SSI & Medicaid questions

Discussion in 'General Parenting' started by klmno, Jul 7, 2008.

  1. klmno

    klmno Active Member

    Pertaining to applying for medicaid for a difficult child:

    I'm getting mixed messages regarding medicaid- do they only go by the parent's gross monthly income? Or do they ever look at income coming in and bills that have to be paid to consider what is left to live on- maybe not all bills, but mortgage, utilities, etc.? Also, what do they do if your pay varies from month to month because you (the parent) are working by the hour?

    Regarding SSI: The man at the social security office told me that they use the parent's monthly income to decide what child qualifies for SSI for disability. Is this true? Meaning, if a child is disabled, the child won't qualify for anything if the parent's income is above the poverty level? Also, he said it took 4 to 6 months to find out if the application is approved- does that sound right?

    Someone from one of the state agencies said that difficult child would qualify for SSI because of his BiPolar (BP) diagnosis, previous acute psychiatric hospital stays and now sentence in detention. She said this meant he had previously been institutionalized. However, on the SSI child report form, it asks if and how the disability seriously impacts the kid's daily life. What on earth would I put there? He goes to mainstream school, in collaborative classes, on an IEP. He goes to day camps in the summer and lives at home. But, I have to supervise him more because of him being unpredictable at times and now with the legal problems, the PO and GAL are requiring it- and imply that I don't do enough as a mom if I don't make sure he's supervised 24/7 (even though none of his legal violations occureed when I was not at home). I'm starting to think that he really wouldn't qualify.
  2. dreamer

    dreamer New Member

    first, with ssi and medicaide, I think it can vary by state.
    over the years we have had all of us at times, and at other times just the kids on Medicaide here. Me and husband are both on soc sec disability, so- our income is the same, fixed and does not vary, but the eligibility $ amunt year to year can change sometimes. But yes, here by me, my oldest- my difficult child altho she was pretty nonfunctional, could not get Medicaide simply becuz of her disability- it was only given by income criteria here, and we did not have waivers here at the time for her type diagnosis. (it may have changed, this was a couple-- few years ago) so sometimes our income as a family was low enough for the kids to have Medicaide and some years it wasn't.
    We tried to get SSI or coverage thru soc sec of one kind or another for difficult child for her own diagnosis, BUT.....our case was not standard or typical... our kids already got dependants benefits from soc sec due to both me and husband being disabled, and the $ amount they got as dependants- whether disabled or not was at just the $$ amount that preccluded her from getting awarded for her diagnosis.....BUT, if they DID award her ssi, it would have been slightly less than what she already got for being a dependant of disabled.
    Once she turned 18, and no longer qualified as a dependant on us, THEN she DID apply for and get her own soc sec disability disabled before 18, and now gets the same $$ amount she got as our dependant (if they had given her pure ssi, she would have gotten slightly less) And then, after age 18, she did apply for Medicaide and she did get that as well, becuz her income is below the income cutoff NOW......on her own.....where only her income counts- becuz she is over 18. BUT there is some other weird glitch, she also applied for foodstamps, and they said only her income counts, and she qualifies $$ wise BUT......there is some "special" thing about her being between ages 18-21?22? and they told us, nope, it is up to US to feed her until then?

    The other problem here where I am, (I do not think it is the same in the major cities or further south in the more rural and less affluent counties---??) There is an extreme problem of FINDING a doctor who will ACCEPT Medicaide.....and even the hospital gives Medicaide recipeints a hard time. No, they are not supposed to----it is illegal, where I is a huge problem....and yes, it is even spoken of and acknowledged in media......but---- thats just HERE. So for my difficult child? Her Medicaide? she has had it 18 months? It is useless, as we have called now over 100 docs for her high blood pressure, bipolar, agoraphobia etc and not a single doctor anywhere we have called thus far will accept her. <sigh> HOPEULLY that will NOT be a problem for y0u----
    and yes, it took us like 9 months to get the answer for the soc sec and 3 months to get answer re Medicaide. The soc sec comes up for reiview approx every 18 mos to 3 years, the Medicaide comes up formally once per year but you must immediately report certain status changes to income, family size, living arrangements etc. and here the Medicaide card is issued monthly for that specific month.
  3. dreamer

