Insurance Agent Forum

[salpro22]

Originally Posted by john_petrowski

If he needs on-going treatment - medication, doctor visits, etc...he'd be ass-out. You have any idea of the paperwork and approval process for Medicaid?

Let's play devil's advocate and say he's on $300 a month of medication and loses his job on the 1st. His bene's run out in 31 days and if he can't afford Cobra there's not a chance in hell he'll be accepted into Medicaid in that time-frame.

By the way, most applicants who qualify for Medicaid are initially declined. It's the little game the gov't plays. Ever read about people applying for social security disability? Good Lord.

And by the way - income is just one factor for Medicaid eligibility.

I recently experienced what it is like to get somebody approved for SS disability and Medicaid with a family members. It took SS a little less tha 1 month to deny the claim, which was a good turn around time, however, a decision for Medicaid is still pending after 3 months. Apparently there are companies out there that have agreements with local hospitals here in MD in which they focus on helping hospitals get more money out of the Medicaid system. Fortunately, MHIP is available as a back-up plan.

[healthagent]

First of all, you have to fill out a detailed statement of assets - and if you have basically any you instantly don't qualify. I think in MD you're not qualified for Medicaid if the individual has more than $2,500 in assets. If you do they allow a "spend down" period of six months. That means you have to exhaust all of your assets until you're basically broke - then six months later they'll review.

There have been many articles exposing Medicaid and social security disablity; as in gov't employees are trained to instantly kick back the first application. There are attornies that specialize in people being denied Medicaid and SSD.

[al3]

I recently experienced what it is like to get somebody approved for SS disability

I went through this with wife about 6 or 7 years ago. She was denied twice and it took 2 years for the decisions to be rendered.

I ran into a friend who told me to hire a government-approved SS lawyer. I checked around and there are many lawyers who specialize in SS cases and their fee is maxed at $5,000 or less depending on the outcome.

So we hired a lawyer. He took all the x-rays and med docs, and other stuff and put in a new application for us. It was denied in about three mojnths. He was pissed and said we need to go to court. Eight months later the administrative law judge issued an 18 page written opinion that blasted the SSA, saying (sort of) "Hey you assholes, this woman qualifies on every one of YOUR conditions. What kind of crap are you trying to pull here? I want her ass on SSI Disability and I'm awarding her 5 years of back benefits."

About 3 months later we got a check from the US Government for $70,000. The award was $75K, but attorney got $5,000 per Federal law.

She also, of course, got Medicare. Unfortunately no one would write her a Med-Sup since she was under 65. (Now we could get one but Blue Shield wants $450 a month for an F and it's not worth it. I put her on Blue Cross Freedom One.... for free!) To be honest, all we really WANTED was Medicare. We could have waited until she was 65 (she is now 60) for the monthly SS check... but it's nice to have. And why not. She worked 40 years (as an RN in surgery.)

So........ if you know anyone who is applying for SSI DI, tell them to hire a lawyer on the government list (it's on the net somewhere) and save yourself several years of beating your head against the bureauracy. I wish I had known back than what I wrote above.

Al

[healthagent]

I only have a third party story - one of my clients trying to get his mother onto Medicaid. Over a year now and just decline after decline. Right now the kids are picking up the medical tabs but everyone's almost tapped out.

[salpro22]

I checked around and there are many lawyers who specialize in SS cases and their fee is maxed at $5,000 or less depending on the outcome.

Do you know if that is the current max on lawyers who specialize in SS? If so, is that paid up front or taken from the proceeds? Thanks.

[al3]

Originally Posted by salpro22

Do you know if that is the current max on lawyers who specialize in SS? If so, is that paid up front or taken from the proceeds? Thanks.

Max as of 2005 was $5300 from award.
For more info see:

http://www.disabilitysecrets.com/dis...ive-index.html

Here are more search results:

http://www.google.com/search?hl=en&q...oogle +Search

Al

[somarco]

you're not qualified for Medicaid if the individual has more than $2,500 in assets. If you do they allow a "spend down" period of six months.

You are referring to Medicaid for nursing home care. The spend down is not limited to 6 months and does not enter the equation when one is applying for Medicaid for other than long term care.

Pregnant women, children & low income individuals & families can qualify for Medicaid to cover their medical bills based solely on income. I have encountered people who had a medical emergency, racked up thousands in bills (no insurance) and were able to get Medicaid retroactive (up to 90 days) to cover the hospital & doc charges.

Pregnant women can drop their insurance, call the Medicaid office and ask to be put on the plan. They get coverage thru the delivery + 3 months. The baby has free health coverage thru the first 12 months.

None of this has anything to do with long term care where assets are part of the equation, or SSDI.

http://www.hrsa.gov/reimbursement/st...ligibility.htm
No one in this country is denied health care. They are treated and eventually someone (mostly taxpayers & insureds) pick up the tab.