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

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Robin Mead

Heidi’s Story

“My Medicaid spend-down was miscalculated three different times. Finally, I filed a complaint and got to speak to a supervisor.

The end result was I saved $3,000 per year on the spend-down, and got my Medicaid backdated by six months. Some Medicaid employees have an imperfect understanding of how to apply different regulations and formulas. You will get a different story depending on who you talk to.” – Heidi C. Johnson

Jill’s Story

The woman on the phone looked up my file and told me there was no way that I was eligible. She was very clear and specific. I applied anyway and got approved.

Aster’s Story

My brother had cancer and needed life-saving treatment. Medicaid told him the only program he qualified for was a Medicaid spend down (share of cost) program that would cost $700 per month. This was almost all his income and would leave him with nothing to live on. Then we discovered that he was only $80 over the income limit to qualify for a different Medicaid program. He bought Medicare supplemental health insurance for $85 per month. Suddenly he was under the limit! He applied for Medicaid and got it! He pays the $85 for his supplemental insurance and all other healthcare costs are covered.

Sweet Pea’s Story

My sister was being charged over $300 per month by medicaid in “spend down expenses.” She is poor and disabled and couldn’t pay this and also pay her rent. She started tutoring a neighbor’s child, and we helped her apply for Medicaid for Working Adults with Disabilities. Now she tutors a few afternoons each week (which she likes doing) and she pays $20 per month for Medicaid. All her medical expenses are covered.

Pansy’s Story

My local Social Services and Medicaid Department were completely clueless about the particular Medicaid program I was applying for. 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. Finally I was approved, and got a $40,000 hospital bill paid.

Carnation’s Story

For three years, I was told by everyone that I was not eligible for Medicaid. No matter how many places I called, and no matter how many people I spoke with, and no matter how desperate I was, no one ever told me about Medicaid waivers.

I couldn’t afford any of my medications, our house was going to be foreclosed on because of medical bills, and my husband was missing more and more work to stay home and take care of me and was about to get fired.

Finally, I learned about Medicaid waivers. The income limit was much higher, they did not count any of my husband’s income, and they didn’t even care that we live in a sucky state where no one gets Medicaid.

After I got approved for a waiver, I was able to get a home aide so my husband could start going back to work. Once I was approved for a waiver, they also gave me Medicaid heath insurance, and it pays for all my doctors, hospitals, prescriptions, vision and dental. The program is no cost to us at all. They also are going to give me wheelchair ramps. Everyone should know about this program.

Your Story

If you get turned down for Medicaid, or if someone from the Medicaid office tells you that you are not eligible, don’t give up hope! Just get scrappy. A few things it might help you to know:

💗 The people who work at Medicaid often tell people that they don’t qualify. It is not always true.

💗 Some people apply and get turned down because there was a mistake made on their case.

💗 Many, many people don’t realize there is more than one Medicaid program. You may not be eligible for one, but you may be eligible for a different one!

💗 Find a program you want to apply for and learn the rules yourself! The rules are different in every state. The people who answer the phones at Medicaid often do not know all the rules. Medicaid policy manuals are usually available online.

💗 Important rule for any program you ever apply for anywhere: Never take no for an answer over the phone or verbally. The worst thing that happens is people get discouraged out of even trying to apply.

💗 If you can find the actual manual and rules and regulation that your state has, then if you are denied, you can find out why. If you find that you should be eligible, you can appeal. Look online to find the regs.

💗 If you discover that Medicaid is not following the regs, you can also contact your congressional rep. They can help get this corrected.

💗 Medicaid can back bill for 3 months before the time of application. So, if you have a big hospital bill in January, and then apply for Medicaid in February, when your application is approved, the hospital can bill Medicaid.

💗  If you get turned down, try contacting disability rights organizations. In some states, they offer legal assistance to help people with Medicaid appeals. You can also appeal on your own.

What to Say When Someone Tells You “No” or “Not Possible” or “You Don’t Qualify”

💗 There are a few magic sentences you can say that can turn a No into a Yes!

💗 Also try these tips for: How to Have a Good, Helpful, Pleasant, Reasonably Successful Phone Call With a Social Service Agency

💗 Don’t forget the Golden Rule The Golden Rule: Never Take No for an Answer Over the Phone

Be Like Pansy

Pansy was told she couldn’t get Medicaid. But she was courageous and smart and persistent and…. She researched and found a Medicaid program she would qualify for. In the end, not only did she get on Medicaid but she also avoided a $40,000 hospital bill. Pansy was kind enough to share her story to help others. How Pansy Got on Medicaid (Including the letter she sent that got her approved!)

Troubleshoot

Are you having one of these problems?

💗  “My spouse makes too much money”

💗  “Someone else I live with makes too much money.”

💗 “My parents have too much money”

💗  “I have a too much income.”

💗  “I was approved but the Spend Down is really expensive”

💗  “I have too much savings or I might get an inheritance”

💗  “Child support is making my child not eligible”

💗  “Medicaid said I’m not disabled or not medically eligible”

 

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