    dreamer New Member

    PS------my easy child recently got Medicaides "Moms and Babies" due toher preg....she already has ins coverage under the military ins we have due to husband being "100% permanant total service connected disabled" - Her Medicaide is secondary coverage for preg moms low income or whatever? (If she had no other it would be primary) Well, ironically while normally Medicaide pays for inpatient and medications etc,?? so far um...non of the medications Rxed by ER this last week have been covered by the Medicaide and our military ins pays 100% for medications recieved thru their medication by mail---those take up to 5 weeks to get? and need was urgent to get these? I have been paying 30% of all these medications out of pocket.....AND PCs Medicaide card says "no inpatient coverage"?? (I have psted several posts the last 10 days or so in watercooler about our joyous being shoved back and forth between doctor and ER.....a very very ill preg easy child stuck in middle, in spite of haveing dual coverage insurance, grrrrr
  4. klmno

    klmno Active Member

    Thanks, Dreamer, I just simply don't know what else I can do. I'm going to call the court clerk tomorrow and ask her what a person can do if they cannot afford to do what the judge has ordered. The ONLY hope I have of ever pulling thru this is to go back to work full time next month. I am in this situation due to weekly counseling sessions (that haven't done a damn thing for either of us), meetings with PO, 10 court dates in the past 15 mos., paying for and meeting with attny's for difficult child's legal issues and bro filing for custody, not to mention the typical meetings/appts with school district, dr, etc.

    difficult child would have to be let off probation or at least changed to a PO who will meet after normal working hours. I would either have to find a counselor who meets in eves. (already tried) or the court order removed. The PO and GAL would have to get over difficult child being by himself for 1 - 1 1/2 hours between him getting home from school and me getting home from work. (He can and does and I make him call me.) To me, that doesn't sound like too much to keep a child in the only home he's known, with medical insurance and necessary psychiatrist and dr visits. To them- s**T is going to hit the fan and they might possibly remove him from home, and god forbid, get my bro involved again.
  5. klmno

    klmno Active Member

    Well, I hadn't really considered getting preegnant and having another baby at my age. Boy, I sure hope that isn't what I have to do to make this work!!
  6. flutterbee

    flutterbee Guest

    klmno -

    No offense meant, but why not just apply and see what happens? Once you apply, they should schedule a face to face interview at which you bring all your documentation (financial, proof of identity, proof of citizenship, etc) and they can tell you then if you qualify or not, as well as why. If they say no, they say no. It doesn't mean you can't apply again should your circumstances change. I imagine they will find a way to average your income. They want the most recent pay stubs, but if there is a big discrepancy from one month to the next, I'd take a few months worth and let them come up with an average.

    With our state, the income guidelines for children's medicaid is just what it says. Those numbers already reflect the allowable deductions for utilities, etc.

    As far as SSI, my understanding is that a child has to have a qualifying disability, but there are income limitations as well. So, the lady may have meant that difficult child qualifies because of his disability, but SSI will also look at income.
  7. klmno

    klmno Active Member

    No offense taken, Heather! The lady at soc services today was trying to convince I should just go ahead and apply. I broke out into tears- right there in the waiting room- because I was trying to ask her how long the process would take and explain to her that I couldn't wait for 2 mos to find out it was rejected and to ask if this left any door open for GAL to claim that I couldn't provide for my son- the lady wouldn't let me in to talk with anyone who knew the "ins-and-outs". It was just like at the county mental health dept- the person at the front desk will answer questions- if they know them. I was starting to think that maybe this lady knew the answers- until she asked me what a Guardain ad litem was. Then she said- "so what do you have to lose." That's when I became an emotional basket case, and told her "my son" and just turned around and left.
  8. flutterbee

    flutterbee Guest

    I know in Ohio the process cannot take longer than 30 days. I don't know if that varies by state or if it's a federal guideline. I think 2 months would be extensive and would be surprised if it takes that long.

