Medicaid vs Medicare

[Hoshneer]

I could use some help or expertise in this area. Here is a little back story. We moved in with my parents 12 or so years ago to take care of my father while he was dying. After he had passed we stayed with my mother and we pay all the bills for the house and utilities for her along with groceries and such.

She was on Medicare with Medicaid to supplement spending costs for her prescriptions and such. Over the years they have started charging her more and more until things are so tight now she can barely even cover her own costs even with us paying for her living costs. We have never claimed her on taxes for fear they would take her benefits away because of our income.

So today they canceled her Medicaid and it's freaking us all out. I don't understand the system because I don't deal with it and she is lost because the papers read like you are supposed to have a law degree. If there is anyone on this board that knows much about this subject I would just appreciate some advice on what we should try and do at this point.

 

[3/5King]

Hey Hoshy, sorry to hear about the headache. What happened that made them take away her Medicaid benefits? I'm assuming it has to do with the paperwork they send. They send a paper that askes where you live, who you live with, if you pay the bills, among other questions. Do you have any more info?? I feel more details are necessary. PM me if you don't want to air it all out here. I'll try to help the best I can.

 

[Hoshneer]

Apparently her income was to high for a single person this year which bumped her out of the category for Medicaid help. They restructured the program this year and changed some qualifications. She is talking to someone right now and it's possible she may be helped by our state program. I really do need to look into other aspects as well. Like whether we should put the house in our name or claim her on taxes and such. It's just hard to predict the repercussions from any actions.

 

[3/5King]

Sounds like a money game and you need to put bills in her name, she needs to show that she is paying for everything (even of you are but it cannot exceed her SSI income. It can't show as if anyone is helping her financially or living with her. My aunt goes through the same thing. She lives with my great aunt but cannot tell them that or the same type of situation will come about. It's all a numbers game.

 

[Sirspanksalot]

What king said. You kinda have to play the system. Sounds bad, but it's for your mother

 

[RamzaFreak20]

What king said. You kinda have to play the system. Sounds bad, but it's for your mother

If the numbers get pushed around and she ends back up on Medicaid, that's not playing the system. The system is just flawed and (without getting into a political debate with anyone) it needs to change. I remember my folks taking in my great grandmother when I was younger and they did this same thing. The taxes keep increasing, but people keep getting kicked off of coverage. I hope everything works out for you, brother. Many prayers

 

[stukibuilt]

So for starters and clarification, Medicaid is state funded coverage while Medicare is federal. If her Medicaid was dropped due to income then there is a high likelihood that your state is changing it's guidelines. Medicaid, at least in the state of Florida, is going through a huge overhaul of the HMO system and moving to MMA (I think if memory serves... It's a managed entity system) and it's causing a lot of concern here with the people I work with. Was there any change in her declared income? Is she currently receiving SSDI or SSI and does she have more than 2k saved in a bank account?

 

[Hoshneer]

So for starters and clarification, Medicaid is state funded coverage while Medicare is federal. If her Medicaid was dropped due to income then there is a high likelihood that your state is changing it's guidelines. Medicaid, at least in the state of Florida, is going through a huge overhaul of the HMO system and moving to MMA (I think if memory serves... It's a managed entity system) and it's causing a lot of concern here with the people I work with. Was there any change in her declared income? Is she currently receiving SSDI or SSI and does she have more than 2k saved in a bank account?

Yeah, they are overhauling the system, it's effective June 1st. They lowered the poverty level they require you to be at to reach spend down. To my knowledge they are getting rid of spend down all together and just paying for more of the medication if you are on a lower poverty scale. She makes roughly $1300 a month but after medication and such she lives off of around $800. Under the new guidelines she would have to make under $973 on SSI to receive Medicaid. It looks like there may be other programs in the state to help her though hopefully.

 

[stukibuilt]

Yeah, that's way above the threshold here as well. I have people who get 771 a month total and can't get Medicaid. Best bet is to reevaluate her Medicare plan and see if there is a better deal out there. There are also grant programs that may be able to help. If she calls a social worker for her HMO they should be able to help point you in the right direction as well.

Most stuff varies state to state so much that you need to talk with someone there.

 

[Hoshneer]

Thanks man.

 

[stukibuilt]

No worries. Best of luck to you!

 

[Crusader]

Honshy, I have no advise, but wanted to commend you and you're wife for taking care of you're parents the way you did. Bless you!

 

[Hoshneer]

Thanks guys, you all were a huge help and some of you had some great ideas. I appreciate all the PM's.