“I Applied for Medicaid and Something Went Wrong”

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Artwork: Robin Mead

What went wrong?

“Someone I live with makes too much money.”

Don’t list weird people on your Medicaid application. List yourself and your minor children. List your spouse if you are not legally separated. Don’t put down other people just because you live with them!! In most cases, you do not want to list your housemate, friend, landlord, aunt, sister, brother, or other random people who live with you. Here’s a list of who to include and who not to include. If you did list these people and got turned down…. apply again!

“My parents have too much money”

If you are an adult and you live with your parents, check your states Medicaid rules about dependents. If your parents do not list you as a dependent on their taxes, you may be able to apply for Medicaid without them. Their income will not be considered.

For children who are minors, many Medicaid Waiver programs do not count parental income.

“My spouse makes too much money”

See this page on How to Get Medicaid if Your Spouse Makes Moolah

“I have a little too much income.” 

Check how close you are – If you are just a little over the income limit, you may be able purchase some supplemental insurance, or incur another medical expense and bring your countable income down. See Aster’s story below.

If you are applying for MAGI medicaid, they will only count your adjusted gross income. You can check to see if there is any way to lower your adjusted gross income. Check IRS regulations for adjusted gross income. For example, certain kinds of contributions to retirement plans won’t count. If you operate a small business, many business expenses won’t count.

“That won’t work. I still have too much income.”

In some states, you may be able to qualify by setting up a trust. Research Qualifying Income Trusts, Qualified Income Trusts, or Miller Trusts.

“I have too many assets or too much money.”

You may be able to spend your money in allowable ways and then apply for Medicaid, or put your money in a trust. For example, you are allowed to purchase a house or pay the mortgage if you live in the house. This is a list of how to qualify for SSI if you have too much money. Many of the things on this list apply to both SSI and Medicaid. Please confirm the rules in your state.

“I have too much money or I will someday and I’m confused”

You can consult with a medicaid planner. Medicaid planners can be free services at nonprofit agencies, or they can be paid services through an estate planning lawyer who specializes in medicaid.

“I was approved but the Spend Down or Share of Cost is really expensive” 

Here’s how Aster’s family handled this:

“My brother had cancer and needed life-saving treatment. Medicaid told him the only program he qualified for was a Medicaid spend down program that would cost $300 per month. Then we discovered that he was only $30 over the income limit to qualify for a different Medicaid program. He bought Medicare supplemental health insurance for $30 per month. Suddenly he was under the limit! He applied for Medicaid and got it! He pays the $30 for his supplemental insurance and all other healthcare costs are covered.” – Aster

This page is for California, but the information here will apply to most states: How to Avoid Share of Cost for Medi-cal and IHSS

“Medicaid said I am not disabled.”

Check to see if you live in a state that expanded Medicaid. If your state did expand Medicaid, check the rules in your state. You may be able to apply again, and this time do not apply for Medicaid for people with disabilities. When you apply, they will ask if you are disabled. In many states, you are not legally considered disabled if you have not been approved for disability. This is good! If they will allow you to apply for regular Medicaid, and not apply for Medicaid for people with disabilities, it may be much easier for you.

“I got cut off Medicaid when I was approved for disability.”

You still may have a lot of options. Check out the section on Medicaid for People On SSDI on ths page: Different Medicaid Programs

“I applied for a Medicaid home aide, but they said I am not medically eligible.”

If you qualified financially but not medically, there are a few possibilities: 1) You don’t have enough needs to qualify for this program. These programs are only for people with very high needs. 2) You do have high needs, but this is not what your doctor wrote on the form. Make 100% sure your doctor knows everything and fully supports you. Then apply again and if at all possible, sit right there with your doctor while she fills out the form. 3) You do have high needs but you did not fully explain all your needs during the Medicaid interview. Learn more about how this program works and you can apply again.

“I looked up the rules and I have too much money” 

There are many different Medicaid programs. If you don’t qualify for one, you might qualify for another! Make sure to check out this list of Different Medicaid Programs. Also worth noting: Some prescription assistance programs are available to people who are not low income: Help Paying for Meds

“My state didn’t expand Medicaid. No one can get on.” 

