Medi-Cal State Health Insurance, Gross Incompetence, and Lies

[RedSoxWife]

I am very upset and asking for prayers. For the past we have been trying to get Medi-Cal, the California state health insurance coverage, for the past 15+ months. We lost our insurance shortly after our daughter Sadie was born. We qualified for Medi-Cal the first time we applied, but gross incompetence (and the inability of our first social worker to (name removed by moderator)ut simple information into a computer) meant our application was rejected. We reapplied two months ago (they promised to respond in 45 days). Today, after leaving multiple notes and phone messages with our social worker (this is social worker #5) my husband was told that our application was rejected. The reason: Because we’re “together.” He’s claiming that being married means automatic disqualification. According to everything I’ve read this is absolutely not true. It’s so stressful and it means that if we want to appeal it we have to court or we can reapply and hope we get a different decision. This is insane!

I guess I shouldn’t be surprised. This is California we’re talking about.

 

[Ailina]

Is that the only insurance company you can approach, or are there others? I live in a country where everyone is covered by public health care, so being turned down for insurance is not an issue here.

 

[psr13]

Is that the only insurance company you can approach, or are there others? I live in a country where everyone is covered by public health care, so being turned down for insurance is not an issue here.

Medi-Cal is the insurance run by the government. In this case, California.

 

[kage_ar]

The state Medicaid programs I am aware of will provide coverage to low income children and pregnant women. Those on SSDI can usually qualify after 2 years for Medicaid.

Healthy adults are rarely covered.

Are you trying to get your kids covered or the adults?

The system IS broken. Low income/working poor need some kind of medical care.

 

[RedSoxWife]

We’re trying to get the whole family covered and in California under the qualifications we do qualify. That’s why this is so frustrating.

 

[Linda_Marie]

In Australia, we have an ombudsman who people can go to when they feel they have been unjustly dealt with by whatever government agency.

Is there something similar in California? Is there a board or panel to whom you can appeal?

 

[kage_ar]

We’re trying to get the whole family covered and in California under the qualifications we do qualify. That’s why this is so frustrating.

WOW. I need to send a bunch of families to California! What an amazing blessing.

Keep working through the system, if they are covering healthy adults, it is likely a huge system that moves slowly. Will they cover the kids while the adults work on getting covered?

 

[CopyKat]

RedSoxWife, please go to the Healthy Families website. You’ll have to do a seach because I don’t have it off hand but it’s much easier than medi-cal to qualify for, the coverage is GREAT, you’re not obligated to go to medi cal only doctors, AND you won’t be treated like a social reject. Trust me, been down the medi-cal road and never will again!

 

[RedSoxWife]

RedSoxWife, please go to the Healthy Families website. You’ll have to do a seach because I don’t have it off hand but it’s much easier than medi-cal to qualify for, the coverage is GREAT, you’re not obligated to go to medi cal only doctors, AND you won’t be treated like a social reject. Trust me, been down the medi-cal road and never will again!

I was on the phone sobbing with Healthy Families after they told us that we don’t make enough money to qualify. We only make $800 a month and you have to make more then that to be on Healthy Families. Anything below that and you get shuffled off to medi-cal.

 

[RedSoxWife]

WOW. I need to send a bunch of families to California! What an amazing blessing.

Keep working through the system, if they are covering healthy adults, it is likely a huge system that moves slowly. Will they cover the kids while the adults work on getting covered?

They claim that my daughter is covered and has been for the last ten or so months, but when the doctor bills them they say that her birthday is wrong, or her gender is wrong and refuse to pay (we went and talked to them today and they said that there isn’t a problem and reassured us that they will pay, but our doctor whose office is used to Medi-Cal and bills them again and again isn’t getting any money from them). We’ve had to pay for the vaccinations out of pocket for her (and that’s pretty pricey, especially considering what we bring home). Unemployment in our county is over 25% so my husband is lucky to have the job that he has (he’s also a full time grad student, going to school to be a Canon Lawyer, I can not wait until he’s done with school), so the office is very busy.

But 15 months of paperwork is so frustrating… I could handle that though. The thing that got me so upset is when he lied and said that we weren’t covered because we’re married. Having done a lot of reading it’s not true. The packets actually say how much married couples can make. I do wonder how many people he convinces to leave and not come back with that strategy, because the main concern seems to be getting rid of people there.

 

[RedSoxWife]

In Australia, we have an ombudsman who people can go to when they feel they have been unjustly dealt with by whatever government agency.

Is there something similar in California? Is there a board or panel to whom you can appeal?

We were told we can go to court. We’ll have to drive 500 miles roundtrip for it though and because my husbands in school and work he’ll have to take off time for work. That’s the next step we’re looking at though, if talking to our social workers supervisor doesn’t change anything.

