Know Your Resources: How Congressional Caseworkers Can Help You Obtain Insurance Coverage for New Therapies

Your elected officials who represent you in Washington, D.C. have caseworkers in their regional and district offices in your communities. These caseworkers can help you work with and better understand government programs, like Medicaid, Medicare, TRICARE, and Social Security.

Caseworkers, also sometimes called constituent services representatives, are in the local community offices of federal elected officials specifically to help constituents navigate requests or problems relating to federal agencies and programs. The use of their services is free and available to anyone who lives in the elected official’s state (for U.S. Senators) and in the district (for U.S. House Representatives).

Individuals and families affected by SMA can use these caseworkers to help with public insurance denials or delays relating to any aspect of treatment and care. This includes coverage decisions for Spinraza.

How can a Congressional caseworker help?

  • Inform you of access to care, providers, and services in your area and around your state as well as the eligibility requirements and enrollment processes for insurance coverage provided by Medicare and Medicaid and the eligibility for Veterans benefits and Social Security Disability Insurance. 
  • Direct you to the appropriate persons within federal agencies who can help provide additional answers for your request or appeals. 
  • Serve as an advocate on your behalf to appeal adverse decisions made by Medicare, Medicaid, TRICARE, Social Security, and the Veterans Administration.

How do I access these resources?

  • Look up your Representative or Senators or call (202) 224-3121 to find who represents you in Washington, D.C. 
  • Call the Washington office or appropriate local office and briefly indicate your request for a caseworker and the specific issue that requires their assistance. 
  • Representatives’ offices can sometimes respond more quickly to casework requests than Senators’ offices due to the smaller population served, as they serve a district while Senators’ offices serve the entire state. 
  • Caseworkers may require you to submit materials to assist them with your request. Electronic communication is ideal as mail takes 2-3 weeks to reach offices due to security screenings. 
  • Offices may also ask you to complete a release form so they can work on your behalf.

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