    SSI does take longer.
  9. dreamer

    dreamer New Member

    Nah, the preg thing ONLY covers the preg mommy and then the new baby- noone else. I think it is to try to help "ensure" healthy newborns? (HA! yeah, OK but then WHY are they not SEEING the preg mommmies?)

    I agree, go ahead and apply- worst that can happen is they say "no" and then you can still appeal?

    THey might not know what guardian ad litem is.....they know only their dept, their info-----depending on what position the person you talked to holds, might ONLY know how to set you an appointment to talk to one of the people you meet up with.....and even the person you do meet up with face to face might only know what is on their application form, and maybe nothing more...depends how long they have worked there and all kinds of other things. And I am fairly sure the person you meet face to face is not the person who makes the determination, they are just the person who tells you what to bring in for documentation.....

    It actually took like 3 months to hear determination for difficult children soc sec status....and then another month after she was granted it to GET it..and they paid retroactive to the date we filed. It took like 3 months to get her Medicaide rolling.....and they never told us if she did get it, it just one day arrived. PCs Medicaide came MUCH faster----butthey told us when we applied she WOULD get it, I think due to the preg? Her "card" arrived in 20 days. and was backdated on it to the date we applied.

    When dealing with gov agencies, who knows what they think ? My husband military bens took 10 YEARS of us actively pursuing his claim.....and then yes, it was also retro.....actually it came in in "peices" first 10% awarded with an appeal, then 30% awarded and retro back to make up for the time when they only gave him 10% and so on......appeals every step of the way.....10 years from first filing to his 100%----and gypped out of 5 years before that when he was told orally not to apply for his vets bens- even tho he was already disabled from the same diagnosis but only got soc sec ..... gov agencies live in their own world. The Twilite Zone, I think?
  10. klmno

    klmno Active Member

    Other than the concerns of stirring up issues with the GAL/judge, having to go thru the "where is difficult child going to live" tramatic experience again, and worry over going after difficult child's father until he is involved in difficult child's life (which would be wonderful if he wasn't the way he is)- the problem is that if I don't have this resolved in 1 month, we are going to be in a bigger financial mess. So, given that the medicaid would help a great deal but even that won't solve the problem, I'm kind of wondering if I shoul;d pursue it. Basicly, the problem won't be solved until I can work full time againi or get a much better paying job if I have to be paid by the hour. Usually, if there are no benefits paid by the employer then the hourly rate paid is higher. That isn't the case here. Anyway, if I pursue getting more income coming in, difficult child definitely won't qualify. Maybe I should file, then if I can't find a better paying situation, at least this would help.

    I need to feel the situation out with the GAL. I have a call into her- I asked her to call me back at home because it would be difficult to discuss this from work. Any time I've asked that before, she has called me at work. During lunch time.
  11. klmno, I empathize with you on your situation. I would definitely apply - if you don't you never know. I have applied for Medicaid (even though i knew financially we didn't qualify) I did specify for the Katie Beckett Waiver though. I received a denial for Medicaid, but then I received a letter stating that my app had been forwarded to the office that handles the Katie Beckett waiver. I submitted an application for SSI for difficult child and had my interview in April. I was told it could take up to 6 months to find out. I was also told by the case worker at the hospital that difficult child would qualify for SSI but be prepared for a denial - because that is just what happens sometimes and then you have to appeal. difficult child already receives survivors benefits because his father is deceased. The SSI payment probably wouldn't kick in until he turns 18 then he would receive the SSI instead of survivors. The biggest thing is though that if difficult child qualifies for even $1 on SSI he will AUTOMATICALLY get medicaid. That is what I am hoping for even if no additional funds come in (even though I could really use them), I need the Medicaid coverage for difficult child to help out with the difference in what our current coverage is.

    I am drowning in medical bills for difficult child even with insurance - I can't imagine not having any coverage at all.