 

[CopyKat]

Wow, how incredibly frustrating! I know sitting in the county office is grueling (I’ve never applied for services where it wasn’t an all day event) but I can only suggest you give it another go. There is no earthly reason why your family shouldn’t qualify. The fact that you’re married being an obstacle is purely false information.

Come equipped with bank statements, stubs, birth certs on all kids, etc etc. Apply for each program you qualify for, including food stamps. That’s what those programs are there for. I was in a position that I never thought I’d be in and I received all of that stuff. They make it so difficult I think so they can weed out the ones who won’t be persistent! Sounds awful but I really think thats the case.

Don’t give up and I will be praying for you!

 

[RedSoxWife]

Wow, how incredibly frustrating! I know sitting in the county office is grueling (I’ve never applied for services where it wasn’t an all day event) but I can only suggest you give it another go. There is no earthly reason why your family shouldn’t qualify. The fact that you’re married being an obstacle is purely false information.

Come equipped with bank statements, stubs, birth certs on all kids, etc etc. Apply for each program you qualify for, including food stamps. That’s what those programs are there for. I was in a position that I never thought I’d be in and I received all of that stuff. They make it so difficult I think so they can weed out the ones who won’t be persistent! Sounds awful but I really think thats the case.

Don’t give up and I will be praying for you!

Hi CopyKat,

Thanks for your prayers. Two months ago we finally brought everything back in a second time (bank statements, birth certificates, paystubs, car registration, everything on the list) and they made copies again, although I could see that she had it all there in front of her (she since quit, which is why we’re onto #5 who appears to have truth issues). I think we are probably going to have to go through it all again. It’s strange because my husband has made friends with all the other social workers who come into his work and they keep giving us advice and trying to help us and leaving him notes telling him to contact us.

Thanks for your kind comments though. We did get on food stamps (and we only applied to them because we were there applying for the medi-cal and didn’t really expect to qualify and then found we more then qualified!). I think it just hit me hard earlier because I really thought we’d gotten everything perfect this time.

I’m just hoping that if I’m pregnant they manage to speed things up a bit.

 

[Secret_Square]

He’s claiming that being married means automatic disqualification. According to everything I’ve read this is absolutely not true.

I work with the agency that handles Medicaid in the state of Illinois. What follows is based on my experience but may be applicable to other states as well.

States often have different levels of state-supported or -funded medical assistance which the general public lumps together under the heading of Medicaid. However, “Medicaid” specifically refers to medical assistance supported by federal matching funds under Title XIX of the Social Security Act. This form of medical assistance is generally limited to very low-income households (below 133 percent of the federal poverty level) and persons with disabilities.

Another federal program known as SCHIP (Title XXI of the Social Security Act) funds state children’s health insurance programs, some of which also cover parents or “caretaker relatives” of minor children. SCHIP-type programs cover people with incomes too high to qualify for Medicaid but still not high enough to afford their own insurance.

Some states may also provide 100 percent state-funded insurance for people who aren’t eligible for the federal matching fund programs (e.g., single adults, adults with incomes too high for Medicaid or SCHIP); in those cases the people who sign up may have to pay monthly premiums or co-payments for doctor visits, prescriptions, etc.

Because these programs are funded differently they may require different forms or different processes for determining eligibility. It is very easy to get them confused – when I started working with my agency it took me a while to distinguish between all the different programs and levels of coverage offered. So I wouldn’t be at all surprised if, perhaps, your caseworker signed you up for the wrong program, or confused the eligibility rules of one program with another.

Right now I am not aware of ANY federal Medicaid law or regulation that makes married couples ineligible for coverage provided they meet the income standards. So I have no idea where your caseworker got the idea that being married would automatically disqualify you. Could it be that since California (like Illinois and many other states) has a severe budget crisis and the state isn’t sure how it’s going to pay for all the people who have signed up for Medi-Cal, that they are trying to discourage new people from signing up?

 

[RedSoxWife]

He’s claiming that being married means automatic disqualification. According to everything I’ve read this is absolutely not true.

I work with the agency that handles Medicaid in the state of Illinois. What follows is based on my experience but may be applicable to other states as well.

States often have different levels of state-supported or -funded medical assistance which the general public lumps together under the heading of Medicaid. However, “Medicaid” specifically refers to medical assistance supported by federal matching funds under Title XIX of the Social Security Act. This form of medical assistance is generally limited to very low-income households (below 133 percent of the federal poverty level) and persons with disabilities.

Another federal program known as SCHIP (Title XXI of the Social Security Act) funds state children’s health insurance programs, some of which also cover parents or “caretaker relatives” of minor children. SCHIP-type programs cover people with incomes too high to qualify for Medicaid but still not high enough to afford their own insurance.

