My sister emailed Sylvia Gray at Woodland Terrace in response to my message from last night. I’m including here both the content of the message sent from my sister to Sylvia and also a copy of the letter that was sent to my mother.

Hi, Sylvia.

I will try to give you a call sometime tomorrow when I am on a break at work, but I wanted to send you what I could for now. I have attached a copy of a letter that apparently was sent to Mom and, I believe, ChamberlinEdmonds. I found it on the MyAccess Florida site when I went to check on the status of Mom’s application. I do not know how to proceed since the three things they are asking about are forms that Mom is unable to sign.

Everyone I have spoken to and everything I have seen says that Mom is not eligible for Medicare yet because she is not 65 and has not been receiving Social Security Disability for 2 years.

The last time I spoke with someone with Social Security, I was told that they were waiting for a release to see Mom’s medical records. The woman handling her case, Jessica, said that she would send a release form to the doctor to sign stating Mom’s incapable of signing for herself. When I last tried to call her, her voicemail stated she was out of the office until, I believe, July 16th. Her number is 866-210-8089, and her extension is 11415. I was told they have to make a decision on Mom’s case by August 2, 2012.


This is a copy of the letter that was sent (allegedly) to the apartment where my mom hasn’t lived in nine months. Give it a read and tell me if you think anyone over the age of 60 and experiencing a hardship of just about any type would be able to easily understand it.

Dear Kathleen Gagne,
The following is information about your eligibility.

Your application received on May 24, 2012 has not been processed because:
You have not returned everything we need to determine your eligibility. Please return or fax the information to the return address or fax number listed above. You still need to return:

  • Other – please see comments below
  • Please complete and sign the Authorization To Disclose Information Form
  • Please complete and sign the Informed Consent Form
  • Please complete and sign the Affidavit for Designated Representative Form

case is pending: placement in nursing home. level of care. 2/12 to current bank statements. Requested items with an asterisk (*) must be provided if you are applying for food assistance.

If you do not return this information by July 23, 2012, we will deny your application because you did not provide the requested information and you will not receive a separate denial notice. This is your denial notice.
42 CFR 435.912

If you think you already returned this information, go to your MyACCESS Account and it will tell you which information we are waiting for.

If you do not already have an account, you can set one up using your case number listed above . Go to to activate your MyACCESS Account and check the status of your application.

Please contact our office at the number listed above, if you have questions, need additional information, or need help getting this information.

AE44 P1 FORM : CF-ES 160 06 2012