Medicaid and retro claims

Jul 1, 2008

  1. Crabcake Johnny
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    Crabcake Johnny Guru

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    Anyone here know something about Medicaid?

    Just took a call - father freaking out. His 23 year old daughter is currently hospitalized - major accident (not car) and apparently she is going to need a lot of care.

    She is not a dependent - father did not claim her and she's not a student - worked for a peace group and made next to nothing however still lives at home.

    She has no coverage and the hospital is playing hard-ball regarding the money owed. The father is going nuts thinking that some way some how the hospital is going to try and attach his assets...which he thinks they cannot do since she is not a dependent.

    We were talking about the state plan however another insurance agents told him she the daughter can get onto Medicaid and get all the current hospital bills paid. To me, that doesn't play out.

    So basically the advise the father got from this other agent (local agent) was if his daughter went onto the state plan she obviously cannot also get onto Medicaid which means someone owes the bill....which he cannot come close to paying.

    The only correct piece of advice the father got was MHIP has outpatient limitations and with the level of care she'll need MHIP is almost a worthless option.

    He also doesn't want his daughter to have to file for BK. Now, why she's running around without coverage is one issue but I'm trying to find whether or not that other agent's advice was accurate about Medicaid paying the current bill.
     
  2. SportsNut
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    I think the info the other agent provided is accurate... Into the state pool or plan, not medicaid, at least for health benefits.

    Medicaid is administered by each state... and the income limits for each state are different, but appx if she has less than 10K of sustainable income, and NO assets, then she may be eligible. The trick here is the admin of the program is slow... and they may well want t look at her prior income in which to disqualify her from benefits. Any assets she has such as a car or real estate or savings will have to be nearly exhausted before any benefits are afforded.

    The father should take extra care so that the hospital doesn't attempt to slide some paperwork in front of him where is accepting financial responisibility or a co-gaurantor. Other than that he would have NO liability for payment of any bill for a child who hase reached the age of majority; (18), regardless of whether they are a student or claim them as a dependent on their taxes.

    The hospital should have a patient relations office that can counsel him on what to do relative to getting in touch with Medicaid for any potential benefits. The problem here is Medicaid is not likely to pay for the costs being incurred NOW, or until her approval and acceptance onto Medicaid was effective. Then and only then would they pay for costs going forward, not back. She may also have to qualify for SSI disability first, which is a terribly time consuming event... If seriously incapacitated, she may need to made a ward of the state first, in order to qualify... Said but true.

    So, the daughter will certainly have some costs hanging over her head either way... those sound like charge off costs to me and every hospital knows those ropes. It doesn't mean that the daughter may not have to file Bk to rid herself of such claims, but this is the realities of not being covered in advance.... If you spin the roulete wheel of life and forego the cost of adequate coverage against such contingencies, sometimes you LOSE BIG... and in that, and other respects she has... unfortunately.

    You might want to check the link below, assuming the person is in MD.

    http://www.dhmh.state.md.us/mma/html/WEB--ma apply2-06.htm
     
  3. bluemarlin08
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    SportsNut is right on target. Can't emphasize enough the point about dad not signing anything. The suggestion about talking to a representative from patient services is SO important. Hospitals deal with this daily and understand that unless they help the client navigate the government programs they won't get paid anything.
    Unfortunately, this is also an example of how long term care insurance isn't just for old folks and nursing home care. Without LTCi most everyone must pay for all custodial care.
     
  4. theinuranceguy
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    The daughter is 23. She needs to be pregnant or have already had a kid before she can enroll into the Medicaid program, regardless of income.
     
  5. SportsNut
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    Are you volunteering any services...? (ala The World According to Garp).

    I think that if she is long term disabled, (likely to be permanent) then she will qualify regardless of the dependent or almost dependent.
     
  6. theinuranceguy
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    :D

    As for her being disabled... she would have to be disabled for 24 months before she could get Medicare... or be blind...

    In OH, I have seen people live in filth, but have no health insurance because they had no dependents...
     
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