Loss of Medicaid, Any Ideas?

Feb 7, 2013

  1. Lowcountry 42
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    Lowcountry 42 Expert

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    I met with a lady about her Life Insurance and instead ended up listening to her story about loosing her medicaid and I'm clueless about a possible solution.

    Client has A dual needs MAPD and in November due to spouse passing her income increased so she lost mediciad but did not change her MAPD so now she is getting the 20% that medicaid used to pay billed to her. She is a very sick woman so I'm wondering if the loss of medicaid gives her any GI type rights to enter a Medsup(no way she is gonna pass any underwriting)?

    She gets extra help with her precriptions, so any ideas on how I Might help her?
     
  2. Guest
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    she has an sep code to use when she loses her medicaid status, put her into another mapd that fits her needs.
     
    Last edited by a moderator: Feb 7, 2013
    Guest, Feb 7, 2013
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  3. honestagent
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    Also tell her to get with a case worker at the local office that can either put her back onto Medicaid if that's what she needs/wants. Depending on her Medicaid status, (what tier she falls under be it LIS QMBI, etc., etc. ) it may make sense to go back onto the system or get into another MAPD.

    If she's hurting for money, and she's getting aid for drugs right now but not on the medical, that tells me she's not a full blown medi medi which means she may be better off on an MAPD.

    I don't know... that's where you come into play to dig and ask more qs about her care while she was on Medicaid, ie. were you on spend down? what did you play for copays on drugs? dr.s visits? what was/is your monthly income? If it was over 1000k a month, then she's most like not a full blown dual, which means get an MAPD, but def. she should consult with a case worker to affirm her status of full blown dual eligible, spend down, or something other.

    PS if they see she has money, she won't get the aid; or any aid. Let her know that. And yes, they will find it even if she tries to hide it. (5 year look back or longer depending on the state). Good luck!
     
    Last edited: Feb 7, 2013
  4. Lowcountry 42
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    Lowcountry 42 Expert

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    She is QI and she goes to the doctors 3-6 times a month so it seems to me the copays she would pay with an MAPD would be more in a month than a medsup premium. So is it possible to go with the medsup? She will not pass underwriting which is why I asked about any GI rights due to her loss of medicare?
     
  5. BobbyMcGee
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    BobbyMcGee Guru

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    Being so sick, maybe she qualifies for a chronic Snipper. Some have "social services coordinators" that try to get her what she needs.
     
  6. abcsales
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    abcsales Super Genius

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    yes, she is GI from loosing Medicaid
     
  7. Millwood
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    Millwood Super Genius

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    Will depend on your states law whether losing Medicaid is GI. In OK it's not. This will vary by state.
    Even though our state doesn't consider losing Medicaid a GI event some companies like Blue Cross will issue the policy GI.
    Best bet is to contact the company directly and ask underwriting about your specific state.
     
  8. G.Gordon
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    Mill wood has it down.
     
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