Does Medicaid in the state of IL pay for surgery?

Doesn't social security disability qualify a person for Medicare, regardless of age?

Thanks everyone for their comments- this site has been helpful for a lot of families including ours.

I am grateful to have found it and hope I can pay it forward with a reply that helps someone else.

I would use his money to pay for his out of pocket expenses for the surgery. You will need to do a spend down anyway. If it works then from what you say he won't need a nursing home, win/win, because he could live alone or in an AL.

I wouldn't wait for the surgery if he has insurance now and the prognosis is good for recovery. Do your research and get a 2nd or 3rd opinion. My husband had 15 doctors telling him no surgery, the odds of him being worse were higher than the odds of him getting any better. Then the insurance company says they need an independent medical exam. Oh yeah, I can operate and it's all good. Really? We saw world renown doctors and they said no way and here you are needing what a new Mercedes or did the insurance offer a bonus to cut him open and completely cripple him. Get a firm understanding of what his prognosis with surgery would be.

I would also question whether this will create a degenerative issue where the vertebrae next to the surgical site will start to fail, common, and what range of motion and mobility can he expect worse case and best case.

I hope he can have the surgery and go on to live life outside of a NH.

Since he’s not on Medicaid and hasn’t applied for it, you need to contact his private insurance and find out how much they will pay. As long as it’s medically necessary they should pay for the surgery excluding his deductible if it’s not met and his share of cost.

Well, it says:

"Primary services funded through Medicaid are physician, hospital and long term care. Additional coverage includes drugs, medical equipment and transportation, family planning, laboratory tests, x-rays and other medical services." Which I guess includes surgery.

Other documents discuss the need for a proposed treatment to be "medically necessary" (so I should hope).

And, of course, your LO would have to qualify for Medicaid. Have you been to the site to see if he's eligible? There's a checker function on this page: https://www.benefits.gov/benefit/1628

Sorry, starting again.

His income is too high for him to qualify for Medicaid.
But not too high for him to qualify for ltc through Medicaid as a person with a disability.
He is (just) too young to qualify for Medicare as a senior.

He currently has health insurance - with whom? Have you asked them if they'd cover the proposed surgery?

If the surgery were successful, would he be hoping not to need a nursing home? How long has he been there? What happened?

J, Check with his private insurance. It may be covered and they should be able to provide you with a list of providers who accept their insurance.

If the surgery could improve your LO's health and quality of life significantly, it would make him a lot cheaper to care for and it would be only cost-effective for Medicaid to fund the surgery.

And if it couldn't make much difference... why would you put him through it?

I haven't been to check what Medicaid in IL says about it, mind, but that shouldn't be difficult to do.

Does he have community Medicaid for medical service? Is he on Medicare? Both will pay if medically necessary. The biggest hurdle will be finding an orthopedic surgeon who accepts Medicare or Medicaid. Also some newer types of spinal surgery are not yet covered by Medicare or Medicaid.