How Pansy Got on Medicaid By Being Smart, Scrappy & Persistent

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Artwork: Robin Mead

When I was a Social Worker and advocating for my clients, I rarely took no for an answer. Now I do the same thing for myself.

I’ve learned to never take anything anyone from Social Security or Social Services says at face value. A Social Service caseworker once told me in confidence that they are supposed to find ways to make people ineligible.

The Problem

My Medicaid was mysteriously cancelled and I was not told for 9 months, including co-pays on a $40,000 hospital bill.

No one at social services could tell me why my Medicaid was cut. They kept telling me that I should never have been eligible in the first place.

The Solution

I researched my state, and learned there was a different Medicaid program I was eligible for.

The program I found is a buy-in program for working adults while disabled. I used to make jewelry, so my work now is selling a few pieces of jewelry each month as self-employment. There is no limit on how little I earn. Each state has different rules.

The Next Problem

It turned out that my local Social Services and Medicaid Department were completely clueless about this particular Medicaid program.

I had to find the actual employee training manual and educate them about it and they still refused to find me eligible. So, I had to take it to the state level.

The Next Solution

I wrote a letter and copied and pasted the parts of the employee manual that would prove I was eligible (See bottom of this page for copy of the letter)

I sent a letter by email to the local office and cc’d the state. I also looked at forms sent by Social Services – they all will include instructions on how to appeal.

I had also attached a PDF of the Medicaid Buy In Manual for Social Services employees. I found it using Google.

I was on the phone and sent multiple emails back and forth for about two weeks and I had to get quite insistent. I just would not take no for an answer. At one point I actually said that I knew I was eligible and was not going to give up until I was approved.

The Happy Ending!

It was worth it. I had a $40,000 hospital stay that was fully paid for. Once I had Medicaid, the hospital could back-bill Medicaid 3 months from the time of application.

Now I pay $90 per month for Medicaid, but Medicaid pays more than $100 per month for my Medicare premium, and also covers the cost of my co-pays.

Persisting is worth it.

Learn More

How to Respond When You Are Told You Can’t Get Medicaid

A List of Different Medicaid Programs You Can Apply For

The Golden Rule: Never Take No for an Answer Over the Phone


Pansy’s Medicaid Letter

I have applied for the Medicaid Buy-in Program for Working Adults with Disabilities. I just got off the phone and had been told that my SSDI amount is too high for me to qualify.

I have attached a PDF document from the Colorado Department of Health Care Policy and Financing that states to qualify, I must have an adjusted income at or below 450% of the Federal Poverty Level. My combined earned and unearned income does not even come close to being over 450%. Page 5, question 16 of the attached document outlines how income eligibility is determined.

I was also told that I was ineligible due to losing eligibility for SSI. It seems from question 39, page 11, that would not make me ineligible. I still have SSDI.

I am disabled, have some earned income from self-employment and my income is not over 450%, so I don’t understand why I do not qualify. I have not received any notice by mail that I have been denied. I have had to call to find out the status of my case. I would like to know the official status of my case, because the time to appeal is dependent on the date I was denied. I have just had major surgery and am unable to drive, much less leave the house.

I would like to appeal this decision, if a decision to deny has been made. I would like to request a State Hearing and a County or Medical Assistance site conference.

Sincerely,

Pansy

 

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