Medicaid frustration

[Janeway]

I was already frustrated that no doctors here, or pharmacies, take medicaid. However, if anything happened, I can take a child to the ER. So fine. I feel like things should change as people should have medical care and the state pays A LOT for medicaid per person to private insurance companies only for medicaid to not be valid. 

 

I called last month to report my husband's new job and was told that medicaid would still continue through Nov. As a result, my husband decided not to put the kids on the insurance which would have cost $500 a month to have them on. It would just be for a few more months like that. Fine. But, when I called medicaid today to report the income had actually come, as in, actual paycheck received, they say now that our medicaid will be terminated now. AND, they want the name of my husband's employer so they can call them and speak to them. WHAT????? My husband is working for a very small company. He does not want everyone to know his kids had been on medicaid.

 

I feel like when dealing with the government, they never know what they are doing. To top it off, son already started his ASD eval, at a place that takes medicaid, only to find out that medicaid may be cut off retroactively. He has his final testing date on Friday and I feel like I have to cancel or risk owing thousands of dollars. Ugh! No one can give us a straight answer!

Edited July 10, 2017 by Janeway

[Carol in Cal.]

That's awful, sorry to hear it.

Can he still add the kids to his employee plan or is it too late for this year?  Open enrollment is coming--out here most companies have it in the fall.  

[Lang Syne Boardie]

:( I think I wouldn't have felt entitled to Medicaid once the family had access to employer insurance; I would have switched at once (especially given your hatred of Medicaid - in your prior posts you seemed to think that your family deserved better). That said, I hope you are able to find treatment for your son. I'm sorry for all the confusion and bureaucratic red tape.

[goldberry]

Your Walgreens doesn't take Medicaid?  Or is the state plan for prescription a different plan?  Walgreens accepts Medicaid nationwide.

 

I do find it odd they want to call your employer.  Maybe they have to verify you qualify for something else before they remove you. If it was me, I would just ask if that was the case, and then see if I could provide them with information.

[TravelingChris]

Look, it is simple You get government help, you get government rules. They probably need to speak to the employer to find out the starting date of employment because your children would not be eligible then. I find that with government things, it is much better to read the regulations oneself because the people on the phone too often give wrong answers. I just have experience with that on federal income tax but I suspect that state social service phone people are also prone to errors. My understanding, without looking anything up and having no personal experience with Medicaid, is that its children's program is for children whose parents do not make enough money and can't get insurance otherwise. That wasn't the case once your husband started working.

 

I hope you get the help that you need and that you can get the children added on to the insurance at this date.

[maize]

:( I think I wouldn't have felt entitled to Medicaid once the family had access to employer insurance; I would have switched at once (especially given your hatred of Medicaid - in your prior posts you seemed to think that your family deserved better). That said, I hope you are able to find treatment for your son. I'm sorry for all the confusion and bureaucratic red tape.

I think the autism evaluations were a reason for not switching. In my state as well autism evaluations are only covered by medicaid, so if you do not have medicaid you are self pay; no other insurance covers them.

 

OP was not trying to game the system, just making decisions based on the information that had been given to her.

[lauraw4321]

You should be able to get the children onto DH's insurance backdated to the date they cancel your Medicaid.  It's a qualifying event, even if you have to go backwards in time.

[Janeway]

:( I think I wouldn't have felt entitled to Medicaid once the family had access to employer insurance; I would have switched at once (especially given your hatred of Medicaid - in your prior posts you seemed to think that your family deserved better). That said, I hope you are able to find treatment for your son. I'm sorry for all the confusion and bureaucratic red tape.

On our previous insurance, we spent years on various waiting lists trying to get him an evaluation. With the medicaid, the children's hospital took it, which had people who do this type of evaluation. So, we begged and pleaded with them to get him in quickly on the medicaid for an eval. Now, he finally has the eval, in July. IF we cancel these appointments, we will have to go back to the bottom of the wait list and it might not even be covered by the insurance again. We have been waiting years for this. Having this eval is the only silver lining in all this. However, where we live, no family doctors or pediatricians or pharmacies or otherwise take medicaid. I am driving him 45 minutes away to a specialist who is through the children's hospital that takes medicaid. Since he is 13 yrs old now, even if the new insurance allows the children's hospital, the wait lists are 3 years and up. He would age out before he gets in. So the attempts to get an eval will be over. The children's hospital ages out any new patients at 16 yrs old. IF you are already a patient there, you can go to them until 21 yrs old. 

 

Since he has already had multiple appointments and only has one left, I do not want to terminate testing. It is not like he can just go under the new insurance. Besides, the new insurance has not even kicked in yet. So we cannot even get on the wait list until we have the new cards. 

[Janeway]

Look, it is simple You get government help, you get government rules. They probably need to speak to the employer to find out the starting date of employment because your children would not be eligible then. I find that with government things, it is much better to read the regulations oneself because the people on the phone too often give wrong answers. I just have experience with that on federal income tax but I suspect that state social service phone people are also prone to errors. My understanding, without looking anything up and having no personal experience with Medicaid, is that its children's program is for children whose parents do not make enough money and can't get insurance otherwise. That wasn't the case once your husband started working.

