Boyfriend has lung disease and is trying for transplant. He is on SSDI and has Medicaid insurance that covers everything. We are planning to get married so I can get family leave to care for him after transplant and can only get that if we are married. I don't want him to lose his excellent coverage, but I can't lose my job either.

If you marry him, he will loose his Medicaid.
Your income & assets come into play. & he’s now on your health insurance and I bet they will decline to pay for anything. The bill that y’all will be personally libel for will be huge, like bankruptcy in your future huge. I wouldn’t be surprised that if he changes his insurance at this stage, that it resets his timing on having a transplant.

Don’t get married.

Akso please please please heed AlvaDear’s advise. You need a team to do transplant care and your team needs their own support system.
Helpful Answer (3)
Reply to igloo572

Marrying your boyfriend at this time my indeed affect his medicaid status. As previously stated, each state has its own rules, but generally your income will likely be taken into consideration and could disqualify BF from medicaid benefits. So research your state first. When dad went to skilled nursing care (SNC) we applied for medicaid and I had to provide a mountain of paperwork on both mom and dad's income and assets for review.

Where your work - while you may not be able to take FLMA, would they be willing to give you a leave of absence while you care for BF? Can your duties be performed at home allowing you to work around your caregiving duties? Is there any way you could work reduced hours and be able to go in for a few hours a week when not caregiving?

I don't know how post transplant caregiving is done, so if my questions in the above paragraph sound like I don't know what I'm talking about - it because I don't know what I'm talking about. But just trying to be helpful.

Good luck and blessing to you and your BF. I hope you can find a workable solution.
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Reply to cweissp

Several issues here - the SSI income and the Medicaid that goes along with SSI. Both programs established for low income people - not enough work history to be eligible for regular social security disability payments earned by working enough quarters.

For the income part - managed by SSA - when you marry, your income will be tested to see if he is eligible to continue getting his SSI check. A portion of your money is 'deemed' to be counted as income for him.

They will also look at your 'resources'. Example: Single, he can't have over $2000 in the bank. I think for a couple, it's $3000. And that means at any time during the month. You deposit $4000 in the bank from your pay - it would make him over the limit.

For the Medicaid part - it is managed by both Federal and State - so rules can vary from state to state. But remember - Medicaid is a program for people with limited or no income. Very likely that your income is going to put him over the limit to keep the Medicaid. Really low income limits for adults to be eligible for Medicaid.

You should really talk to the dr. If he has this surgery, wouldn't he go to a rehab afterwards? Taking time off using the FMLA does not necessarily mean you will get paid leave for the maximum 12 weeks of leave. Most companies let you take off, but you have to use your own saved sick time and vacation time to get paid. If that's true of your company, do you have 12 weeks saved up? Or will you be without a check for most of that 12 weeks? Too many people assume FMLA is a paid benefit by their company and it's not.

The other thing I will point out: If you have been 'holding out' or representing yourself to others as already married (like common-law), SSI and Medicaid could make him pay back benefits he was not eligible for. In Texas, you are considered common law simply by telling others 'he is my husband'. It doesn't have anything to do with how long you have lived together (as some believe), it's about how you present yourselves in public, legal documents, etc. Your insurance company may require you to sign documents for an informal marriage to add him, but the Medicaid and SSI may just go by how you present yourselves.

Remember, Medicaid is a needs based program, which means a beneficiary must have limited financial means. Unfortunately, a marriage can push a beneficiary over the Medicaid set limits and result in Medicaid disqualification of the newly married spouse. It is very possible in your state that as a married couple, even if your income was quite low, that you would be required to add him to any other insurance available to him - such as your insurance at work. Medicaid wants you to use any other program/insurance available to you before using fed/state paid coverage.

IRS documents are another way for the Social Security Administration and Medicaid to find out if you have filed taxes together and failed to report the husb/wife relationship to them. So if you've ever done that, even though no formal marriage, you could have already created issues.
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Reply to my2cents

I would not marry for this reason. And yes, others living in the household incomes maybe considered. I would not give up my job. Your BF may get more services because he is single. Medicaid "in home" may give him an aide for a certain time a day.

There are no guarantees with transplants. A friend of mine lasted 3 yrs after hers. I would think he is not going to be sent home right away. I would think he would need to be monitored for rejection and ongoing med adjustment.
Helpful Answer (1)
Reply to JoAnn29
AlvaDeer Jun 6, 2021
Problem here is that no transplant will be done without between 1 and 3 caregivers who are full time 24/7. Following this transplant there are often many complications that need quick action; there can be episodic confusion. No team will do the transplant without assurance of 24/7 care, and some will require you have upwards of 10,000 on hand for possible need for hiring on medical help. Even the medication is onerous in and of itself. This is truly a difficult surgery. And there are many stipulations that don't happen in regular surgeries.
Every state has different rules. You need to be certain of the rules for your own State and you will need to research them completely. You will need to be absolutely certain of the rules. The rules for lung transplants are very very touchy and often you need a total of THREE people signed up according to the hospital rules. The truth is that the job of the person who is with the transplant patient afterward is very very difficult. Were I you I would ask to speak to a doctor about attending the classes that the transplant team often supply to families.
Do your research with your boyfriend's medicaid caseworker. You cannot have him lose that insurance. You may be a position of having to quit your job for the duration of this time frame.
I am so sorry you are dealing with this difficult situation. I had a friend you was unable to get transplant because she was never able to get that team for home care together for 24/7 care. I sure wish you both good luck in moving forward.
Helpful Answer (1)
Reply to AlvaDeer

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