Monday, June 08, 2009

The Scoop on Medicaid

Ok, I've had a few q's on this one... so here goes my attempt at an explanation...

First off, EVERY STATE IS DIFFERENT. Some states, like Georgia for instance, allow ANY child that has a definitive diagnosis to be covered, and it does not take into account the parents' income.

Florida, however, DOES count the parents' income and our assets. So since we live in Florida... the rest of this is just about what I learned this weekend about FLORIDA.

Now, keep in mind, that this is from talking to a "high up rep" at a conference, not from going through the application process and actually having it work.

What we were told is that there are three different types of Medicaid eligibility. One is when you are on SSI (based on income and assets as well). SSI is 'harder' to get, so those on SSI automatically get medicaid. Then there's Medicaid for families and children which is NOT based on disability. Then there's medicaid for the aged and disabled. THAT is what we need to make sure the kids are 'categorized' as when we apply. It has a different set of criteria than the one for families and children. In fact, we were told that if we don't write anything in the 'comments' section of the paperwork, our paperwork will automatically go onto that 'track', and the qualifications for that will be used to determine our kids' eligibility.

Instead, he said we need to write in the comments section "Emma, Micah, and Brianna need to be determined as disabled and processed as disabled individuals." Now, this goes against a thread of "why label your child", but reality is that as an adult, our kids WILL need disability services to help them out, and they HAVE to have the determination of disability done as a child for Social Security and Medicaid if they are going to get any help as adults. So whether we do it at 2,3, and 6, or each of them at 16, the result is the same... but they may be able to receive a little help NOW as well.

So essentially what he said is that with our family of 7 with three people that are disabled, there is a process to determine what income is allowed, and this takes our total income, subtracts a little here and a little there because it's earned income and because we as parents are allowed to have a TINY bit. Then the rest is divided among the children that are disabled and if that final $ determination for each child is within the income allowances, then we would qualify based on income. (We have always qualified based on income for our family of 4 then of 6, so this isn't an issue for us, but it may be for other families.)

Then there's the issue of assets. This has always been where we were denied. They don't count the house and one car. This is good, but we have 2 cars. And both are in our names, one is paid off (we try to keep very little if any debt- our big van is our only debt apart from the house now). So one car is not counted, but the other one is counted toward our assets. The second car and any bank accounts that we hold are all put into a big pot. We were told our assets could be no more than $3k. Period. Total.

And that is where we said "How in the world do you live with a household of 7, multiple doctor's appointments each month, one person working full time, and yes, owning a home, with less than $3k between your second vehicle and accounts? If the second car is worth less than $3k, then I'd hope we have some money we put away for repairs, because it likely will need them regularly! And what about home repairs? We know we'll need a new AC system in the next few years and we are slowly putting away to have that... eventually... But we're hot allowed to have any accrual accounts? What about our home insurance and taxes that we pay yearly. No, they don't come out of escrow because of the type of mortgage we have. So we put that money aside monthly in order to have it when it is due. That's a pretty big chunk of $, but it's not "ours," it's as if we're paying it to a mortgage company it just only leaves our hands annually. Our auto insurance is done yearly on one vehicle as well. Do we need to set up the (more expensive) monthly plan in order for that money to not count against us in the time we are holding it until it's due? I believe these things we're doing are helping us financially, but in the great scheme of things, it sounds as though having these types of billing (saving us money and making our monthly payments work out ok) might actually be working against us. What about all those things our kids need that aren't covered by insurance and we still need to purchase? Like the glasses that Micah needs and the new lenses for Emma? And that special needs bed my dad is building for us?

Essentially, though, it comes back to this, told to us by the nice man at the conference... The asset limit is for one couple with one disabled child. For each additional child there is another amount of assets allowed. And the $3k is for family based medicaid, not Medicaid for the aged and disabled. See where I'm going? Our family is allowed a certain amount of assets (we are told $6k) and then each additional disabled child is allowed another amount in assets ($5k). So according to this man whom we hope is very knowledgeable... our family could have $16k in liquid assets (including the worth of our car and our bank accounts) and be eligible for Medicaid for the three children that need it.