 

I hope you get the help that you need and that you can get the children added on to the insurance at this date.

Actually, they are eligible until we earn more than 4200 a month, OR until we earn more than an amount for the year. No one seems sure of that. So no one is sure if they are supposed to be cut off when my husband gets his NEXT paycheck, or cut off when a new year starts, or if they are just allowed to stay on until the end date of the current coverage. Every person we have spoken to has given us a different answer.

[Lang Syne Boardie]

I understand now about the eval. :( If it comes to having to pay for the last of the testing, I hope you'll be able to figure out a way.

[Janeway]

I understand now about the eval. :( If it comes to having to pay for the last of the testing, I hope you'll be able to figure out a way.

One interesting thing though..IF we pay for the kids to have insurance, our income ends up being low enough to qualify for CHIP. LOL...IF we do not pay for the insurance, it is not low enough for that. 

 

I will have to wait and see with the next pay check though. If we do not qualify for chip when not paying for their insurance, I am thinking our income will only be too high by about $100 a month or so. We will see though, when the paycheck arrives.

Edited July 10, 2017 by Janeway

[cjzimmer1]

I don't find it the least bit strange that you have to report your husband's employer and number to them.  That's standard operating procedure around here.  It seems like a bit of pride issue that you DH doesn't even want them to know that his kids were/are on Medicaid.  There is no shame in using assistance when you need it.  In our state even though we get insurance through DH"s company (and the entire family is on that), my kids are still eligible to have medicaid as a free supplimentary insurance.  What this means is the work insurance is primary but for all those lovely thousands of dollars of copays, deductible and billions of other exceptions that the insurance companies find to make us pay for everything out of pocket, is then picked up by medicaid and we only have to pay medicaid's very reasonable co-pays.  I am most grateful to have that extra assistance.  

[Spryte]

I would imagine that it's no secret that your kids were on Medicaid, to your employer. Anyone who took the time to consider employing your DH would know he was out of work for X months, therefore the kids would have needed insurance. Not having insurance for the kids would have been irresponsible, so enter Medicaid. That's what it's there for. So while your DH's employer may not have consciously thought, "this man's kids are on Medicaid," it would certainly come as no surprise, either. I really don't think you need to waste time and energy worrying about what your employer thinks.

[cjzimmer1]

Actually, they are eligible until we earn more than 4200 a month, OR until we earn more than an amount for the year. No one seems sure of that. So no one is sure if they are supposed to be cut off when my husband gets his NEXT paycheck, or cut off when a new year starts, or if they are just allowed to stay on until the end date of the current coverage. Every person we have spoken to has given us a different answer.

 

 

One interesting thing though..IF we pay for the kids to have insurance, our income ends up being low enough to qualify for CHIP. LOL...IF we do not pay for the insurance, it is not low enough for that. 

 

I will have to wait and see with the next pay check though. If we do not qualify for chip when not paying for their insurance, I am thinking our income will only be too high by about $100 a month or so. We will see though, when the paycheck arrives.

 

I realize every state is difference but here there is more to eligibility than just the income number.  So the ability to look at your paycheck is probably not enough to know for certain.  They have a horribly complicated formula to figure this out and I don't think anyone can really tell for certain until all the information is entered into the system (which is probably why you are receiving different answers).  It really sucks as far as planning goes though because you never know the answer until its too late to change things.

 

But in our state, it's income minus deductions (401K contributions, medical, dental and flex spending contributions plus a few other things that I can't figure out because their numbers never match mine).  They also consider college tuition costs.

 

They also consider the insurance a family is offered at work.  If the employer pays less than 80% of the cost of the insurance, that works in the family's favor.  Depending on how soon you are eligible for insurance at the new job is also a factor.  

 

That will also retroactively remove or reinstate insurance depending on what documentation they get.  Yes it's maddening.  But persistance with calling and calling and calling has always worked things out in our favor.  I've always said it's rediculous that despite having a college education, I can't figure out half the time what documentation I have to provide and when.

 

If I were you I wouldn't cancel the appointments either.  You are too far into the process to let go that easily.  In my experience they don't cancel the medicaid midmonth so I would think you'd still be covered for this month.

[goldberry]

On our previous insurance, we spent years on various waiting lists trying to get him an evaluation. With the medicaid, the children's hospital took it, which had people who do this type of evaluation. So, we begged and pleaded with them to get him in quickly on the medicaid for an eval. Now, he finally has the eval, in July. IF we cancel these appointments, we will have to go back to the bottom of the wait list and it might not even be covered by the insurance again. We have been waiting years for this. Having this eval is the only silver lining in all this. However, where we live, no family doctors or pediatricians or pharmacies or otherwise take medicaid. I am driving him 45 minutes away to a specialist who is through the children's hospital that takes medicaid. Since he is 13 yrs old now, even if the new insurance allows the children's hospital, the wait lists are 3 years and up. He would age out before he gets in. So the attempts to get an eval will be over. The children's hospital ages out any new patients at 16 yrs old. IF you are already a patient there, you can go to them until 21 yrs old. 

