Was Medicaid falsely terminated? Should we appeal this decision?

Your father has a social worker at dialysis. I suggest asking her as this is part of her job responsibilities & will gladly help you.

All dialysis centers must have a MSW on staff to assist patients with obtaining/keeping insurance. 

His income on SSDI may take him over Medicaid eligibility but speak with the social worker. I have seen many dialysis patients as having both Medicare & Medicaid. He may be eligible for both.

Good luck!

Well, it sure sounds like an error to me. By all means, appeal the decision. There should be instructions for appeal in the letter that informed you of the termination. The case worker may be overwhelmed (especially if a lot of erroneous terminations went out), but a formal appeal must be reviewed promptly. Do that.

Talking to the social worker at dialysis as Shane suggests is also a wonderful idea. Maybe he or she can help you with the appeal.

Come back and let us know how this works out. We care!

Is the $1220 net after Medicare premium? The monthly income limit in New Mexico is $1316.67 or $15,800 per year for household of 1. The federal Medicare premium is usually between $109 and $134 per month. It’s possible his income if Medicare premium is high enough that he is above Medicaid limit. If that is case you might be able to set up a QIT qualified income trust in New Mexico where the excess money goes into trust, brings your income below Medicaid level, and voila! Look at the gross income on Dad’s stub for disability to see if it exceeds the monthly amounts. If no one will help you, find a Medicaid and disability lawyer that can. Still cheaper than all healthcare out of pocket.

Definitely go in person to talk to Medicaid worker, taking all the documentation you can so that the situation is clear to them. You should certainly be entitled to know what is the basis of their decision and also what alternatives they can suggest. They can be incredibly helpful, but in-person is better than phone.

Ok, here is the explanation. Medicare Savings Programs (MSP) are based on being within certain resource and income limits. Qualified Medicare Beneficiary (QMB) is for the lowest income, and the next level is SLIMB. That will have the state pay his Medicare premium and he gets his full SSDI check. (By the way, if the money from Social Security comes on the first it is SSI and if the disability check comes another day it is SSDI.)
Next step is to decide how you want to cover what Medicare doesn't cover. This is where Medicare Supplement or Medicare Advantage plans that you buy in the public market place comes in. Or you may get help from charities that help with costs for people with certain types of illnesses. And here is where additional aid from the state Medicaid program comes in. So whatever the program is called in your state, you have a cost sharing responsibility which might be called cost sharing or spend down or something else. This means that if qualified based on resources you will have a certain amount you have to pay...or at least owe...in a 3 or 6 month period before the state picks up the rest for you. Example: income of 1220 per month, less 20 (it's just the rule) = 1200 -735 (which is the max in 2017 that a person on SSI gets...it's just the rule) = 465 per month available for medical expenses. Muliply 465 x 6 months =2610 which is your share of your mefical costs. Submit the bills to the state within 30 days of the end of the 6 months and the state will pay the amount over your share of 2610. You renew your eligibility for this every 3-6 months. You decide which is better for you, paying for your Advantage or Supplemental plan, spend down or both. Hopes this helps. I work with eligibility for this program on a daily basis. My state has whole units of people whose job it is to look at people's medical bills when they have qualified for spend down and pay those bills. Oh, and other news...you can ask for three months retroactive coverage when you first apply. So say you were hospitalized in last three months and only had Medicare because you hadn't done anything to cover what Medicare doesn't pay. Now you have a huge bill. Apply for state assistance and if you are considered financially needy part of that retro period bill may also be covered. Just don't delay. Hope this helps.

Hello guestshopadmin! I don’t think Medicare premiums are being taken out of the $1220 because from what we were told he was enrolled into Extra Care program and SLIMB that helps pay those premiums because he is low income?.. BUT not too sure if that is also going to be terminated with Medicaid on nov. 1 now that I think of it! We are in a very confusing situation. Being that he is enrolled into those programs the $1220 would put him under income limit making him eligible for Medicaid am I right? I hope I am not coming off as ungrateful or unappreciative for the benifits he is still receiving because I know there are people who have no coverage at all. I just don’t understand why his Medicaid is being terminated. Like I stated above NO ONE I have spoken with on the phone has been helpful. We did go ahead and reapply for Medicaid Benifits online and will be headed to Medicaid office first thing tomorrow morning to speak with someone face to face. I was under impression that he’d be eligible for dual eligibility but I guess I was completely wrong.

*I’d like to add that I just went back and checked his benifits report and it states that $1220 is before deductions if any apply. Which they don’t because of SLIMB.

Have you asked if he qualifies for the QMB program? That would cover Medicare parts AB premiums and out of pocket. It may be that he’s not qualified for one program and its specific requirements but does qualify for the other. Qualified Medicare beneficiary program.

My mom got a pooled trust to qualify for Medicaid, under similar circumstance, her income being a little too high otherwise but way too low to actually cover her care. My experience is that most people don't know about this pooled trust option-- I found out about it from the Alzheimer's Association. (My mom has memory loss, which is called dementia in medical diagnosis language.) She pays her Medicaid spend down to the trust, and her rent is paid from that, that is how it works.

Your local council on aging may be able to help you investigate a trust -- in my state, NY, we needed a pro bono lawyer to set it up.

Thanks you all! It’s been a long day but after a nice long needed shower I decided that it’s best to remain calm instead of freaking out and panicking. This situation is beyond stressful, especually because my father is so young and going through so much but freaking out isn’t going to make anything better. I will come back on tomorrow and let you all know how things went in person. Please send good vibes!!

Well everyone just left Medicaid office and was informed that there is nothing that can be done. They stated that because he is receiving Medicare and SSDI he does not qualify for full Medicaid. There may be programs to help cover some services such as transportation, prescriptions, etc. but we would have to contact Medicare for all of that! Not sure what to think but I guess we should be grateful that he has the Medicare to cover his treatments and such. *sigh*