively back to the time of application. If she survives that long. If she dies. . . no dice. You must be present to win!

This is one of a number of "systems" that depend on the ponderousness of the process to effectively limit which of many eligible recipients get the benefits to which they're entitled. Social Security Disability is another one. There's an entire industry built around the multiple denial, multiple appeal process that even a wizened quadriplegic in an iron lung must negotiate.

This morning I'm going to meet with a family that has decided to pay out of pocket for my services, rather than using the available therapists on a "list" provided by their insurance company. This company has what is called "a closed panel." The way these panels work is that insurance companies determine how many therapists they need in a given population area. They only "open" a panel when their number of therapists dips. This depends on therapists updating their own insurance information, which we seldom do, because there are a lot of different companies and besides we'd rather talk than do paperwork. In the end, this family couldn't find a therapist they felt their child could relate to, and felt strongly enough about it that they're going to forgo their insurance all together and just pay. This works if you're middle class and have a "cafeteria" health plan. If you're working poor, and happen to choose this insurance company for your Hawk-I (SCHIPS) coverage, you're ham-strung by this "panel" and therapist availability. The effect is that the company controls cost by limiting their customers' access to care. In this case, being alive doesn't necessarily help.

In the case of Mom and the VA, I'm really only going to be saving Medicaid money by going through this process. Mom's going to spend all her monthly income and Medicaid will pick up the remainder. Whether or not VA picks up a part is irrelevant to me. I'm done with those boxes in the basement for a while.