 

Since he has already had multiple appointments and only has one left, I do not want to terminate testing. It is not like he can just go under the new insurance. Besides, the new insurance has not even kicked in yet. So we cannot even get on the wait list until we have the new cards. 

 

There is no way I would cancel any appointments then.  If it all gets hashed out and you owe some money, I am sure they will make a payment arrangement with you at that point.  That would still be better than canceling based on what you are saying.  I wouldn't even say anything to the childrens hospital at this point.  

 

Also... I have to drive 45 minutes to just about anything, so don't feel too bad! ;)

[Janeway]

There is no way I would cancel any appointments then.  If it all gets hashed out and you owe some money, I am sure they will make a payment arrangement with you at that point.  That would still be better than canceling based on what you are saying.  I wouldn't even say anything to the childrens hospital at this point.  

 

Also... I have to drive 45 minutes to just about anything, so don't feel too bad! ;)

I don't mind driving that far for a doctors appointment, but it would be hard to do with a sick child. Doesn't matter. I never did find anyone who would take the medicaid. There was one doctor in our area listed on it. But when the baby got sick with a high fever, I tried to get an appointment. It was a month out to be seen with a fever. I even tried speaking to the nurse and explaining he was 1 yr old and had a high fever, but no help. It was going to be 32 days until he could be seen. We went elsewhere, but when we tried to get to the pharmacy to fill the prescription, I thought we could use the medicaid for that portion at least. Nope. I went to two pharmacies and neither took it. I finally ended up just paying for the prescription too.

 

I really am concerned that people who cannot come up with the money to pay out of pocket, like we did, are stuck leaving their children with untreated ear infections and such. It is not ok. AND, for all the money the state pays for these kids to private companies to have the medicaid, a simple antibiotic or trip to a pediatrician should be covered.

[EMS83]

It's because they don't know the answer, and don't know who to ask, and probably don't care.  One of many reasons why we are self-pay, even when we were in the Medicaid bracket.  BUT, we are a relatively healthy, NT family and don't incur much expense. 

[Ravin]

The biggest problem I see here (aside from your state having lousy implementation of medicaid resulting in so few doctors accepting it) is your hang-up and shame over using public assistance.

 

YOU PAY TAXES that pay for these programs to be there when you hit hard times and need them. 

 

Just jump through the hoops, give the required information. It's really not that big a deal. Do get the kids onto your DH's insurance ASAP. 

 

I ran into something like this when I started my current job; we were in a weird status where we'd had to appeal our medicaid benefits (they suddenly remembered a rule they'd never bothered with before about wanting proof we'd exhausted VA benefits first) and didn't know how long we'd have them. I was fortunately able to appeal to have our insurance with my new job retroactively start from my start date of employment (normal policy for my employer is for it to start after 60 days of employment), which covered the gap that was created when they decided we didn't qualify for medicaid for that period because of the VA benefit rule (we would have been okay for the first month or two had they not invoked that rule because it took a while for my first paycheck to show up).

 

I would keep the appointment for the evals regardless of how the insurance sorts out.

[Janeway]

The biggest problem I see here (aside from your state having lousy implementation of medicaid resulting in so few doctors accepting it) is your hang-up and shame over using public assistance.

 

YOU PAY TAXES that pay for these programs to be there when you hit hard times and need them.

 

Just jump through the hoops, give the required information. It's really not that big a deal. Do get the kids onto your DH's insurance ASAP.

 

I ran into something like this when I started my current job; we were in a weird status where we'd had to appeal our medicaid benefits (they suddenly remembered a rule they'd never bothered with before about wanting proof we'd exhausted VA benefits first) and didn't know how long we'd have them. I was fortunately able to appeal to have our insurance with my new job retroactively start from my start date of employment (normal policy for my employer is for it to start after 60 days of employment), which covered the gap that was created when they decided we didn't qualify for medicaid for that period because of the VA benefit rule (we would have been okay for the first month or two had they not invoked that rule because it took a while for my first paycheck to show up).

 

I would keep the appointment for the evals regardless of how the insurance sorts out.

It is not so much shame for me. My husband has shame over the medicaid. BUT, my thing about medicaid is that I have a huge passion for foster kids and homeless people and I feel that the system is making things so much worse. I am not sure what I can even do to try to help change happen. But needy people are pretty much shut up and shut out by those who are in the position to make laws and policy to fix this. I found the whole applying process to be mind boggling. I STILL have not even reported the increased income as no one seems to know how to do it and the website keeps saying I never entered the information when I get to the end of the form and click submit. And what about people who do not have computers or internet? Or phones to do the multiple long interviews? I had to do several interviews over the phone, per child. I spent many many hours and frustration just signing up for this. It is not as simple as fill out a form and prove the income. There is a very complicated and glitchy website with redundant forms to be filled in many times over and then try to submit, only for it to blank out and make a person re-fill them in. It is demoralizing to treat people this way based on low income and even on this board, people have made it clear "you want a government hand out so just deal with it." Ok...umm...first off, no, I did not want medicaid, but the government made a law requiring us to get it. BUT, since we had to do it anyway, why is it ok for anyone to be treated this way or put through this..and "government" is just the people. I paid way more in taxes in last year alone than what all of the medicaid cost for my children the entire time they were on it. The "government" is the people. They are not some anonymous force with the right to abuse and mistreat people all in the name of "handout." How about if we go down to a tent city and then wave food at people and warm clothes but then, make them do circus tricks for hours and laugh at them in order to get a pair of socks for their children. It is just not ok.

