My mother is 76 years old and is on a fixed income. We live in the state of Louisiana and she was on Medicaid for a while until one day they cut her off with no explanation. So I reapplied and turned in every document they asked me to turn in. I receive a letter a couple of days ago stating she was denied because I didn't send them all the documents, so I called them and told them I did send in what they needed. The customer service representative says well she receives too much money a month that's why she was denied. I don't understand, my mom is 76 she has type a diabetes,she takes insulin on a daily basis, she has depression, back trouble, and a lot of other medical issues. I sent Medicaid a copy of her costs of medications, proof of income, unpaid Dr bills ,and I also sent them proof of all the bills that come out of the little check she gets every month. They still denied her what can I do, I already appealed it. What else can do
I’m guessing this is Medicaid as health Insurance? Not Louisiana LTC Medicaid which pays for custodial care costs in a facility or Community based Medicaid which pays for an InHomeHealthcare provider or pays to be enrolled in PACE. It’s Medicaid as health insurance in addition to her being on Medicare, right?
If so, this is probably what has happened for your mom….. hang with me as it’s not straight forward…. when Covid hit, almost everyone who at the time was lower income was qualified to have Medicaid as health insurance. Whether your State took Medicaid expansion (LA did in 2016) or didn’t take Expansion (like MS) prior to Covid did not matter. Due to Covid, was Emergency CARES Act with Federal $ to support Medicaid coverage starting March 2020. Provided for continuous enrollment for Medicaid without recertification which would otherwise have been done every year for Medicaid eligibility. No income & asset verification as “continuous eligibility”. (fwiw imo if this hadn't happened, probably 1/3 of the hospitals & clinics in the US would have closed as losses stemming from uninsured or from those unable to do a copay, would have been staggering.)
Sometime after Feb 2020, mom was on Medicaid. If you don’t think she was on it before 2020, might have been her Health insurance did a “Medicaid alignment” because of Cares Act. And since then, she has had enough of a change of income &/or assets, that she’s over LA threshold for Medicaid. But it didn’t matter due to CARES Act “continuous eligibility”.
The Act ended Feb, 2023 & disenrollment could start April 2023. All States had 14 months to do it, if a State wanted to s..t…r…e..t..c..h it out they could. It’s called the “unwinding”. As each State runs & funds its Medicaid programs uniquely, the “unwinding” is crazy different for each State. States that did not take Medicaid expansion at all, started shutting folks off pretty immediately as really DNGAF for the more at need residents of their State and placed very narrow timeframes to submit info for review. Louisiana took expansion & rolled “unwinding” in phases, starting last Summer on the 2Million reviews of LA’s 40% population on Medicaid. LSS due to “unwinding” every State has done a giant reset & purge of eligibility to be on Medicaid.
For whatever reasons, mom missed filing under timeframe required. Went into suspended system. Then you called; reopened her file. So documents got looked at. She was determined over-resourced for income or assets or for both. She should get a letter from the State as to how she is over resourced. It should also be on her HealthyLA online portal. She needs to do an appeal or a fresh application IF having extraordinary required health care costs that were not clearly submitted. This is biggie that often overlooked. Or if the documents attached for her case# are incorrect or missing. It’s 2M applications in LA undergoing review, mistakes happen
I know this is a lot to take in. It’s overwhelming and stressful. If you are at all located where AccessHealthLA is, they can help you with all this. Access is in Tangi, the “St.” parishes, Rapides, parts of JP. 1-866-530-6111. Their website is really informative. Go to it and find the various items. So when you call or do an in person, you have precisely the documents required.
If despite all that, she is still over resourced, it can be dealt with. She can get health insurance besides her Medicare. Imo very much interdependent on just how she is over-resourced. If it’s a too too much income that is a different problem to solve than an assets problem. The regional Area on Aging for your parish should be able to help with this as well. Good luck.
As she has Medicare, she or you can go to LaSHIP to find health insurance carriers to use alongside her existing MediCARE. It’s a bit a minefield…… as the Medicare Advantage Plans will be relentless in trying to enroll her onto their coverage, so she goes off Original Medicare and onto an Advantage Plan. You really have to do your research to find the insurance that benefits her best for the doctors, clinics, hospital groups and drugs she currently needs and highly likely to use later on that are actually covered.
Not the Navigator system! Navigator is for those looking for health insurance but do NOT have Medicare and do not have employer sponsored health insurance. They can get info on ACA subsides through the Navigator, if that is a possibility based on their income. ACA doesn’t meld if you have Medicare.
Less than $1000 a month in LA