A veteran with 21 years served in the United States Army, Kermit Garrison isn’t someone to be taken lightly.
His military career taught Garrison the importance of keeping a paper trail for documentation, as the Army had a form to complete for almost every scenario.
So when Garrison didn’t receive the answers he sought from a local nursing home, he reverted back to his Army days—documenting everything he did and was told, while respectfully standing up to the administrator of a facility who wasn’t providing him the answers and information he believes the law entitles him to receive.
Garrison has power of attorney from his 83-year-old sister, a bedridden resident of Arabella Health & Wellness of Russellville, a nursing home formerly known as Russellville Health Care, located on Gandy Street.
Garrison’s sister, a widow whose son predeceased her, needed someone to help when her health declined and she had to be admitted to Helen Keller Hospital last fall.
That’s where her brother Kermit stepped in. While he wasn’t in a position to financially support his sister, Garrison agreed to serve as her attorney-in-fact, or agent, so she signed a durable power of attorney to allow him to do so legally.
As the agent, or attorney-in-fact, Garrison has the legal right under Alabama law to stand in the shoes of his sister to make financial, business, legal and medical decisions on her behalf, subject to a duty of good faith.
After the first of two hospital stays, Garrison’s sister was admitted into Arabella as a rehabilitation resident on September 11, 2023. That meant her Blue Cross/Blue Shield Blue Advantage Plan insurance would pay for her care during the rehab stay, Garrison said.
But after she contracted C.diff., a serious infection of the colon, last October, Garrison’s sister went from Helen Keller Hospital to Huntsville Hospital for surgery to repair a bleeding ulcer. She was later transferred back to Helen Keller, followed by discharge to Arabella, where she was admitted as a long-term care resident.
The facility is owned by Arabella Healthcare Management, a corporation with its headquarters in Florida. The Russellville facility has 50 beds.
According to Garrison, the only income his sister received was a monthly Social Security check for $1707.70.
After BCBS paid for her care during the months of September-November 2023, Garrison said he received a call on November 28th from Ashlyn Nolen, Director of Social Services for Arabella Health & Wellness Russellville.
“She explained that the Blue Advantage plan would stop paying my sister’s expenses at Arabella on November 30, 2023, and that she would be financially liable beginning December 1, 2023,” Garrison said.
From September through November 2023, when BCBS was paying for his sister’s care, Garrison said there was never any mention of a copayment nor did any Arabella employee suggest Garrison should start the process of applying his sister for Medicaid.
The events that happened next, and why they happened, are the reasons Garrison sought the assistance of the Office of the State Long-Term Care Ombudsman Program through its Muscle Shoals office, administered through the Northwest Alabama Council of Local Governments.
The mission of the investigative agency is to protect the rights of long-term care facilities and to ensure they receive fair treatment and quality care.
Garrison maintains he paid every dollar invoiced to his sister, but in spite of that, Arabella officials allege the facility is owed an additional $4,735.80. Garrison, who has a valid power of attorney for his sister, said Arabella officials refuse to explain what this additional amount results from.
Additionally, he says Arabella’s administrator told Garrison his bedridden sister would be served a 30-day notice and evicted if the balance wasn’t paid.
In December, Garrison paid $1,677 for his sister’s care and another $1,477 in January 2024. He provided the FFP a statement from Arabella for $3,154 for December and January, which he paid in full.
In January, Garrison applied his sister for Medicaid, and received notification she had been approved on January 22, 2024. Garrison says he was told by Nolen that Medicaid would also make all back payments due for the 90-day period immediately prior to approval.
After Medicaid paid the February 2024 bill and Garrison paid Arabella an additional $1,477, Garrison received a statement on March 1, 2024, that said his sister owed Arabella $4,735.80, even though Medicaid began paying for his sister’s care in January.
After his sister’s Social Security check amount increased to $1,935 in March, he has paid Arabella $1,906 each month, leaving her $29 for Alabama’s maximum ‘personal needs allowance’ as outlined in state Medicaid policy.
Alabama’s personal needs allowance is the nation’s lowest at $30 per month. This means the long-term care resident must pay all Social Security payments received, less $30, to the facility.
With his sister’s monthly Social Security check of $1,935, Garrison pays the facility $1,906 and retains $29 for his sister’s personal needs each month.
