Before you hire anybody, find out who pays.
Ninth Street Social Work does the half of social work that is not therapy: benefits, care coordination, discharge follow through, placement and guardianship questions, school and court paperwork. Below is the route we walk with every caller, in the order we walk it. Four of the eight stops end with you not needing us.
Read this first
This page is a design mockup. Ninth Street Social Work is an invented practice. It does not exist, there is no office at the address in the footer, the telephone number is a placeholder, and no person described or implied anywhere on this page holds a social work licence or any other licence.
Every description here of Medicare, Medicaid, MO HealthNet, Medicare Advantage plans, county developmental disability board levy funding, school district obligations, discharge timelines, waiting periods, application processing times, fees and sliding scale figures is an illustration written to carry the shape of a page. The figures are invented and are presented as illustrations, not as rules. Nothing on this page is benefits advice, legal advice or medical advice. Nothing on it is a statement of federal law, of Missouri law, or of what any particular plan, agency or district covers.
The people who can give you a real answer are your own plan, the Missouri Family Support Division, your county developmental disability board, your school district, the discharge planner at the hospital you are standing in, a licensed attorney, and a licensed clinician. Ask them. Do not rely on this page for anything.
The route, on one screen
Eight questions, in this order, because the order is the work. You cannot know whether the county board matters until you know what the disability is, and you cannot know whether the discharge clock matters until you know the date. Marked stops are the ones where the honest answer is that you do not need to hire anyone.
- Is anyone in a hospital or rehabilitation bed right now?You can stop here
- Is there Medicare?
- Is it Original Medicare, or a Medicare Advantage plan?
- Is there MO HealthNet, or could there be?You can stop here
- Is this a developmental disability, and is there a county board?You can stop here
- Is a school district involved?You can stop here
- Is there a court order, a guardianship or a conservatorship?
- None of the above, so it is private pay.
Is anyone in a hospital or rehabilitation bed right now?
What this route pays for
Discharge planning is already inside what the stay pays for. Hospitals and skilled nursing facilities have planners and case managers who can arrange home health, equipment and a transfer, at no extra charge to the family.
What it does not pay for
Anything after the discharge date. That job ends when the bed empties. The follow through at home, the appeal, and the second placement when the first one does not hold are all outside it.
How long the paperwork actually takes
Days, and that is the problem. In this illustration a stay is reviewed every few days and notice can arrive with a day or two of warning, on a Friday.
What you can do this week without us
Ask at the nurses' station for the discharge planner by name and write it down. Ask for the planned discharge date and the written notice of your appeal rights. Both are free and both are yours.
If there is a bed and a planner assigned, you do not need us this week. Call the week before the bed empties, not the week after.
If nobody is in a bed, keep going to stop 2.
Is there Medicare?
What this route pays for
Medical care. Doctors, hospital stays, a limited course of skilled nursing after a qualifying stay, home health when a clinician certifies it, hospice, and medical social work delivered inside those episodes by that agency's own staff.
What it does not pay for
The work this practice does. An outside care manager, a placement search, someone sitting beside you at a hearing, custodial care and long term help at home are not Medicare benefits.
How long the paperwork actually takes
No application, if the person is enrolled already. The delay is the certification: getting a physician to order home health takes, in this illustration, three days to three weeks of telephone calls, most of them yours.
What you can do this week without us
Get the Medicare number, the effective dates and whether Part B is active, on one sheet of paper. Everything downstream asks for those three, and much of the delay blamed on agencies is a card nobody could find.
Either way, keep going to stop 3, because the kind of Medicare changes the answer more than the presence of it does.
Is it Original Medicare, or a Medicare Advantage plan?
What this route pays for
An Advantage plan covers at least what Original Medicare covers, and may add supplemental benefits on top. Some plans here have paid for things adjacent to this work: care manager hours, rides, meals after a discharge, a grab bar.
What it does not pay for
Anything out of network without prior authorization. Supplemental benefits are not standard between plans, so two neighbours get two answers to the same question, which is why nobody at the hospital can tell you what yours covers.
How long the paperwork actually takes
In this illustration a prior authorization runs from a few business days to about two weeks, and a denial with an appeal on top runs longer. Then the discharge date lands in the middle of it.
What you can do this week without us
Turn the plan card over and call member services. Ask one question: does my plan have a supplemental benefit for care management, and does it need prior authorization. Write down the date, the time and who answered.
If there is no Medicare at all, or if Medicare is not going to be enough, go to stop 4.
Is there MO HealthNet, or could there be?
What this route pays for
MO HealthNet is Missouri's Medicaid programme. For people who qualify it is the only route here that pays for long term help rather than medical episodes: in home services, personal care, nursing facility care.
What it does not pay for
A private social worker the family picked. Where case management comes with a programme it is delivered by the agency that programme assigns. If you qualify you get a coordinator, and it will not be us.
How long the paperwork actually takes
The number nobody says out loud. In this illustration a plain application runs about six weeks, one with an asset question or a look back at transfers runs several months, and an assessment sits on top. Families pay privately through the whole wait.
What you can do this week without us
Gather the documents, because most rejections are missing paper rather than real ineligibility: bank statements, the deed, life insurance policies, and any transfer of money or property in the last five years.