 

My concern is not for me. What I've had to deal with this so small it's a drop in the bucket. However for people who really really need the Medicaid, who can't get medical care for their kids, that is what concerns me. Something needs to be done to help people who need Medicaid so that their kids can get medical care. And what about disable people? What did they do? No wonder we have

Edited July 10, 2017 by Janeway

[mom2scouts]

One interesting thing though..IF we pay for the kids to have insurance, our income ends up being low enough to qualify for CHIP. LOL...IF we do not pay for the insurance, it is not low enough for that. 

 

I will have to wait and see with the next pay check though. If we do not qualify for chip when not paying for their insurance, I am thinking our income will only be too high by about $100 a month or so. We will see though, when the paycheck arrives.

 

It doesn't work like that. You have to report your GROSS income and that is what is paid *before* they take out for insurance, taxes and other stuff. As soon as your monthly *gross* income exceeds the CHIP amount, your kids will probably lose Medicaid. I wouldn't cancel the appointment you have though. The worst case is that you'll have to make payments for the evaluation, but at least you can get it done.

[EMS83]

The biggest problem I see here (aside from your state having lousy implementation of medicaid resulting in so few doctors accepting it) is your hang-up and shame over using public assistance.

 

YOU PAY TAXES that pay for these programs to be there when you hit hard times and need them. 

 

Just jump through the hoops, give the required information. It's really not that big a deal. Do get the kids onto your DH's insurance ASAP. 

 

I ran into something like this when I started my current job; we were in a weird status where we'd had to appeal our medicaid benefits (they suddenly remembered a rule they'd never bothered with before about wanting proof we'd exhausted VA benefits first) and didn't know how long we'd have them. I was fortunately able to appeal to have our insurance with my new job retroactively start from my start date of employment (normal policy for my employer is for it to start after 60 days of employment), which covered the gap that was created when they decided we didn't qualify for medicaid for that period because of the VA benefit rule (we would have been okay for the first month or two had they not invoked that rule because it took a while for my first paycheck to show up).

 

I would keep the appointment for the evals regardless of how the insurance sorts out.

 

Haven't paid federal income tax yet.  AND get thousands back every year.  Literally, $0 for twelve years now.  Biggest state bill was a few hundred.  Payroll taxes for Medicare and SSI, yes.  That's not what funds Medicaid, as I understand it.  We have never actually paid for the services we received.  And we live in a gap state, so we don't pay the penalty now, either.  And still get thousands back.  We use it to pay for healthcare.   :)

 

Edited because I can't type anymore.

Edited July 10, 2017 by CES2005

[Ravin]

Yes, medicaid can have byzantine bureaucracy. The first time we applied in my home state, we were turned down even though we had NO income and what savings we'd had we'd used up to put down a deposit on a place to live (when we moved here). I was six month pregnant with DD so it should have been a shoo-in. I had to reapply and got on about a month before I was due.

 

The whole "you're a veteran so you should have gone to the VA" after we'd been on medicaid for several years (and they'd never before brought up this VA rule though it had been on the books--I looked it up), in Arizona, one of the states with a huge backlog and problems with the VA benefit system...it was insulting and felt an awful lot like discrimination based on veteran status (although technically it wasn't; they were just capriciously selectively remembering to apply an existing rule). 

 

Before the computer setup was functional in my state, I did what people still do who don't have computers--go in to an office, fill in an application, and wait for hours for an interview. Basically it was AT LEAST a day's work every six months.

[Catwoman]

I was already frustrated that no doctors here, or pharmacies, take medicaid. However, if anything happened, I can take a child to the ER. So fine. I feel like things should change as people should have medical care and the state pays A LOT for medicaid per person to private insurance companies only for medicaid to not be valid. 

 

I called last month to report my husband's new job and was told that medicaid would still continue through Nov. As a result, my husband decided not to put the kids on the insurance which would have cost $500 a month to have them on. It would just be for a few more months like that. Fine. But, when I called medicaid today to report the income had actually come, as in, actual paycheck received, they say now that our medicaid will be terminated now. AND, they want the name of my husband's employer so they can call them and speak to them. WHAT????? My husband is working for a very small company. He does not want everyone to know his kids had been on medicaid.

 

I feel like when dealing with the government, they never know what they are doing. To top it off, son already started his ASD eval, at a place that takes medicaid, only to find out that medicaid may be cut off retroactively. He has his final testing date on Friday and I feel like I have to cancel or risk owing thousands of dollars. Ugh! No one can give us a straight answer!