He questions why his sister would owe an additional $4,735.80 when Garrison says he’s paid every invoice in full. And when he went to speak with Arabella staff, Garrison said they refused to provide any explanation of what the $4,735.80 was for.
Richard Walls, Arabella of Russellville’s Administrator, told the Franklin Free Press last week that Medicaid’s patient debt liability is based on the resident’s income. Medicaid debt is what the patient owes to a long-term care facility when they apply for Medicaid, Walls said.
Although Walls did not discuss Garrison’s sister’s case specifically due to HIPAA laws, he said all residents or their representatives sign an admission agreement with Arabella and they’re given all information up front.
“This is the case whether they come in with Medicare, private insurance, self-pay or a HMO,” Walls said. “You can only have Medicaid pay for a nursing home while you’re actually in a nursing home. Everyone is directed by Medicaid what their payment will be.
“Arabella has no input on what the payment will be,” he added.
Garrison, who keeps a log of every contact, meeting and conversation he has on his sister’s behalf, maintains Arabella officials refuse to provide him any documentation on why his sister would owe more than $4,700 when he’s made all payments every month.
Medicaid rules contain a cap on assets, $2,000 in Alabama, and Garrison said his sister met all guidelines, including limits of assets during the Medicaid look back period. Otherwise, she would not have been approved.
Along with a representative from the Ombudsman’s office, Garrison met with Arabella administrators earlier this month but says he received no explanation or paperwork to explain the balance.
“I have the legal authority to handle my sister’s affairs, and no one is going to pay a bill when they don’t understand what it’s for,” Garrison said. “It’s like a mechanic saying you owe $5,000 for car repairs and he refuses to tell you what the cost is for.
“I’m able to help my sister and shouldn’t be having these problems with Arabella refusing to explain an invoice. There are 49 other residents there who might not have anyone to speak for them. If they’ll do this to my sister, what will they do to other residents who don’t have someone to speak up for them?,” he added.
The suggestion his sister would be evicted after Garrison has documentation showing he’s made every payment on her behalf does not sit well with the Army veteran. And he reached out to Rep. Robert Aderholt’s office for assistance.
“To say if these supposedly delinquent payments aren’t paid they will start the 30-day eviction process makes no sense. Congressman Aderholt wrote a letter on my sister’s behalf to Arabella,” Garrison said.
Late last week, Aderholt contacted Garrison to say he received billing documents related to Garrison’s sister that showed the balance owed to be $2829.80. Aderholt’s letter to Garrison said the charges were not set by Arabella and had been confirmed by the federal government agencies involved as being authorized. As a result, Aderholt said there was nothing further his office could do to dispute them.
Garrison said Arabella is now attempting to set up a direct deposit to directly receive his sister’s Social Security check. Yet there has been no explanation to him of where the charges come from.
Regardless of what amount is actually owed, Garrison said his sister is indigent, otherwise she would not have approved for Medicaid. And he questions why the billing explanation has never been provided by Arabella to him as her attorney-in-fact.
“If Mr. Walls has these documents from Medicaid stating how much Arabella Health and Wellness of Russellville can charge, why isn't he providing them to me so that I can substantiate Mr. Walls’ claims?,” Garrison said.
“What part of my sister's Personal Needs Allowance of $29.00 (per month) does Arabella Health and Wellness of Russellville Alabama want?
She is already below the State Medicaid Personal Needs Allowance of $30.00. After paying Arabella each month, my sister is left with $29 to her name. That’s it,” he added.
Garrison has documentation showing Blue Cross Blue Shield paid $27,456.07 for his sister’s care last year before she become Medicaid eligible. Garrison said he has billing statements from Arabella that conflict with what the company provided to Aderholt’s office.
Garrison says a total of $49,525.74 was paid on his sister's account from September 2023 through January 2024. Documents sent by Arabella to Aderholt's office show a total of $28,597.80 for that same time period, Garrison said.
And as her attorney-in-fact, he’s repeatedly requested an itemized billing and an explanation of why Arabella claims his sister still owes more than $2,800. At a minimum, Garrison says there has been a lack of communication from Arabella.
“If it’s a charge she really owes, I’ll find a way to try and pay it. But they won’t explain it and won’t show any billing paperwork. How would they expect anyone to pay in that situation?,” Garrison said.
