He is a first generation American. He is a grandson with the the skills to research the information needed for the sharp pointy pen let-me-make-it-clear-I-am-so-on-to-your-bullshit letter.
His parents came to America and brought their parents from ex-Soviet Ukraine in the refugee migration of the 1990s which brought artists, doctors, lawyers, engineers, professors and accountants to the collective brain power and labor force of America. His parents brought their parents who were also the intelligentsia class, but because of age, the older generation didn’t integrate into the professional American fabric. The oldest generation who came and settled in far out Brooklyn, far north the Bronx, Rego Park and Inwood as part of this mass migration came to work in the job description of grandparents for their first generation American grandchildren. Emigrating in your 60s or 70s isn’t easy and wasn’t necessarily their choice. They became grandparents of Americans because their children offered them the choice, come to America with us or grow old alone in a post-Soviet country.
I briefly took care of Grandson One’s mother’s mother who had been a physician. Then I joined the problem solving team for Grandson One’s father’s mother a year or so later. I already knew how he advocated for grandmothers.
The famously successful letter he wrote is below. I think it is self-explanatory to the situation we found ourselves in for her home care needs. It really doesn’t matter what her medical conditions are. She can’t be alone. She either can’t do for herself or needs to be cued to do the things she is still able to do with oversight. Leaving her alone for any part of a circadian cycle could result in harm to her or even to her neighbors if she caused a kitchen fire. I was given permission to publish the redacted version of this letter so that others could use it as a template because this letter achieved the intended end, his grandmother was approved for split shift care, one home health aide for the day and another who is paid to be awake at night. This arrangement for care is now difficult to get from a Medicaid home care provider because it is more costly for the home care agency and the the Managed Long Term Care insurance company. Spending revenue on the intended recipient leaves less for greedy bastard’s Wall Street range salaries. Grandson One brought the CEO of New York State plan Senior Whole Health owned by Fortune 500 Molina Healthcare Inc. to his knees and quite abruptly. There was no first rebuttal followed by slow capitulation in response to the letter. Mr CEO just appropriately caved. Of note, I was told that Mr CEO threw the nursing and utilization management staff under the bus. Mr CEO said it was all just a big mistake. His underlings were wrong not to approve the request for two 12 hour shifts of a home health aide. No no no, Senior Whole Health doesn’t condone denying Medicaid beneficiaries the home care hours that they need. Don’t be silly, Senior Whole Health doesn’t pay midlevel nurses to perform the daily task of denying members the homecare hours that they need (personal reply: oh yes they do). This whole thing was an aberration, a big boo boo. They don’t have employees trained to look sons and grandsons in the eye and say, “she only needs 12 hours or a family member should sleep in her apartment and take care of her overnight. The fact that you all have to work during the day or don’t live nearby is irrelevant.” (personal reply: oh yes they do). Whoever said that is a rouge nurse-employee. No, its not our corporate culture to $kimp on homecare hour$. “Look over there” said Mr CEO pointing, “that mid level manager under the bus did the wrong thing.” I heard say that Mr CEO told the grandson all of this and as I was hearing it said, I was rolling on the floor laughing because all MLTCs do this so frequently and often that I tell daughters and grandsons to expect it. Mr CEO knows that Grandson One has only his personal experience, but he doesn’t know that grandma’s doctor sees this every day. I know they all try to save state-administered federal revenue to support their own salaries instead of using the tax dollars revenue for the cost of home health aides to help the legitimate beneficiary, his paternal grandmother. And that’s why I am sharing this sharp pointed pen letter which caused Mr CEO to immediately take notice. Its a template what works.
Hello Ryan [CEO] and Holly [COO],
My name is Dr.***** ******** . I am a New York-based physician and the grandson of two longtime Senior Whole Health members, I am contacting you directly due to Senior Whole Health’s ongoing failure to fulfill its medical obligations to my grandparents. Despite multiple attempts, I have been unable to reach anyone other than their recently-reassigned Case Manager, Kelly Pascarella (in copy).
My immediate priority is ensuring appropriate and safe care for my grandmother, ****, following the passing of my grandfather, yesterday. Of note, ****** died after two weeks in home hospice, while waiting for SWH to permit escalation of his care (6 hours per day while fully bedbound and dependent in all ADLs).
Immediate Action Required:
Senior Whole Health must authorize and implement continuous, 24-hour split-shift home care for **** by EOD, Wednesday, July 16. **** is 92 and suffers from advanced dementia and severe medical instability, posing well-documented safety risks, including falls, skin infections, and potential fires due to unattended stove use. Her medical team has extensively documented these risks, underscoring the urgency of immediate intervention. While SWH has taken months to consider, then deny, any increases in her support, SWH reduced her effective support to 5 hours per day with remarkable efficiency (within hours of my grandfather’s passing) and now refuses to provide even interim respite care.