In your previous thread, you said that your children rarely go to the doctor so it would be absolutely fine that you didn't want to pay the $500 per month to cover their medical insurance -- despite the fact that you could apparently afford to pay the $500. Many of us thought that was an unwise decision, but apparently you disagreed. In that thread, you never mentioned that it would be "just a few more months like that." It seemed quite clear that your intention was to skip the health insurance for your children altogether. You never mentioned that the Medicaid benefits were a factor in your decision. You made it sound as though you didn't intend to insure your children, period, so your story seems to have changed quite a bit.

 

I thought I might be remembering incorrectly, so I found the old thread ( http://forums.welltrainedmind.com/topic/647051-health-insurance-would-you-skip-it/ )

 

This was your OP:

 

Husband got the information on the insurance. It is $148 for us, each pay check, which means about $300 per month. THEN, it is $600 per month for the kids. OK..and THEN, it is a about $6400 out of pocket deductible before it starts to pay. Then once it starts to pay, it seems to be a copay plan, with then paying 70/30 after, we pay 30%, they pay 70. The copays are to the tune of $500 per ER visit, $40 per regular doctor visit, $70 per specialist visit, and then for tests, we pay a portion.

 

This is all to say, I am thinking maybe we should just skip the health insurance. For the kids at least. As it stands, they rarely go to the doctor. And= even if they have to go, it would cost a lot less than this. Short of something catastrophic, thinking this insurance is so expensive that we might be better off skipping it? Not sure.

You have also posted in the past about how you hated Medicaid and that you were totally embarrassed to have to admit to anyone that your family was using that service.

 

I'm not really sure what you want us to tell you. What's the real story here? Are you just venting about how you're angry that you can no longer receive Medicaid benefits, or are you upset about having to pay for the insurance because you now realize that you need it?

 

I honestly don't know what to advise you to do, other than to realize that you made a mistake and your husband needs to contact his employer and arrange to get the health insurance coverage for your children ASAP.

[chiguirre]

In Texas, you can buy into Medicaid for disabled kids who wouldn't qualify by income. It's a sliding scale and was pretty affordable IMHO. I found out about this possibility and could apply at my county's Mental Health and Mental Retardation Department. The Harris County office was very helpful and professional, but that undoubtedly varies. Good luck!

[Janeway]

In your previous thread, you said that your children rarely go to the doctor so it would be absolutely fine that you didn't want to pay the $500 per month to cover their medical insurance -- despite the fact that you could apparently afford to pay the $500. Many of us thought that was an unwise decision, but apparently you disagreed. In that thread, you never mentioned that it would be "just a few more months like that." It seemed quite clear that your intention was to skip the health insurance for your children altogether. You never mentioned that the Medicaid benefits were a factor in your decision. You made it sound as though you didn't intend to insure your children, period, so your story seems to have changed quite a bit.

 

I thought I might be remembering incorrectly, so I found the old thread ( http://forums.welltrainedmind.com/topic/647051-health-insurance-would-you-skip-it/ )

 

This was your OP:

 

 

You have also posted in the past about how you hated Medicaid and that you were totally embarrassed to have to admit to anyone that your family was using that service.

 

I'm not really sure what you want us to tell you. What's the real story here? Are you just venting about how you're angry that you can no longer receive Medicaid benefits, or are you upset about having to pay for the insurance because you now realize that you need it?

 

I honestly don't know what to advise you to do, other than to realize that you made a mistake and your husband needs to contact his employer and arrange to get the health insurance coverage for your children ASAP.

I made an additional post that the state told us that the medicaid would continue through the period it was already approved for. However, I do not know how to search the board for even my own posts so I cannot pull it up to show.

 

And NO, I did not make a mistake. I made a decision based on the information the state gave me. The state made a mistake. Not me.

Edited July 10, 2017 by Janeway

[Catwoman]

I made an additional post that the state told us that the medicaid would continue through the period it was already approved for. However, I do not know how to search the board for even my own posts so I cannot pull it up to show.

 

And NO, I did not make a mistake. I made a decision based on the information the state gave me. The state made a mistake. Not me.

Yes, you made a mistake in assuming that your children wouldn't need health insurance.

 

This story about how the Medicaid was supposed to continue for several more months is irrelevant to your previous thread where you said that you did not want to pay for health insurance coverage for your children. You said they didn't need to be insured.

 

I linked your old thread about health insurance in the post you quoted. You never mentioned Medicaid in any post in that thread, so clearly it was not a consideration when you made the decision not to insure your children. Here is that link again, in case you missed it in my other post: http://forums.welltrainedmind.com/topic/647051-health-insurance-would-you-skip-it/

 

 

(Edited to add link to old thread)

Edited July 10, 2017 by Catwoman

[Crimson Wife]

Your Walgreens doesn't take Medicaid?  Or is the state plan for prescription a different plan?  Walgreens accepts Medicaid nationwide.

