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

[OLHope]

Document Document Document

Discourage is right!!!

Document all calls or letters… date time person company…, they are trying to wear you out with admin BS…, if there is no stipulation to warrant them from denying you…, then you may need to seek a lawyer…, but that can be very stressful, too.

Next step is to call or write your state rep, and while you are at it…, call your congressman to push a federally low cost option…, universal healthcare should have been pushed, but people are still too fearful and do not understand that the private insurance companies and state ins. are gouging your pockets, by making up restrictions on the spot.

You need a crowd to fight for you or this will lessen the American family and drive you and your husband deeper in debt…, fight fight fight… You will probably be on the phone all day tomorrow, but it is necessary. I have a computer program where I record all my calls…, if you have that, you could go public with it…, more action by politicians to fight on your cause.

Fight fight fight!

-God Bless
Hope

 

[RedSoxWife]

Hi Everybody!

Thank you so much for all the supportive comments and prayers. I do feel calmer now that few hours have passed.

My husband and I are going to go in at the start of next week together (he drives down to school tomorrow since it’s a weekend program) and ask to speak to our social workers supervisor.

On the upside, we have yet to have a social worker who has worked in the county for more than 3 months, so if the averages mean anything we’ll probably have a new one soon (there are some really nice ones and I keep hoping we get one of the ones my husband is friends with because it seems like it would make life so much easier!).

I’m still slightly hopeful that there’s a mistake because we haven’t been informed in writing that we were denied. He claimed that we were, but I obsessively read and file everything and I can say with 100% certainty that we weren’t.

We’ll keep pushing through all this until it gets worked out. I told my mom tonight that I feel silly for feeling shocked by anything that happens (regarding the state of California) at this point. I was surprised when the Healthy Family people told me the only way they’d cover my daughter was if we made more money and I was shocked when, after turning in the paperwork last time that said we qualified, I got a letter rejecting us, for the problem that the paper I’d turned in had just dispelled (the papers proved we spent our savings on medical bills for the c-section).

My lesson of the day is that I shouldn’t be shocked by anything anymore.

Oh and I did call some of the people at our parish who I’m close to and told them to feel free to tell everyone what’s going on. We have some parish members who work in the office and I’m hoping someone will be able to help.

Thanks again for all the great advice.

 

[kage_ar]

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

Nope.

We have Medicaid for the situations I described, it is very hard to be poor here.

 

[Secret_Square]

One last thought. States MUST observe all the federal laws and regulations governing Medicaid and Medicaid eligibility or risk losing their federal matching funds.

In addition, there is a provision in the federal stimulus bill requiring “maintenance of eligibility” – that is, if a state wants to get additional Medicaid reimbursement as part of the stimulus package, that state CANNOT make its Medicaid eligibility rules tighter or more restrictive than it did before, and it cannot kick current Medicaid clients off its rolls.

If this caseworker and others are telling people that married couples can’t qualify for Medicaid, they are almost certainly violating the maintenance of eligibility provisions, and if the federal Centers for Medicare and Medicaid Services were to find out about it, California could end up losing federal money it urgently needs.

You might want to remind your caseworker and his supervisor about this provision… just sayin’.

 

[RedSoxWife]

One last thought. States MUST observe all the federal laws and regulations governing Medicaid and Medicaid eligibility or risk losing their federal matching funds.

In addition, there is a provision in the federal stimulus bill requiring “maintenance of eligibility” – that is, if a state wants to get additional Medicaid reimbursement as part of the stimulus package, that state CANNOT make its Medicaid eligibility rules tighter or more restrictive than it did before, and it cannot kick current Medicaid clients off its rolls.

If this caseworker and others are telling people that married couples can’t qualify for Medicaid, they are almost certainly violating the maintenance of eligibility provisions, and if the federal Centers for Medicare and Medicaid Services were to find out about it, California could end up losing federal money it urgently needs.

You might want to remind your caseworker and his supervisor about this provision… just sayin’.

That’s good to know! Thanks! I’m feeling more and more ready to face this whole thing again.

 

[RedSoxWife]

My husband talked to one of his friends who works in Health and Human Services at work last night and she agreed with everything our social worker said (very depressing news). She said that we were rejected because we didn’t meet the “deprivation” requirements because we are married. I just went and looked at the definition of “deprivation” in the Medi-Cal handbook thing online and this is what it says:

54.2.6 Deprivation

1. Verification of deprivation is missing, expired, or will expire in month of transfer
   and no action was taken.
2. Incorrect deprivation was established AND the payment is affected, or
   verification to establish the correct deprivation is not in the case.
3. An incorrect/unclear determination of the primary wage earner (PWE) was
   made on an unemployed parent case AND eligibility is affected or
   questionable.
4. Unemployed parent deprivation was authorized and either parent is on strike.
5. An Absent Parent is in the home and timely action has not been taken to
   discontinue or reestablish eligibility.
6. An Unrelated Adult Male (UAM) is listed on the birth certificate as the parent
   but is not being treated as the parent on the case in terms of deprivation,
   budgeting, required signatures, etc.; and there is no explanation on file.
7. Maximum Family Grant (MFG) rules were not applied and/or the “Application of
   Maximum Family Grant (MFG) Rule” (SC 1248) is not on file. “The Maximum
   Family Grant (MFG) for Recipients of Cash Aid” (CW 2102) MFG is not on file,
   or is on file but is incomplete.

It doesn’t seem to say anything about being married. They said we really shouldn’t appeal this (which makes me suspicious). I just don’t see how someone in our income bracket, who definitely meets the income requirements, can be rejected and it seems like the reason associated with the explanation that they gave us really has nothing to do with it.