Patient and Family Background:
**** and ******—Holocaust survivors and longstanding SWH members—have consistently received inadequate and unsafe home care. SWH has alternately combined their care hours or individually reduced hours during hospitalizations, resulting in care plans that fail Medicaid and New York State DOH standards. Following ******’s death yesterday—bedridden and without adequate medical support— ****’s home support has been more than halved, compounding her significant safety and health risks. This ongoing administrative neglect has placed extraordinary burdens on my family, with my father providing constant, uncompensated care (while working full-time), and months spent personally navigating SWH’s deliberately obstructive bureaucracy.
Senior Whole Health’s Role:
SWH’s handling of my grandparents’ care clearly violates regulatory and contractual standards under Medicaid, Medicare, and New York State Department of Health guidelines. Specifically:
• Denying care based on inaccurate or incomplete medical assessments breaches SWH’s legal duty for accurate patient evaluation
• Approving demonstrably impractical or insufficient care plans violates regulatory mandates for medically appropriate and safe patient care
• Intentionally delaying essential care through unnecessary appeals (that do not change initial outcomes) contravenes Medicaid guidelines requiring timely provision of medically necessary services
• Defending these callous violations of patients rights and administrative standards by ensuring nil transparency and accountability -- in direct violation of state and federal regulations
• These documented systemic practices, explicitly demonstrated in the care of my grandparents, open SWH to substantial risk of class-action litigation, civil actions, and regulatory action
Broader Context:
As per the Wall Street Journal’s coverage last week, SWH’s parent company clearly faces mounting pressure to manage costs. However, this company will not be doing so at the expense of my only remaining grandparent’s health, safety, or human dignity.
Consequences of Inaction (Deadline: Wednesday, July 16, EOD):
Failure to address this matter immediately will result in:
• Outreach to investigative journalists at major media outlets, including but not limited to: The New York Times (Sarah Kliff), Wall Street Journal (Anna Wilde Mathews), and The Washington Post (Amy Goldstein).
• Engagement of legal counsel to initiate class-action litigation (refer to Bucceri v. Zucker, NY, (2016) and pursue civil legal remedies.
• Contacting state and federal regulators, including the New York State DOH, CMS, and the Office of the Medicaid Inspector General, to formally report SWH’s violations and request investigation into its practices, especially with vulnerable populations.
Ensuring immediate, appropriate care for **** is my sole priority. Please confirm your commitment and detailed action plan by the stated deadline.
I am reachable directly at *** ***-**** .
Regards,
Grandson One, MD, PhD
I want to point out a few important “I see what he did here” aspects of this successful letter.
He blocked, bolded and bulleted.
His letter is addressed to Ryan and Holly. He addressed the CEO by his first name. This caused me to gasp because even I don’t do that in my call-them-what-they-are letters, but I do think it was brilliant. Respect is earned. I guess Ryan, just some dude on the basketball court or the guy in the aisle seat on the long-distance bus, is not worthy of an honorific. Ryan, now you know, its real people with real articulate grandsons who are on to your bullshit.
He succinctly told a very personal story to let them know that grandma is more than her member number. I can not imagine how difficult it was to write this letter the day after his grandfather died. Ryan and Holly are very far removed from the lives of those impacted by their decisions.
He background checked publicly available information on the organization. He searched for legal claims against Senior Whole Health which is an insurance company who provides homecare from revenue that is our tax dollars while being a branch of a Fortune 500 company. Senior Whole Health is a government contractor. We all have the right to critique or criticize them for how they spend tax dollars and the quality of the care that results from that spending.
He gave them a deadline and concluded with the deadline.
He invited them to think how visits from government regulators, letters from lawyers and more publicity would feel.
He threatened Senior Whole Health with exposure by journalism. Remember they are a federal-state government contractor. We are owed transparency.
Senior Whole Health is owned by Molina Healthcare, Inc., a Fortune 500 company. It operates as a subsidiary providing government-funded healthcare (Medicare and Medicaid) to seniors in Massachusetts and New York. Notably, Senior Whole Health is transitioning to operate under the Molina Healthcare brand name effective January 1, 2026.
Oops. Maybe The Senior Care Industrial Complex government dollars sector isn’t so good for shareholders. Maybe Molina and Senior Whole Health can only cheat their members so far while buffing their not publicly available salaries. Why is our federal government giving our money to Wall Street to then decide who among the legitimate beneficiaries gets what? How does Wall Street know how best to provide home care?
Oh my I am in a third connection relationship to Mr CEO.
The CEO of Molina Health’s Senior Whole Health MLTC plan in New York State is salesman and that explains why he is no match for Grandson One.
Thanks for how you presented and described this: who the individuals are and what happened (probably as a result of corporate greed), with its attendant human costs; the letter; and your comments on the situation and his letter.