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 make jewelry at home, so my work is selling a few pieces of jewelry each month as self-employment. There is no minimum income rules. 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.

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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