 

Walgreens accepts Medicaid *IF* the medication is on the Medicaid formulary, which I have found to be VERY limited. Cheap medications are but expensive ones aren't. The doctor is supposed to be able to put in for a waiver but the waiver form disappears into a black hole :rolleyes: I gave up on trying to get my DD's ADHD medication approved by Medi-Cal after multiple attempts and just pay the 10% co-pay out-of-pocket (our primary insurance picks up the other 90%). If we were stuck using Medicaid as primary I would be p***** about that.

[rjand6more]

I don't mind driving that far for a doctors appointment, but it would be hard to do with a sick child. Doesn't matter. I never did find anyone who would take the medicaid. There was one doctor in our area listed on it. But when the baby got sick with a high fever, I tried to get an appointment. It was a month out to be seen with a fever. I even tried speaking to the nurse and explaining he was 1 yr old and had a high fever, but no help. It was going to be 32 days until he could be seen. We went elsewhere, but when we tried to get to the pharmacy to fill the prescription, I thought we could use the medicaid for that portion at least. Nope. I went to two pharmacies and neither took it. I finally ended up just paying for the prescription too.

 

I really am concerned that people who cannot come up with the money to pay out of pocket, like we did, are stuck leaving their children with untreated ear infections and such. It is not ok. AND, for all the money the state pays for these kids to private companies to have the medicaid, a simple antibiotic or trip to a pediatrician should be covered.

Was this the dr that was chosen as the child's physician on Medicaid?  Was the child an established patient?  If not, I would expect this.  Most offices in our area will not accept emergency patients.  They send them to urgent care/ER.  This is not special to Medicaid.  And if a doctor writes a RX and is not an accepted provider on your insurance, the RX will not be covered. (Same if the dr orders labs or tests.)  Again, not a Medicaid issue.

[regentrude]

It is not so much shame for me. My husband has shame over the medicaid. BUT, my thing about medicaid is that I have a huge passion for foster kids and homeless people and I feel that the system is making things so much worse. I am not sure what I can even do to try to help change happen. ...

 

My concern is not for me. What I've had to deal with this so small it's a drop in the bucket. However for people who really really need the Medicaid, who can't get medical care for their kids, that is what concerns me. Something needs to be done to help people who need Medicaid so that their kids can get medical care. And what about disable people? What did they do? No wonder we have

 

Become politically active.

Lobby for a single payer health care system.

Campaign and vote for candidates who care about the poor.  

 

Yeah, in your glorious state of Texas that is probably a losing proposition. But still, it's the only thing one can do.

Edited July 10, 2017 by regentrude

[Crimson Wife]

If your child does wind up with an autism diagnosis, he may qualify for Medicaid regardless of your income and if so, they will retroactively approve it for 3 months prior to the date you applied.

 

We experienced an issue last year where Medi-Cal mistakenly terminated my SN child's coverage (probably due to an administrative error) in June. I didn't find out about the error until October when a different program that depends on Medi-Cal coverage terminated her. Medi-Cal found her re-eligible as of 3 months prior to the date I contacted them, so August. Fortunately we had already hit our primary insurance's annual out-of-pocket maximum prior to the lapse in coverage (why I hadn't realized that there was a problem with Medi-Cal) so no cost to us. But the point is that Medicaid will retroactively approve 3 months from the date the child qualifies.

[Crimson Wife]

 Lobby for a single payer health care system.

 

Single payer would be a disaster for those of us whose kids have complex medical needs. My daughter only got her cochlear implant because we were able to switch to a PPO plan after the HMO plan we had at the time flat-out denied the surgery. I've seen the criteria for qualifying for a CI in countries with socialized medicine like Canada and the UK and it is WAY more stringent than even the HMO's criteria. Many children like my DD who would benefit from this amazing-but-expensive technology are S.O.L. when the government rations care. :thumbdown:

[Rebecca]

I did not read all the responses but Medicaid is based on income not on employment. You need to check the income guidelines. You can also choose a pay in option. My state has this. Does yours? Check. This means for a small amount a month, your children can stay on Medicaid. Again, you have to meet the income guidelines. Finaly, the new insurance should be able to retroact as well.

 

HTH

Rebecca

[nixpix5]

I think the autism evaluations were a reason for not switching. In my state as well autism evaluations are only covered by medicaid, so if you do not have medicaid you are self pay; no other insurance covers them.

 

OP was not trying to game the system, just making decisions based on the information that had been given to her.

This absolutely.

In my state most insurance companies will not cover autism treatment but medicaid does so if you are "fortunate" enough to fall under that umbrella you get much needed therapy for your child. If not then you are looking at hundreds to thousands of dollars in treatment costs. This leads to many people opting for subpar ABA therapists that they can pay an hourly wage to just to get some support. It is just not feasible even if you make enough to not qualify for medicaid.

[maize]

Single payer would be a disaster for those of us whose kids have complex medical needs. My daughter only got her cochlear implant because we were able to switch to a PPO plan after the HMO plan we had at the time flat-out denied the surgery. I've seen the criteria for qualifying for a CI in countries with socialized medicine like Canada and the UK and it is WAY more stringent than even the HMO's criteria. Many children like my DD who would benefit from this amazing-but-expensive technology are S.O.L. when the government rations care. :thumbdown:

There is nothing about implementing universal coverage under a government plan that would prevent people from getting additional private plans. Just like your daughter having both medicaid and private insurance now.