There are people on Medicaid in every state in America. Once again, check out this list of Different Medicaid Programs

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

Please consult with a Medicaid planner or Medicaid estate attorney. They can help you protect your life savings and make sure you do not become impoverished by establishing a trust. This is especially important if you think you may need a nursing home, or care in your own home (now or in the next five years). If you cannot afford a medicaid planner, you can check to see if there are any nonprofits that can assist you. Try contacting your local Area Agency on Aging (even if you are young) or Aging and Disability Resource Center.

 “Someone at Medicaid told me I don’t qualify”

Don’t take no for an answer. Never, ever let someone discourage you from applying. No matter who you talk to and no matter what they say. Learn the rules yourself and make sure you get everything in writing. See below for details.

“I applied years ago and got turned down”

If you applied for Medicaid many years ago and got turned down, try again now. The laws have changed a lot in recent years, and are continuing to change constantly.

“I believe I should qualify but I got turned down” 

If you tried the above things are are still getting turned down, check to make sure you are under the income limit for the program you are applying for. If you are, appeal and keep appealing! You can do it on your own, you do not need a lawyer, but in some cases, your states disability rights organization, or your local legal aide nonprofit may be able to help.

“Child support is making my child not eligible” 

If you have a child with disabilities and you are are going through a divorce or collecting child support or paying child support, please consult with a Medicaid Planning Attorney. Child support can take away your child’s Medicaid, SSI and other benefits. There are solutions for this problem by paying support through a trust.

“Child support is making my adult child not eligible” 

Same deal.

DON’T TAKE NO FOR AN ANSWER

🍁  If you got turned down for Medicaid, even though you think you meet the requirements, appeal the medicaid decision. They do make mistakes sometimes.

🍁 The people who work at Medicaid do not always know all the policies, and sometimes you can to learn the policies yourself and educate them. Look online to find Medicaid policy manuals. Or call the office and ask how you can find the policy manuals online.

🍁 Double check. The income limits are completely different for different Medicaid programs. Make sure you are being told the correct limits for the program you are actually applying for. Ask to see the policy it IN WRITING.

🍁 Here’s a few magic sentences that sometimes turn a no into a yes. How to Respond When You Are Told You Can’t Get Medicaid

🍁  Never take no for an answer over the phone or in person. People are told weird, discouraging things all the time. Let them turn you down IN WRITING. Many of our readers were told they would not be eligible, then applied anyway, and got approved.

🍁  Check the facts. That’s what Heidi did: “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.

🍁  If you run into problems, try asking to speak to a supervisor. Then try contacting your state Medicaid office, and then your regional Medicaid office. People at higher levels often know more of the rules.

💗 If someone on the phone at Medicaid says no to you, 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

🍁 If all else fails, you can give up on Medicaid and instead try some other ways to find medical care: How to Get to the Doctor When You Can’t Get to the Doctor

💗 In Florida: How to Get Medicaid in Florida

Readers recommend:

In Massachusetts: Programs that help with Medicaid and health insurance:

https://www.hcfama.org/helpline

https://www.healthlawadvocates.org

 

 

 

 

 

 

 

7 thoughts on ““I Applied for Medicaid and Something Went Wrong””

  1. In Massachusetts there are different groups that can help you for free if you were denied. I imagine that other states have similar agencies. The ones I know of in MA are: Health Care for All, Health Law Advocates. I have used Health Care for All multiple times, and they have been AMAZING.

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  2. Thank You so very much for compiling these informative posts. I am paying attention to each one, and incorporating many of the ideas into my daughter’s thick medical notes binders in the hope that she too will be approved for disability.

    Like

  3. this so helpful in reducing the amount of stress I have been under with a huge share of cost and many monthly medical bills. Thank you so much for giving me hope and good information. You are so blessed to bring this positive help to people that are in the dark. You shine a light and lead us out of the darkness.

    Like

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