How to get the state to change my Medicaid status to full coverage?

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At 70, I've been rather healthy and have not had a need to utilize - as yet - my Medicare or Medicaid. At age 62, due to lack of work, I had to take early retirement and begin Social Security. I also qualified for food stamps. I'm not married; no children; no relatives. For awhile I didn't participate in Medicare Plan B because I simply couldn't afford to. Then I realized that there was help to pay for the premiums called the Medicare Savings Program, which I qualified for.

This in turn led me to more help via Medicaid. I assumed, wrongly it would seem, that I qualified for full Medicaid help. The term they have used on the yearly renewal papers I receive for Medicaid is "Medically Needy." I assumed I would not have to worry about any "deductibles" should the need arise since I was both Medicare and Medicaid. I wrongly didn't investigate any further since I didn't have any medical needs.

I now have some eye and other issues that need to be taken care of. So I looked into "Medically Needy." Imagine my surprise when it said I must "share the cost" because some bureaucrat decided my income "exceeded" the Medicaid limits!

First, the ONLY income I have is Social Security and that is $8,460 A YEAR (2018) I have no other assets; I don't own a car; I don't have other means of support; I don't own a home; I must pay rent from only $705 SS a month (rent goes up each year; currently it's $500 month, one of the cheapest in town). Utilities are always high no matter how much I conserve in this old apt. complex; my city has the highest rates in the state of Florida. I have qualified for a very low rate of Internet for a couple of years but once that program ends, I won't be able to afford ANY Internet. There is no suitable senior public housing. I have one credit card with a low limit that I am attempting to pay off but must use for necessities (dish liquid, toilet paper, etc) sometimes or other household emergencies. I get $192 month in food stamps and that may sound like a lot but with always rising food costs, it really isn't. I often use the credit card to pay for food. And round and round I go. I'm lucky if I "clear" $10 each month in "cash." Sometimes it's less than that, depending on utilities.

Really, if anyone should qualify for full Medicaid and prescriptions, I think I would be a likely candidate. So what do I do now? They've put me at "Medically Needy" for several years! How can I correct this? Getting anyone on the phone in years past has been a nightmare - one cannot stay on hold, you're repeatedly disconnected and forced to call back FOR HOURS.

I need to use the system in the coming weeks and this is worrying the heck out of me. I don't have any extra cash to pay outright to any doctor until Medicaid decides to kick in for that one month.

I am at a loss to explain why someone could see that I somehow exceeded the poverty limits for Medicaid. My poverty level "income" is right there on my annual renewal forms! If anyone can explain this, please do. What am I missing? How to get real help with this on Monday?

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MaggieP - I also just had this happen. I am "dual eligible", I have had full Medicaid for 4 years, my Medicare started 12/1. What was supposed to happen was to be moved from full Medicaid to the MSP, then the state (Medicaid) pays your Part B monthly premium, and depending on your level of assistance you qualify for, pay for your Part B office and lab fees. What also should have happened is either SSA/Medicare or the state sends out a notice for your level of Extra Help you are entitled to for Part D, being dually eligible I would get 100%.

What happened in practice? DHS/Medicaid did not send me anything, and neither did SSA, there was no auto enrolling, no notifications. I found out later when I went to pick up a $2,000 prescription (generic) and Medicaid did the pre-auth, then refused to pay for it and said for Part D to be billed, which I did not have.

You can apply for Extra Help online if you haven't: www.ssa.gov/benefits/medicare/prescriptionhelp/
I received it in 1 business day after applying, but I had no idea it existed. My monthly Part B premium is now being paid for by Michigan, but that is because I finally got a new DHS worker who actually does work.

My income is similar to yours, my rent, I have no assets, etc. I was enrolled in a MSP and my SS income is slightly over the cut-off too, my "spend down" is $989/month. I have no idea how I would ever reach this amount either. I am also "Medically Needy" and was able to get Medicaid when there was open enrollment, and my co-pays for doctors, hospitals and prescriptions was $0.

But in the case of these other programs I was eligible for, my DHS state worker was not available either, like yours. At all. I have a new one now, but even she is trying to complain that I am at the "end of her line of accounts because she has 900 other people in front of me who were here first." But when I started receiving SS, they were very fast in cutting my Food Stamp benefits from $189/month to $15. That they were right on top of.
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Reply to asylum23
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The state I work for does not have caseloads so there is no one person you call. Any worker you see in person or reach at a call center can review the file and tell you what's going on.
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Reply to vegaslady
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On your Medicaid paperwork you fill out annually, there is a name of your caseworker. You need to call him/her and discuss your problem. My nephew gets Medicaid in NJ. He makes more than you and gets special help. He has no co pays for medical but does pay a small amount for prescriptions. You may want to check out Senior apartments thru HUD. They only take 30% of your income. There is help with utilities. Office of Aging maybe able to help with other services. If you r on Medicaid, you can participate in the government food and there is a voucher for produce stands you can get. Here, the United way has the schedule for the government food and where to pick up. Churches have food closets to help those who can't make it on their income. Call around.
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Reply to JoAnn29
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I forgot to say that you should be able to get the Medicaid Long Term Care and a separate MMA (Managed Medical Assistance), which is the acute care part of it.
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Reply to Myownlife
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1. Call the Area Agency on Aging - 800-963-5337 to get your local office for seniors help.
2. Instead of calling DCF, go to your local office, in person
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Reply to Myownlife
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There are income and resource limits for Medicaid and MSP programs and the limits are different. Any chance that you have assets that exceed the Medicaid limit, such as several vehicles still in your name, property? Your denial letter should have had the specific reason you did not qualify.
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Reply to vegaslady
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Thank you, BarbBrooklyn. I thought that's what I did online after I applied for the Medicare Savings Program. When you apply (renew in my case every year) you check off boxes as to which you wish to apply/qualify for and Medicaid (after I turned 65) was one of them. We have to essentially fill out a new application each year for all programs, but mainly it's a matter of confirming what you have previously filled in.

So, I already had the food stamps - and then I applied for the Medicare Savings Program, and then I applied for Medicaid - it's all done at the same site within your account. When I received the "Medically Needy," I assumed it was for the full Medicaid. Someone in the office who looks over these online applications at the ACCESS site (the renewal site for my account) is the one who determined that I inexplicably exceeded the poverty level which makes no sense at all since I was already on food stamps and qualified for the Medicare Savings Program.

I just took a look at the link you provided and then other links they provided and while Florida didn't expand Medicaid, I STILL qualify according to their poverty level figure (which is around $11k a year for a single person; as mentioned, I'm far below that).

Thank you. I'll call Monday but dealing with the people involved directly has never been easy.
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Reply to MaggieP
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govthub.com/florida-benefits-guide.aspx?c=medicaid

I think you should fill out an application for Florida Medicaid
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Reply to BarbBrooklyn
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Bumping this up
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Reply to BarbBrooklyn
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