[Seasider]

:( I think I wouldn't have felt entitled to Medicaid once the family had access to employer insurance; I would have switched at once (especially given your hatred of Medicaid - in your prior posts you seemed to think that your family deserved better). That said, I hope you are able to find treatment for your son. I'm sorry for all the confusion and bureaucratic red tape.

 

 

Along this line of thought, I wouldn't have been a bit surprised to have medicaid dropped or at the very least adjusted downward once there was any family income. It's like FAFSA - they automatically assume any available funds are going to be used to defray costs, regardless of whatever else your family might need the money for. Frustrating, I'm sure, but not unexpected.

 

Hope you can find a satisfactory way to get your son's needs met. 

[goldberry]

Single payer would be a disaster for those of us whose kids have complex medical needs. My daughter only got her cochlear implant because we were able to switch to a PPO plan after the HMO plan we had at the time flat-out denied the surgery. I've seen the criteria for qualifying for a CI in countries with socialized medicine like Canada and the UK and it is WAY more stringent than even the HMO's criteria. Many children like my DD who would benefit from this amazing-but-expensive technology are S.O.L. when the government rations care. :thumbdown:

 

There are a lot of families whose kids have complex medical needs that are not getting any decent care at all.  They don't have options like switching plans.

 

Single payer would be a disaster for those of us whose kids have complex medical needs 

 

This may be true *for your family" but that doesn't mean it's true for all or even most.  Saying "when the government rations care"... you JUST SAID your private insurance denied it.  If you are not able to change plans, your PRIVATE INSURANCE has just rationed your care. 

[Alessandra]

Yes, medicaid can have byzantine bureaucracy. The first time we applied in my home state, we were turned down even though we had NO income and what savings we'd had we'd used up to put down a deposit on a place to live (when we moved here). I was six month pregnant with DD so it should have been a shoo-in. I had to reapply and got on about a month before I was due.

 

The whole "you're a veteran so you should have gone to the VA" after we'd been on medicaid for several years (and they'd never before brought up this VA rule though it had been on the books--I looked it up), in Arizona, one of the states with a huge backlog and problems with the VA benefit system...it was insulting and felt an awful lot like discrimination based on veteran status (although technically it wasn't; they were just capriciously selectively remembering to apply an existing rule).

 

Before the computer setup was functional in my state, I did what people still do who don't have computers--go in to an office, fill in an application, and wait for hours for an interview. Basically it was AT LEAST a day's work every six months.

I am another advocate of physically going in to a government office and getting the paperwork done. IMO, it saves time and stress in the long run. Getting in line way before the office opens is important, imo.

[QueenCat]

I don't mind driving that far for a doctors appointment, but it would be hard to do with a sick child. Doesn't matter. I never did find anyone who would take the medicaid. There was one doctor in our area listed on it. But when the baby got sick with a high fever, I tried to get an appointment. It was a month out to be seen with a fever. I even tried speaking to the nurse and explaining he was 1 yr old and had a high fever, but no help. It was going to be 32 days until he could be seen. We went elsewhere, but when we tried to get to the pharmacy to fill the prescription, I thought we could use the medicaid for that portion at least. Nope. I went to two pharmacies and neither took it. I finally ended up just paying for the prescription too.

 

It is typically helpful to establish your self asap with a doctor as soon as you need a new doctor (like when you get new insurance, such as Medicaid) so that you will be seen quickly when sick. Most doctors require a well child/physical or a basic appt to establish oneself as their patient, regardless of which insurance the patient is using. Unfortunately, if one hasn't done that, than urgent care is usually what is needed.

[QueenCat]

 

I called last month to report my husband's new job and was told that medicaid would still continue through Nov. As a result, my husband decided not to put the kids on the insurance which would have cost $500 a month to have them on. It would just be for a few more months like that. Fine. But, when I called medicaid today to report the income had actually come, as in, actual paycheck received, they say now that our medicaid will be terminated now. AND, they want the name of my husband's employer so they can call them and speak to them. WHAT????? My husband is working for a very small company. He does not want everyone to know his kids had been on medicaid.

 

Too bad, if that's the requirement, so be it. It's not the government's problem if your dh is embarrassed. And on the flip side, there is nothing wrong with having kids on Medicaid. Ever. To imply that there is tisn't very nice to those here in this group whose children (or they themselves) need it for the long term.

[Janeway]

Too bad, if that's the requirement, so be it. It's not the government's problem if your dh is embarrassed. And on the flip side, there is nothing wrong with having kids on Medicaid. Ever. To imply that there is tisn't very nice to those here in this group whose children (or they themselves) need it for the long term.