  12. klmno

    klmno Active Member

    Thanks, Christy! Janet and someone else touched on some of the options you pointed out, too. I have been so worried about it all that, I swear, I don't think I am thinking very straight lately. I am going to go back thru some previous threads and write notes!! What office did you go to to apply for Katie Beckett? I remember looking it up online, but I didn't find anything for Virginia.
  13. When I went into apply for Medicaid originally, I had looked up the Katie Beckett waiver and found a flyer for it for Nevada DHS. Anyway, I mentioned it to them when I went in. I was told that in Nevada there is only one DHS office that handled the Katie Beckett waiver regardless what local office you were assigned to. This is where I turned in my Medicaid application. The people there that accepted the application had me write on the top of the application Katie Beckett waiver requested. I would either go into the office where you would apply for Medicaid or call them. Some workers might not know about it. The office I went to, the people at the counter didn't know anything about it, so they had to go ask someone (one of the people that do the interviews). Again, when I took my app to the office that handled the applications, they person at the counter didn't know about it and had to ask someone else. Apparently it is a well-kept secret.

    With the Katie Beckett program you are able to exclude all income except for the child's.

    I hope this helps.


  14. dreamer

    dreamer New Member

    a warning- not all states have waivers, not all call their waivers Katie Beckett- and Medicaide is not automatic with ssi in all states.....

    Apply for everything.....go for it.....but yes, it can take quite awhile, and yes, you might get turned down...appeals take even longer......and I know you prolly do not have a plan B......but it sounds like you are doing all you can humanly do.
  15. klmno

    klmno Active Member

    So, what would you do if you had to choose between paying the house payment or paying (in order to keep) medication insurance for difficult child?
  16. dreamer

    dreamer New Member

    klmno? been there done that, yup- more than once. and been without medical coverage, as well. Had I had coverage when I first got ill? I would not have spent 3 years as a quadriplgic.....I was the sole support for my family, and also the sole caregiver for my very ill husband.
    For a time, our income was $800 per month. 5 of us. husband medications were over $2,000 a month, difficult children were $2500 a month, mine would have been over $5,000 a month.
    we skipped my Rx patient assistance for difficult child and I left husband at VA hospital.
    My house has been in foreclosure twice. For a couple years (before I got so sick) I walked 7 miles to work and back....
    I do undrstand the crummy choices, the gut wrenching decisions, being stuck between a rock and a hard place. Yes, I had CPS here telling me they would yank my kids if I did not find a way to do x, y or z.
    I wish I had magic answers. I never found those magic answers. I attended county board meetings and begged for help------I showed up in person at my state reps offices and begged for help. I do not know what the answers are. I can only offer you my experiences with those programs and how they worked for us when I tried. Apply for them.....worst they can do is turn you down. Then appeal. BUT doubtful any of it will go thru with any measure of speed. Maybe it will, that would be great. Maybe now there are emergency types of ways for it to be handled. I wish you the best luck. But, if we count on luck? Mmmmm mine is not so good. (see my posts in watercooler about my very very ill easy child and her current medical drama unfolding)
    I am hopeing very hard for you that it works out much better for you. I would love nothing more than some serious major reform in those kids of places. Believe me.
  17. klmno

    klmno Active Member

    dreamer- I have read a few posts about what you and your daughter are going through- it is horrific. Our whole medical system (doctors and insur) is a mess.

    I have been sitting here researching online. Our state doesn't have Katie Beckett or TEFRA (I just learned what that is). But, it does have a waiver program. I guess the states that use a waiver program can pick and choose who to give it to- no discrimination that way (LOL!). Anyway, in order to check into and apply for that waiver, youu have to go through your local Children Services Board (CSB) (Community Services Board) case manager. This must have been why the lady at the state mental health office kept telling me to call there and make sure I spoke with a Children Services Board (CSB) case manager and tell them my son had previously been in a psychiatric hospital, twice, and was currently in detention and is being treated for BiPolar (BP). Now, it makes sense.

