My mother started receiving medicaid back in 2008.
We received a letter the other day from Florida Medicaid, saying that her medicaid coverage has ended and they listed the reason as to why. It says (Reason: You are receiving the same type of assistance from another program)
I don't understand what they mean.
She receives SSD benefits, and medicare. Medicaid approved her back in 2008 knowing that she was enrolled in those programs, so why is it that they have ended her medicaid now when nothing has changed in regards to the assistance she receives??.....
Any help is greatly appreciated.
I've been though the appeals process and the caseworker needs to have a paper trail in your mom's file in order to for it to count. Phone calls don't provide that. Mail is good BUT FAX IS BETTER especially when you are under the gun for deadline. FedEx/Kinko's do faxes at pretty competitive rates and you get a copy of the transmission delivery. The fax transmission delivery copy is important as it shows that HHS got a document and when with a date and time stamp. Also with a fax you have in your hands exactly what was sent over. I have a fax @ home and I still go to Kinko's if its something very important because I get a real-time transmission verification. I have no sense of humor in hearing..."we never got it".
When you mail or fax whatever to HHS, I'd suggest, you clearly request that either all documents be mailed to you OR that you are sent a duplicate of all items mailed.State in your letter to them that you were unaware of any items needed as your mom - who received their mailings @ her NH - is unable to because she doesn't have the cognitive ability....has dementia, etc....and that all mailings need to come to you (as her DPOA, MPOA, responsible agent, next of kin, whatever) in order to be dealt with in a timely and consistent manner.
Perchance could this be about non-compliance on recertification? I don't know if all states do this, but my mom's Medicaid has to be recertified annually. The letter comes annually about 1 year and 6 weeks to the date of her initial approval. The paperwork is about a 6 page questionnaire from state HHS. My mom's is a pretty simple check off and is all about verifying or updating info (like SS#, banking info, insurance info, burial policy info) BUT I do have to send in the current month's bank statement and the last 3 before that. It's to make sure that her income and assets are still @ or under the state maximum and that nothing has been sold or changed ownership. Like your mom could have won the lottery - lmao. I think I had 21 days to get all to HHS. Hello Kinko's on Day 20!
One thing that happens commonly is that the NH residents personal needs allowance builds up and puts them out of compliance on "assets" for Medicaid. Are you familiar with the allowance.?..?.......this is the $ (amount is set by each state) that Medicaid NH residents get to keep for their personal use. I think it ranges from $ 35 to 90 depending on the state, my mom's is $ 60.00 a month.
What can happen is that the $ doesn't get spent and builds up either in their bank account or in their personal needs allowance trust at the NH and eventually puts them over the 2K for assets.When my mom went into the NH, her bank account was around $ 1,500 in "assets" and every month gets $ 1,800 in "income" deposited (SS and annuity). Every month a check for $ 1,740 gets paid to the NH and every month her bank account builds by the $ 60.00 personal needs allowance. So I have to make sure she spends it on something within the year so that she doesn't get over 2K. If I just left it there for the year and I personally paid for everything, her bank account would be $ 720.00 bigger and added to her baseline amount of $ 1,500, would take her to $ 2,220 in "assets" & $ 220 above the state limit. According to the social worker at my mom's NH, this happens super often and you can easily deal with this by setting up a monthly expense for her like hair salon services. My mom's NH does this a lot for the hair salon and the canteen where they can "buy" small stuff like candy, magazines, hair barrette's. Whatever they spend gets charged to their personal needs allowance trust @ NH so they don't need to fret about having (& loosing/stealing) $ about in their room.
My mom is in TX and TxDHHS sends everything to both me (I live in another state) and to her at the NH as per my request. I've gone through appeals too. It's usually pretty straightforward in what HHS needs but the timeframe can put you in panic mode. Stay focused & organized & you'll be OK. Good luck & get on it.
Plenty of success with this I hope for you. Let me and the rest of us know how this turns out.
Most states Medicaid programs have very strict timeframe in which to file an appeal and it usually has to be done in writing and mailed in or sent via fax. Phone call is good but usually you have to have appeals in writing. Usually if you appeal, her coverage is continued until the appeal hearing is done. I had 2 appeals with my mom's NH Medicaid and 1 appeal took 3 months for the hearing and the other was scheduled for 6 months and got resolved about 3 weeks before the hearing.
But you have to file an appeal.
Could it be that some of the medical costs that Medicaid was covering is being paid by Medicare or though her SSDI? 4 years is a long time and that might have happened.
My mom had a very good secondary insurance policy (federal BCBS) and once they found out about her being on Medicaid, her BCBS policy was suspended as now Medicare &/or Medicaid are the payers for all medical for her as BCBS would be duplicating services paid by another.
Good luck,
Carol