Need Some Advice(4)

CareBear81

I tried to apply for Medicaid for my mama so she could receive long term care services and support (I mean, we get burned out and need help). Anyways, she got her denial letter today. They say she makes too much money by like $100 or something like that. So I want to appeal the decision. Has anyone done this before? I don't want to quit on my mama just yet. She deserves these services. She's unable to do anything for herself. But I also go to school and take care of her. The extra help would be great. So back to what I was saying, how should I go about appealing the decision? What should I say? I'm terrified of speaking in public but if it's what I have to do then I'm going to do it. Any help would be greatly appreciated.

Cynbar

Read the letter of denial again closely. Usually if a person qualifies for Medicaid in all other ways (meets asset limit, doesn't own other property, etc), the excess income becomes a deductible, also known as a spenddown. The spenddown is done in a 6 month block --- in other words, if your mother is over income by $100/month, she would have a spenddown of $600 for the 6 month period. She would have to spend that much on medical costs, sent in proof to Medicaid and then it kicks in for the rest of the 6 month block. At the end of that time, it starts over again. Does the letter list a deductible amount? Does it say anything like "You have been denied, but spend x amount of money and then you will qualify"?  Sometimes letters from Medicaid (and other government agencies) can be more confusing than they need to be.

PickledCondiment

Building on Cynbar's suggestions, please contact the local Medicaid agency for assistance.  Also contact local agencies on aging, dementia, legal aid (lawyer), etc for the same information.  All those agencies are there to help you with these are complicated issues.  (As a student, ask at your school's guidance office for suggestions.) You will get the best results asking specific questions and insisting on answers you can understand and use. (You will need to be firm and persistent to get the answers you need and deserve.)

CareBear81

I have sat on the phone for hours and hours just trying to get a hold of someone to talk to. I’m just getting to the point where I don’t know who to call. No one answers their phones, no one returns voicemail messages, I can’t get a hold of anybody anywhere! I will see if there’s somewhere I can go on campus for help. I’m trying my hardest to get her what she and our family needs. I’m going to school full-time and take care of her. It’s frustrating not being able to get help. I’m exhausted and the semester just started yesterday.

It states: you are not eligible for benefits. The money individuals gets (income) is more than allowed for this program. They make maybe $586 more than the limit. It’s still not a lot of money. My mom is STILL disabled. That’s not going to change. She’s not going to get better. But then, when I was listening to the recording saying you don’t qualify for this and this and you don’t qualify for long term care services and support but then further on down the message it says she’s on long term care services and support through August 2022. I’m like wait you just told me a bunch of times she didn’t qualify for that? I just want an explanation. She didn’t qualify for Medicaid for the elderly and people with disabilities because “failed to meet the requirements of completing a social security administration qualifying quarter.” Noooo clue what that means. I just wanna roll up in a ball and go to bed.