    She also told me if no one called me back from there, (she gave me the direct number to the Children Services Board (CSB) manager or something), then call the state mental health office back and tell them. I think I'll do that!! :)

    Thank you for your help- especially when you are dealing with so many things in your own family right now... that means a lot to me. And I sincerely hope that someone can jerk those doctors into gear and help your daughter.
  18. dreamer

    dreamer New Member

    I hope so, too, becuz I am starting to be afraid literally that my dtr could.....die.
    This is insane.
    BUT -----so much of this type of craziness? I have been going thru it for years....with difficult child and husband and my son.his eye.difficult children issues, at school, thru WRAP and all that.....I have no faith in anyone at any gov trust things will go the way they are supposed to- not with insurance, not with docs/hosps, not with schools, not in court.....
    I mean, I had court for a case where easy child was a victim back since 99..when her and difficult child DID report it to their school and local police, but school and local police did nothing, not even tell me.....and then in 05, they reported again, further abuse, and the guy was arrested in 05...and here we are and we have not even yet had PRETRIAL ------meanwhile this creep has over 22 felony predatory sex charges 8-10 felony drug charges, then add in child porn, witnes harrassment and in Dec judge reduced his bond and refunded him back $35,000 cash! (becuz defendant had a new baby!)

    I went to due process with school- what a joke.....hearing officer told me, take your child out becuz school is NOT gonna listen to me or her or state or anything......

    Had instense in home services for difficult child.....ha ha they "graduated her" out of their programs saying she completed her goals- while she was at the time inpatient in a psychiatric hospital.

    I have seen and witnessed and experienced so much weirdness.....above and beyond what could ever possibly be blamed on me not knowing how to work any system......

    in my humble opinion there are some times, some agencies, some situations....where powers that be simply hit a dead end and do not know what to do anymore, so to cover their own behind, they begin to manipulate records, charts, files, paperwork, so that in the end, it will LOOK like the difficult child is worse than the difficult child is.and beyond help- or the parents or difficult child were just totally uncooperative (even if that is not at all the reality) or whatever..just so thay can pass the buck.

    And the help agencies I think intentionally keep the desk and phone people unknowledgeable, to make the whole process more difficult, take longer etc.....becuz they hope less people will persvere and continue to keep on trying. If the applicants drop the ball, noone has to be bothered processing their paperwork.
    Yes, I AM cynical, and yes I am paranoid. I have been dealing with Medicaide, Medicare, Veterans AFfairs, phosps, tdocs, soc sec, etc for over 20 years. Yes, we have had some extreme situations in our life here.....between husband, difficult child, me and son and now easy child.

    HA! Go figure, I was an advocate for elderly.....for mentally ill......for ALzheimers AND Hospice......Yes, for a time, I provided in home care and on occasion in home respite.....and I also was called to be a case manager......

    I respectfully declined. From others, I learned just how corrupt it ALL is.and how things get twisted to pass the buck so liability and accountability WILL fall to the people needing the help. (If the helping agencies are not haveing any luck) OK< so, I have NOT been in that now in a few years..and MAYBE things have changed......but......

    It is so sad, so scary, so wrong.
    and yes, Life has been unbelievably difficult. and it has taken a major toll on me. and, I AM a product of my Life experiences. I am hoping SO hard YOUR experiences work out vastly better!
  19. flutterbee

    flutterbee Guest

    Honestly, if I had to choose over the mortgage and medical insurance, I'd pay the insurance. You can always find another place to live. Yep, your credit will be trashed for a while, but that's temporary. If health insurance lapses long enough for pre-existing conditions to apply, it could be detrimental.
  20. klmno

    klmno Active Member

    Ohhh, Dreamer, I will keep her in my thoughts, and you, too. Just keep pushing for her like you have been. I hope she is resting as much as she can. That is so frightening.

    I really don't know how you have withstood all this- what is going on now plus everything you have already had to deal with. I remember you answered some of my questions and frustrations a long time ago- I think they were mostly about school. I know you are telling the truth about these things and most people who have never had to deal with it would never believe it. Some of your responses kept me from thinking I just must be insane. Especially, when the "good and honest" people that I work with, or others who have NEVER walked in these shoes, would just say that I should trust them, or maybe it is me that should listen to them more, and things like that. Now, I realize that I am not always in the right and I can learn a lot from other people. But, I do know what you are saying about people changing records or doing anything else they have to in order to cover their rears. It does happen- and not just with the school district.

    I'm very grateful to you and others on this board who share their stories so that people who come here like me know that it really is that crappy of a situation sometimes and "here are some suggestions" or "this didn't work for us".

    So, keep hanging in there! Again, you and your daughter will be in my thoughts and prayers...