All of this to say... if you are denied Medicaid coverage, but you do feel your children and family would greatly benefit from it, make sure that your application was processed as being for a disabled person, not for a child/family. Make sure that you have all your ducks in a row when you apply- copies of everyone's birth certificates, paycheck stubs, social security numbers, adoption papers (if applicable), bank statements, mortgage paperwork, monthly bills, and anything else I might have left off which would be helpful or better yet, necessary, in determining your eligibility.

I was also told by a helpful person (not the Medicaid man) to make sure our bills are paid up when we apply. For instance, we have $1k in medical expenses that we haven't received the bills for yet, so we need to make sure those are paid so that the money we have for those doesn't count toward our assets-- it's not ours, it's owed. Might also be helpful to do it right after taxes and other things that are generally paid by 'escrow' aredone. Yes, we need to talk with them and make sure that we are allowed to accrue money and find out how that works (or possibly set up an accrual account separate from our regular accounts as an official escrow type thing so that the money is marked as 'designated' instead of just being within our regular bank accounts).

I hope this might be useful to someone out there!


  1. Hey, you should post this on downsyn. There are a lot of parents there who post from Florida who are really struggling trying to get their kids coverage!

  2. building a ears sure did perk up on that one
    I'd love to get the scoop on that.
    Great post btw even though I don't need any of that info

  3. It would probably be a headache, but if it doesn't go through appropriately this time, could the grandparents hold any of the $ for things that are 'owed' until it is time to pay the bills. That way it wouldn't show up in your bank account since it's not really your money anyways. Just a thought!

  4. I'm going to put a link to this on our page. If that's okay. Meredith, great post!

  5. How confusing!!!
    We have already been told that our boys don't qualify for Medicaid or SSI or anything, so I've never even bothered with the applications. We'll be one of those families doing it when the boys are 16 in an effort to have them covered as adults because otherwise, it'll just be denied. They don't qualify for waivers or anything in Alabama.
    But, I'm glad that you got some answers that will help you!

    Maybe we should have moved back to!

  6. Good post. More information to Keep in mind....
    In Florida, families with minor children in the home (regardless of disability) cannot be denied Medicaid based on income. However, eligibility can be denied due to asset limits. In many cases(not all) there is a legal "work around" the asset issue. Make sure your family's eligibility is determined by a DCF Caseworker and NOT a call center employee who works for minimum wage.

    Also, regarding the previous unpaid medical bills. Keep in mind that if you are approved for FL Medicaid you can request a 90 day retro coverage. Will pay for any unpaid medicaid bills ~ i would not recommend paying off medical bills while going thru the Eligibility process. Mark YES on the MA application when it asks you if anyone in the household has unpaid medical bills in the last 90days.

    Hope this helps!!

    Medicaid Eligibility Advocate

  7. Merideth,
    This is Mary Stolz from RR.
    Don't stop at what you are doing right now, but check into "waivers" in the state of FL. You may have a long waiting list, but make sure you get all kids on that list.
    Every state (except on--I think Arizona??) has waivers for people with DD (Developemental Disabilities). Just about ALL of our kids with DS meet the level of care needed to qualify (Usually requiring ICF/MR level of care).
    These waivers, depending on the state and the waiver, will "waive" the parents income and assets in determining coverage. They always come with a medicaid card (I believe). They can be very limited in number, which is why you should ask, ask, ask about any and all waiting lists to be added to. you can always say no when your name comes up, but get on the lists.
    Our bio son (now almost 19)Matt was placed on the waiting list in 1999. His name just came up last year to get a waiver in the state of Ohio. This waiver pays for care for him (our older daughter is the "provider" of care, he still lives with us, but the waiver pays for "homemaker personal care" and "non medical transportation" up to about 34K per year. This, plus the medicaid card. Keep digging and get on any and all waiver lists they are eligible for