Medicare/Medicaid "Full-Dual" Eligibility To "Spend-Down" Special Election Question...

[rmhaire]

He just got booted off his "full dual" Medicaid status

The key word in your post is the word Disability. Nothing is set in stone when we're dealing with a disabled client.

Always start with why they are disabled and work backwards.

SSDI does not consider a spouse's income but Medicaid does. (state specific) Is the boot because of a spouse's income?

Always verify exactly where the payments are coming from. Federal or state.
Clients are easily confused between the two. Get copies of all letters.

Is the boot because of post Covid? Some states are going back to pre-covid benefits.

It takes a little detective work on your part but always find out why.

after more than 30 years in the biz

Just 30? Call me when you hit 50 and I'll buy the beer.

 

[AgentGeneral]

It also doesn't help that I'm in the state of Illinois, and particularly Cook (Crook) County....Chicago's County. This state, and more specifically...county....and even more specifically....city, is run like an absolute clown show circus. Nothing makes sense.

The government administrators have no clue what's going on. They're also overburdened with cases, understaffed, can't be fired (because they all got these cushy jobs from friends and family members), and most couldn't care less.

I have one extended family member on SNAP food benefits, and her benefit amount changes almost every single month, despite nothing of hers changing. It makes no sense.

So don't read too much into the formula of how they figure these things. Whenever the state, county, or city needs more money, they just reduce benefits.

I also work the under-65 insurance marketplace, and I've got people getting Medicaid determinations 11 months after they applied for marketplace insurance. It's insane.

Exactly

I get screen shots almost every single day of jumping/changing benefits.

I kick myself on the regular

When it comes to DSNP---WE ARE UNDERPAID

I keep just dealing with referrals or currents and hot mess express dysfunction junction.

2 in the last 16 hours screen shots come in


One who is way over limit on full medicaid, screen shot from her POA shows $1445 deductible (first time I've seen Medicaid actually use the words "Monthly deductible" and be honest and not try to hide it with the word "spenddown".

And that one isn't eligible for MSP.

Never ceases to amaze me.

Now the point of my post is the the dude talking about a formula and how ignorant agents are who don't get it WAS my entire point. But you know I was in bed relaxing off duty on a nice indica gummy and still understand he's giving very bad info to newer agents.

I'm not looking for it now but the one to Jack was much worse. Lots of misinformation on here, but newer agents actually take everything on here at face value.

 

[AgentGeneral]

BTW Michigan has (and maybe other states do to) not only Medicaid but Medicaid waivers. There are so many other programs people don't even know about here. SPAPs are not a thing that I know of here...but we have a mother load of options even for those on spend downs.....

There aren't many things that surprise me with Mi, I've seen it all. Even the hospitals eat copays in my area in many many cases....

And many I do are U65/disability...

Right to rmhaire....covid -- after dumped many medicaidians. I'd be a happy agents it ALL those extra bs bennies go away....

The formula for a one size fits all doesn't exist here in any way shape or form

 

[AgentGeneral]

whats so stupid about the latest I'm seeing is why bother with medicaid at all if they have that montly deductible $1445 with No eligibility or MSP

Just put em on regular nicest MAPD you can find, make sure LIS is all good, and when the bills roll in on copays/hospital stays etc check the hospital for financial aid. Here that last part is uber easy. One form, two pages....and anyone under about 30k per year gets copays wiped.

 

[Special Agent]

whats so stupid about the latest I'm seeing is why bother with medicaid at all if they have that montly deductible $1445 with No eligibility or MSP

Just put em on regular nicest MAPD you can find, make sure LIS is all good, and when the bills roll in on copays/hospital stays etc check the hospital for financial aid. Here that last part is uber easy. One form, two pages....and anyone under about 30k per year gets copays wiped.

These programs are called different names in different states but the concept is the same.For this purpose i am only talking about people who have medicare and calculation for individuals

In Florida there is Medically Needy for people on medicare and they will have a spend down or share of cost.There is no income eligibility for this only an asset limit to qualify in florida which is 5000.00 .So a person can make 3000 a month and still qualify as long as there assets are under the limit and they have unpaid medical bills.They would have a a spend down 3000-180= 2820(see first link) which is pretty much worthless other than the initial unpaid medical bills it helps with.

Someone who qualifies for a partial MSP ( Slmb,qi) has to qualify on both income and assets will also have a spend down or cost share which based and is calculated the same total income - 180. Since the limit for individual income in florida is aprox 1700 so if i run across a prospect who tells me their share of cost amount is more than 1500.00 then i can assume they just have a medically needy status and not a MSP.

When i see in the OP post guy had a spend down of only 280.00 and lost his MSP something didn't seem right

https://training.floridashine.org/Website_Resources/SSI%20CHART.pdf

Explaining Medicaid Share of Cost & Medically Needy Eligibility

Explanation and definition of Medicaid Share of Cost, Medically Needy Medicaid and which states have these programs.

www.payingforseniorcare.com