Some states may also provide 100 percent state-funded insurance for people who aren’t eligible for the federal matching fund programs (e.g., single adults, adults with incomes too high for Medicaid or SCHIP); in those cases the people who sign up may have to pay monthly premiums or co-payments for doctor visits, prescriptions, etc.

Because these programs are funded differently they may require different forms or different processes for determining eligibility. It is very easy to get them confused – when I started working with my agency it took me a while to distinguish between all the different programs and levels of coverage offered. So I wouldn’t be at all surprised if, perhaps, your caseworker signed you up for the wrong program, or confused the eligibility rules of one program with another.

Right now I am not aware of ANY federal Medicaid law or regulation that makes married couples ineligible for coverage provided they meet the income standards. So I have no idea where your caseworker got the idea that being married would automatically disqualify you. Could it be that since California (like Illinois and many other states) has a severe budget crisis and the state isn’t sure how it’s going to pay for all the people who have signed up for Medi-Cal, that they are trying to discourage new people from signing up?

I think that they are trying to discourage people from signing up. We went through our application step by step with our last social worker and qualified on every single count. We were $20,000 under the income category for qualification and our savings has been decimated (my daughters c-section cost just under $60,000 and while insurance covered a lot of that, and the Catholic hospital forgave a lot, it didn’t cover a lot too). We’ll just keep going in and I think we’ll have to file for the hearing. We’re not giving up!

 

[Secret_Square]

After seeing the subsequent posts to this thread… you’re absolutely right, your caseworker is either lying or covering up his abysmal ignorance of the actual Medi-Cal rules. At your income level you more than qualify for Medicaid anywhere in the nation, and there should be no question what program to sign you up for. You know the rules better than he does so don’t let him discourage you!

Also, I did go through a period when my daughter had to be on Illinois’ Medicaid because I had lost a job and could not afford any other insurance at the time. I know it can be humiliating and frustrating dealing with all the bureaucracy involved. So you will be in my prayers tonight :hug1:

 

[shannyk]

WOW. I need to send a bunch of families to California! What an amazing blessing.

Keep working through the system, if they are covering healthy adults, it is likely a huge system that moves slowly. Will they cover the kids while the adults work on getting covered?

kage do you not have state health care there? I mean not medicaid, but a state run/funded health care?

Here in WI we have Badger Care, and you can qualify if you are within 200% of the poverty level, for a family of 4, and a few other stipulations.

You don’t have to be disabled, under 18, or pregnant, it’s for anyone, married couples, families,even single adults. You also automatically get Badger Care if you ARE disabled, even if you don’t collect SSI.

redsox wife I’m so sorry that really is horrible. Here in WI you can apply very quickly and easily online and usually hear back from the county within a week. If they need more info or documentation you MIGHT wait 30 days for approval total. They pay for anything you incur while you’re waiting too. It’s great for many families I know.

Is there a way to contact the department of health and ask for a supervisor? If your application wasn’t properly filed you might just be able to re apply and not appeal. it sounds like your case worked was a dolt and you might do better talking to a higher up.

Prayers for you that it works out. Cali is not the state I’d want to be living in right now!!

 

[avemaria7]

Considering the budget problems in California, I am not surprised that you are having these problems.

Have you considered a midwife if you do get pregnant? It seems to be the only way I have gotten away with having VBACs.

 

[BrokenFortress]

You know I’m praying for you.

Shannyk- I actually also live in WI, and back when I graduated college, in '08, Badger Care did not have a program for single adults with no children. They didn’t start that til this year, and actually, the program is now full I believe and everyone has to go on a wait list to get in. (kind of goes to show you that there was and is a need). So unfortunately as a single woman with no children, I have private insurance with a super high deductible. I pray that I don’t get sick because I wouldn’t be able to afford it. But in the scheme of things, I’m thankful that I am healthy and was able to get private insurance, even if it isn’t all that good.

This whole health care thing is a mess no matter the state. But it’s so much worse when you’ve got little ones depending on you

 

[jessicaAKAmommy]

The patient financial councelor at the hospital may be able to help you with the process, with possibly reducing your bill more, and also possibly finding a clinic for in the mean time. Sorry I’m not more familiar with your neck of the woods, but I know CHW runs 4 or 5 no/low cost clinics in the Sacramento area, and if you have the time to wait they’re pretty good (at least I know they used to be). Like anything else dealing with the state you’re stuck, and it will be a pain. I went round and round with EDD the last 5 times we had to deal with them. DH went back to work 5 days out of ICU, 3 days out of the hospital just because he needed to KNOW someone would be paying him. They’re now claming he was paid a day of disability he wasn’t owed, and it was a day he was in ICU hooked up to a breathing machine! Ugh. It’s no wonder state workers have the reputation they have.