Friday he stood with Stephenson outside her late mother's small white house, overlooking a crumbling one-lane road outside Crab Orchard. The house was built by her father's hands in 1961 and now has a leaky roof, fallen ceilings and rotted floors. A horse grazed nearby on about four acres of adjacent bluff land not really suited for much else.
According to the letter, Stephenson has 30 days to determine if the property warrants an exclusion. She has pointed the property's shortcomings all of this out to Gambrel in hopes he can juggle the numbers to save her childhood home. Last year, it was valued at $18,000, nearly twice the exempt limit.
"I'll work on some numbers and I'll give you a call," said Gambrel after his inspection, but he grimaced on the drive back to town and shook his head.
This would be a tough case.
"I was really worried about the four acres. I really was," he said. Even a bad acre of land in the county is worth at least $1,000.
This is an ongoing struggle for Gambrel's office. Since this summer he has received a half-dozen calls from citizens asking him to reassess the value of their property in order to be exempt from a sale for Medicaid bills.
"It's just not right. It's not a position we should be put in," Gambrel said.
State officials have different view
But this is all perfectly legal, mandated by the federal government in fact, and should have no bearing on PVA's duties, Frankfort officials said.
"We're required by law to recover that money," said Zach Ramsey, a state Medicaid official whose signature is on the bottom of the letter received by Stephenson.
Ramsey strongly disagreed that PVAs were unjustly forced into a difficult position by having to appraise such property. The idea that it is all Medicaid's fault is "absolutely and completely a false statement," he said. "They're reacting to pressure on their shoulders from the community," and pointing their fingers at the state.
"I don't really know how that becomes Medicaid's problem," he added.
Ramsey recommended PVA officials "do your duty under the law, and we defer to it," but not be influenced by taxpayers standing to lose family land. In fact, those who sign up for Medicaid are made aware of the recovery process during their registration, he said.
"We're required by law to recover that money, and to me it's just that simple."
But it's not that simple for Gambrel, nor the other 119 PVAs in Kentucky.
"We're the person in the middle. We've got the regulation department that regulates us. We've got the taxpayers that elect us," said Gambrel. "If there's any gray area (in an appraisal) I'm going to give the benefit of the doubt to the taxpayers."
Not looking forward to not being able to save a house
Nevertheless, he said he's worried the day will come when no amount of number-crunching can save a house from a Medicaid sale, and he's not looking forward to it.
"It's going to get to the point where I have to say that, there's no way I can justify saying this property is not worth $10,000.... I just can't do that. I'm sworn to do my job."
That day might have come for Stephenson, but she hopes her sons will have more options when it comes to caring for her in the future.
"If they can't help the people who were in the shape (her mom) was in, without coming back and making the family pay, that's sad ... She had to be on it. There was no other choice." Stephenson said. "Somehow there needs to be something, I don't know what, but there's got to be some way to take care of the older people."
Gambrel agreed, though he said there is more at stake than just Stephenson's family home.
"What about the people who aren't sick now, but will be next year? Medicaid is simply just trying to recoup their losses. It's not Medicaid's fault..."
But the system is still broken, he added, and it's the tax payers who will continue to suffer from it.
"This is not a problem that's going to go away... I don't know what the answer is."