I am not saying people on Medicaid are bad. I am saying Medicaid where I live is bad. There is a difference. And the process to get on it is not ok. I probably put in more than 40 hrs of work applying for it. No one there can even tell me of a pharmacy to go to. Some working there think the Medicaid is good until the renew date regardless. Some think it changes based on income. They all agree it takes a month for any changes to be processed. No one has any idea to if they can retroactively take away the Medicaid. They send letters monthly to inform me that my child needs to go to a well check. They don't give a name as to who to take them to. I looked up how much my tax dollars pay for each child to be on Medicaid. The state gives a lot of people's tax dollars to help wealthy insurance companies get wealthier while children still can't see a doctor. I am tired of the uber wealthy getting richer off of the tax dollars of the hard working class people. The government won't fix this because politicians financially benefit by scratching the backs of the wealthy.

[Janeway]

Too bad, if that's the requirement, so be it. It's not the government's problem if your dh is embarrassed. And on the flip side, there is nothing wrong with having kids on Medicaid. Ever. To imply that there is tisn't very nice to those here in this group whose children (or they themselves) need it for the long term.

Well, do YOU have to allow the government to call your employer? Cause if you don't, why should it be a requirement for me?

[PinkyandtheBrains.]

Your Walgreens doesn't take Medicaid?  Or is the state plan for prescription a different plan?  Walgreens accepts Medicaid nationwide.

 

I do find it odd they want to call your employer.  Maybe they have to verify you qualify for something else before they remove you. If it was me, I would just ask if that was the case, and then see if I could provide them with information.

 

 

 

This is only partially true because many states have outsourced Medicaid to private insurance companies. Until a few months ago, I could not use my medicaid option at Walgreens. 

[PinkyandtheBrains.]

Too bad, if that's the requirement, so be it. It's not the government's problem if your dh is embarrassed. And on the flip side, there is nothing wrong with having kids on Medicaid. Ever. To imply that there is tisn't very nice to those here in this group whose children (or they themselves) need it for the long term.

 

 

 

Yeah, I don't understand the embarrassment.  

 

 

We have medicaid, first because of extended unemployment and now because of inadequate income.  There is nothing shameful in this. 

 

 

The idea that using medicaid is somehow shameful is offensive to me.

 

I've read the OP's previous posts about the topic. I am already aware of her feelings on medicaid and people who need it. 

 

smh. 

[Crimson Wife]

There is nothing about implementing universal coverage under a government plan that would prevent people from getting additional private plans. Just like your daughter having both medicaid and private insurance now.

 

You think companies will continue to offer private health insurance to their employees once the Feds stop allowing them to write off the cost on corporate taxes? If you do, I've got some oceanfront property in AZ to sell you...

[QueenCat]

Well, do YOU have to allow the government to call your employer? Cause if you don't, why should it be a requirement for me?

 

Why should I? I have insurance through a private company, paid for by the employer. Totally different scenario. I can see Medicaid needing to verify information with the new employer to be sure of cut off dates, eligibility, etc.

[QueenCat]

I am not saying people on Medicaid are bad. I am saying Medicaid where I live is bad. There is a difference.

 

Actually, you have implied that it is something to be ashamed of, both in this thread that you started and in other past threads.

[QueenCat]

Yeah, I don't understand the embarrassment.  

 

 

We have medicaid, first because of extended unemployment and now because of inadequate income.  There is nothing shameful in this. 

 

 

The idea that using medicaid is somehow shameful is offensive to me.

 

I've read the OP's previous posts about the topic. I am already aware of her feelings on medicaid and people who need it. 

 

smh. 

 

It should be offensive, it's not nice to imply such things. I'm sorry you experienced that here.

[Crimson Wife]

 This may be true *for your family" but that doesn't mean it's true for all or even most.  Saying "when the government rations care"... you JUST SAID your private insurance denied it.  If you are not able to change plans, your PRIVATE INSURANCE has just rationed your care. 

 

But we had the CHOICE of multiple private plans. We could go with the lower premium, lower deductible managed care option or the higher premium, higher deductible PPO option. Single payer puts EVERYONE on the same cheap & cr*ppy plan, regardless of their willingness to pay for a more generous plan.

 

[PinkyandtheBrains.]

There are a lot of families whose kids have complex medical needs that are not getting any decent care at all.  They don't have options like switching plans.

 

Single payer would be a disaster for those of us whose kids have complex medical needs

 

This may be true *for your family" but that doesn't mean it's true for all or even most.  Saying "when the government rations care"... you JUST SAID your private insurance denied it.  If you are not able to change plans, your PRIVATE INSURANCE has just rationed your care. 

 

 

 

Private plans are rationing all the time. Deny Deny Deny, until you get worn out appealing and give up.

[ChocolateReignRemix]

But we had the CHOICE of multiple private plans. We could go with the lower premium, lower deductible managed care option or the higher premium, higher deductible PPO option. Single payer puts EVERYONE on the same cheap & cr*ppy plan, regardless of their willingness to pay for a more generous plan.

 

 

You do get that not everyone has the "choice" of private plans, right?

 

I also feel compelled to point out that those nations with those "crappy" plans somehow have lower costs per capita but better overall health outcomes.  Just sayin'.