The details could easily fill a small book - suffice to say I am qualified for Medicaid (called MO HealthNet in Missouri) and up until March of 2015, I was not paying a spenddown.
That changed and they set the spendown amount at $139 per month. My wife and I decided to pay it because a policy through healthcare.gov would be about the same for premiums and the Medicaid coverage would be better than a private policy.
I began receiving my SSA benifits in April of this year - 2015 (I'm 63, I applied early because we need the income just to get by) - and Medicaid decided that now I have to pay $645 spenddown per month.
We can't afford it.
I had gotten my wife an excellent policy, through healthcare.gov for 2014 and 2105. Se will be 65 on the 23rd of September 2015 and so we canceled the policy when she went on Medicare at the first of the month. We will be paying quite a bit more for her healthcare, given the simple fact that up until August 31st, she was receiving a tax credit subsidy to pay for about 90% of her premiums through healthcare.gov
The next day. September 1st, she had no subsidy because she was on Medicare. So her healthcare expenses have gone up when she started Medicare.
Well, back in March I paid the $139 spenddown for medicaid.
The spendown went up to $645 in July but since I had already paid the spenddown for August, The spendown increase would not take effect September and so I was covered, at the lower spenddown through August 31st.
As I said, we cannot afford the $645 spendown and so I lost coverage effective midnight on the 31st of August.
Last night I enrolled in a policy through healhcare.gov much like the one my wife just left and I thought things were taken care of.
This morning, however, I thought of something that was potentially catastrophic.
I remembered that one of the dozen or more things that you had to "certify" to get the subsidy (about 90% of the premium for me about $550) was that you are not eligible for Medicaid.
I had a bad gut feeling that what I considered "eligible" was likely not what Medicaid and the ACA (Affordable Care Act) considers "eligible."
I was thinking I was not eligible for Medicaid because we cannot afford to pay the $645 monthly spenddown.
But - and it is a HUGE BUT - technically I'm still eligible for Medicaid.
Here in Missouri, the only way and adult can get Medicaid coverage if the state deems him or her disabled.
After a trip through hell - I'm going to make a web site about all of that - I was granted disability status.
I sat on the edge of the bed as concern turned to panic.
I called the people at healthcare.gov and after quite a bit of explanation the agent understood the situation. She put me on hold for quite a while and came back and asked me if the deductible for Medicaid (not the spenddown) was higher than that of the policy I had enrolled in.
I'm guessing that people she conferred with were thinking maybe I could get past the problem if the deductible for Medicaid was more than for the insurance policy.
I explained that there is no deductible for Medicaid. She excused herself and put me back on hold for maybe 30 seconds.
She came back and said that because I was eligible for Medicaid, it did not matter whether I could afford the spend down, if I got a policy through healthcare.gov I would get no subsidy and would have to pay 100% of the premium,.
It just happens that the full cost of the premium is, for all intents and purposes, the same as the Medicaid spenddown - $645 - which I can't afford to pay.
I asked her about appeals and she read a list of things you can appeal and my problem was not on the list.
I went ahead and got an address where I can send a letter and plan to do so. I will also be contacting my federal senators and representative and state seniors and representatives.
I don't have much hope (if any at all) that an appeal will succeed.
A few minutes ago I had the thought "I wonder if there is a way ti could become ineligible for Medicaid?"
Could I use some sort of technicality to become ineligible for Medicaid? Then I could get a subsidized policy through healthcare.gov.
My disability is MDD (Major Depressive Disorder) and I have had two heart attacks - the MDD is what really qualified me.
Maybe I could somehow get the State of Missouri to deem me not disabled???
FYI - technicalities prevented my getting Social Security Disability payments. My "disabled" status is only with the State of Missouri.
Does anyone have any thoughts as to how I might become ineligible for Medicaid? That is, become un-disabled?