The application is free and you can file it yourself, online or on paper, through the Missouri Family Support Division. Nobody has to be paid to submit it. File it, and call us if it is denied.
If this is a developmental or intellectual disability, go to stop 5. Otherwise skip ahead to stop 7.
Is this a developmental disability, and is there a county board?
What this route pays for
Missouri counties may levy a local property tax for services to residents with developmental disabilities, run by a county board. Where a board exists it typically funds service coordination and fills gaps no other payer touches: equipment, respite hours, a deposit, a ramp.
What it does not pay for
Anybody outside the county, and anything the board has not budgeted this year. Board money is local and finite, spent by a public body in public meetings. It is not an entitlement the way Medicaid is.
How long the paperwork actually takes
In this illustration intake and eligibility run about four to ten weeks, and a funding request then waits for a board meeting on the board's calendar rather than yours.
What you can do this week without us
Telephone the county board and ask for intake. Ask two things: whether the county has a levy at all, and whether service coordination is provided at no charge to the family.
If the board takes the case you have a coordinator, and you do not need us for that work. We are useful only on the parts a board does not touch: the estate, the school, the court, and the sibling who disagrees.
Keep going to stop 6.
Is a school district involved?
What this route pays for
If the person is a student the district carries obligations no other payer here carries. Evaluation, the plan meeting and the services written into the plan are the district's responsibility, at no cost to the family. Planning toward adult life is part of it.
What it does not pay for
Anything outside school. The duty stops at the school day and the school year. It does not reach a guardianship, an adult placement, a residential decision, or the summer.
How long the paperwork actually takes
In this illustration a written request starts a clock measured in weeks, and the meeting follows the evaluation. The delay families actually hit is the six weeks it took to put the request in writing.
What you can do this week without us
Put the request in writing and date it. An email counts. A conversation in a hallway starts nothing, and a dated email is the cheapest leverage on this page.
You do not need to pay anyone to write that email, and you do not need us in the room to get the meeting. Bring us in only if the plan on paper and the day your child actually has stop matching.
Keep going to stop 7.
Is there a court order, a guardianship or a conservatorship?
What this route pays for
Nothing. A court order is an instruction, not a payer. It changes who is allowed to sign, which is often the real obstacle: the facility will not release the record, the bank will not discuss the account, the plan will not speak to the daughter doing all the work.
What it does not pay for
Any of it. Filing fees, the attorney, the physician's statement the court asks for and the guardian's own time come out of pocket unless the court appoints and pays counsel.
How long the paperwork actually takes
In this illustration a petition is measured in months from filing to hearing. An emergency appointment is a separate, shorter track with a much higher bar, and it is not a way around the ordinary wait.
What you can do this week without us
Before filing anything, find out whether a durable power of attorney already exists. A signed one nobody ever used will often do in an afternoon, for nothing, what a guardianship takes months to do. Families file without looking in the drawer.
Guardianship is a legal matter, so hire a lawyer rather than a social worker. We are useful beside one and never instead of one. Keep going to stop 8.
None of the above, so it is private pay.
What this route pays for
Us. Our hours, at our rates, billed to the family. If you walked the seven stops above and none fit, this is the route you are on, and nothing here changes that.
What it does not pay for
Itself. Private money is not reimbursed later by anybody. Where a public programme looks likely, the honest advice is to spend as little privately as possible while the application is pending, and we say that on the first call.
How long the paperwork actually takes
None at all. That is the only real advantage this route has over the seven above it, and it is why people take it when they should not.
What you can do this week without us
Ask for a written estimate of hours before agreeing to anything, and ask the same of every other care manager you call. Anyone who will not put an hour estimate in writing has told you something for free.
The rates below are the ones this route uses, and they are illustrations. See what the sliding scale actually means.
What the sliding scale actually means
Every figure in this table is invented for a design mockup. It is not a price list, it is not an offer, and no practice is bound by it. It is here because a page about who pays that does not state its own number is dodging the same question it asks everybody else.
| Household income | Illustrative rate | Notes |
|---|---|---|
| Under $30,000 | No charge | Up to six hours in a year in this illustration, then the next band applies. |
| $30,000 to $50,000 | $35 an hour | Billed in quarter hours, including telephone time. |
| $50,000 to $80,000 | $70 an hour | Billed in quarter hours, including telephone time. |
| Above $80,000 | $125 an hour | The full rate. Most private pay callers land here. |
| First call, any income | No charge | Thirty minutes, which is usually enough to tell you which of the eight stops you are on. |
And what it does not mean
A sliding scale is not a payment plan, and reduced does not mean deferred. It is not applied backwards to work already done. It does not cover travel outside the Northland or time spent waiting at a courthouse, which in this illustration are billed at the full rate to everybody. And it is set from household income, which means somebody has to say a number out loud on the first call.
If someone is in danger right now
This practice does not provide crisis or emergency response. The telephone is answered on weekdays during office hours by one person, and it is not a substitute for emergency services at any hour.
The 988 Suicide and Crisis Lifeline is free, confidential, and answered twenty four hours a day, every day, by call or by text. For a medical emergency, or if someone is in immediate physical danger, call 911.