They said I did not meet by spend-down amount the surgery cost and accompanying cost for one month was more than $40,00.00, How in the world I did not meet my spend-down?
There are Medicaid-mandated cut off dates in our state. The amount of money or resources can stay the same, yet we can be disqualified for a specific month because either a payment to someone or a transfer to a specified account did not happen in time. On paper, this appears to be excess resources for that month. Then Medicaid can determine it does not owe because the patient had not spent down resources to the amount Medicaid said must be spent. If you were in surgery or recovery i.e. bedrest, physical therapy etc. and your funds didn't get spent or transferred in time, our state initially says there is too much money on the date and moment the services were rendered.
Since all monies must be moved quickly within such a short time frame, I call it playing Medicaid hop-scotch. A sick or injured person is even more hard-pressed to meet this timing requirement. Monies have to quickly get to the right account or payments made to make sure it does not appear to be leftover monies that month. If dates don't match up in our state Medicaid can then come back after it paid, and say the bill was "incorrectly paid" so now it goes back to the patient. This is logistical problem. If yours is a logistical problem, ask Medicaid if it can be resolved. If not, I would try to get a fair hearing and have all dates and documents in hand. If you physically just couldn't keep up at some point it's worth a try. Since you were previously eligible, something must have changed the Medicaid scenario, even if you had no changes on your side.
You mean spend-down, I'm sure. If your assets are above a certain amount, then you don't qualify for Medicaid when you have more than this amount. I don't know why it was just for one month. You'll need to discuss this with a Medicaid worker, who will have all the files in front of him/her.
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On paper, this appears to be excess resources for that month. Then Medicaid can determine it does not owe because the patient had not spent down resources to the amount Medicaid said must be spent. If you were in surgery or recovery i.e. bedrest, physical therapy etc. and your funds didn't get spent or transferred in time, our state initially says there is too much money on the date and moment the services were rendered.
Since all monies must be moved quickly within such a short time frame, I call it playing Medicaid hop-scotch. A sick or injured person is even more hard-pressed to meet this timing requirement. Monies have to quickly get to the right account or payments made to make sure it does not appear to be leftover monies that month. If dates don't match up in our state Medicaid can then come back after it paid, and say the bill was "incorrectly paid" so now it goes back to the patient. This is logistical problem.
If yours is a logistical problem, ask Medicaid if it can be resolved. If not, I would try to get a fair hearing and have all dates and documents in hand. If you physically just couldn't keep up at some point it's worth a try. Since you were previously eligible, something must have changed the Medicaid scenario, even if you had no changes on your side.