important info. medi-cal does not tell you up front-vent

Discussion in 'General Health & Wellness' started by daylight, Apr 30, 2009.

  1. daylight

    daylight New Member

    http://www.chcf.org/topics/medi-cal/index.cfm?itemID=20363

    This has just happened to us. I'm on SSDI because of (mctd,spinal problems,vision impaired ,paraplegia ect) my husband is on edd and get least than 1400 a month. I get only 632 for ssdi.
    My daughter has asbergers syndrome. She now gets free medical but my husband and I have to pay a share of cost. So I now have to pay all copays for my 2 visits a month to the doctors (gp,pulmonary,rd) plus copay's for my 8 prescriptions. Along with 1800 worth of bills/rent and hopefully we'll be able to afford bread and baloni so we can eat something. Because we can't get food stamps or food banks! So I'll be off all meds soon and doctors visits . Just because my husband can't get work because of the darn recession.

    I'm sorry for the vent but I'm in so much pain and now have to deal with the knowledge that my joint are going to be distriod faster. All this with a healthy smile on my face because no one likes to see a weak person .
    It ticks me of that the government thinks that 2 adults in california can live off of 934. a month. I am glad that my daughter can get health care but she only needs social training ,a physical,dental and vision care. But here is the kicker I can't drive her to the appointments because of my illnesses . And my husband is having ankle surgery next week . Which he'll be down for 2 to 3 more months ,if the surgery goes well.

    sorry for the rant but people need to know that medi-cal/medicaid is not always free.


  2. daylight

    daylight New Member

    Medi-Cal's Share of Cost Does Not Match the Montly Housing Costs
    by Debra A. Sedeno
    Tuesday May 29th, 2007 11:01 PM

    Medi-Cal policy is imposing a share of cost that is unrealistic. Many Medi-Cal recipients are not on welfare but are offered assistance from the government because they make too much money to qualify for welfare but not enough to pay for health care costs. As a result, they must contribute to their healthcare by paying for a portion of the cost of the services they receive. The calculated amounts of share of costs for a family or individual do not consider the monthly housing costs in California.

    Medi-Cal policy is imposing a share of cost that is unrealistic. Many Medi-Cal recipients are not on welfare but are offered assistance from the government because they make too much money to qualify for welfare but not enough to pay for health care costs. As a result, they must contribute to their healthcare by paying for a portion of the cost of the services they receive. The calculated amounts of share of costs for a family or individual do not consider the monthly housing costs in California.

    Share of cost refers to the amount the recipient must pay the health care provider for health care services each month before Medi-Cal takes over to pay for additional expenses needed for that month. The “share of cost” requires the recipient to pay the full amount of health-care expenses up to a predetermined amount. It is not the same as “cost-sharing” or “premiums”.

    The share of cost is calculated by deducting a fixed amount, the “maintenance need level” from the net income. The net income is determined by subtracting allowable deductions from the gross income. The gross income includes earned income from a job, disability income or alimony. There are about 40 allowable deductions which may include educational expenses, dependent care (e.g., childcare), alimony payments, and an “earned income deduction.” The earned income deduction is the amount deducted for earnings for a job. For example, for families, the first $90 dollars of monthly gross earned income is deducted and then divided in half.

    State law determines the maintenance need level that is regulated by federal guidelines. The maintenance need level is the amount that the state law feels a recipient needs to provide food, clothing, and shelter for themselves. As of 1998, federal law has established the maximum maintenance need to be, for instance, $600 for a family size of one adult. A family size of one adult and one child has a monthly maintenance need level of $750. The amounts increase slightly as the family size increases. Unfortunately, California state law and federal officials fail to realize that the cost of living in California is outrageous. U.S. Census Bureau 2000 reported median gross rents (the amount of rent plus the estimated average of monthly cost of fuel and utilities) at $602 a month. New census reports state that cities like Irvine, Sunnyvale, and Santa Clara in California has a median gross rent of $1,200 a month.

    Eligibility is determined by type of family income. So, if the recipients receive cash aid or are on SSI, they do not have to pay a share of cost. Those that are required to pay a share of cost include those not receiving cash aid benefits due to income. There are two categories of recipients that must pay the share of cost: the medically needy and the medically indigent.

    The medically needy (MN) include the aged, blind, and disabled people along with low-income families who are unable to receive cash aid (e.g., CalWORKS or SSI). However, these families who are not able to receive cash aid due to high incomes must meet other requirements to qualify for MN assistance such as a single parent household or two parent household that is unemployed or underemployed. According to the Medi-Cal Policy Institute, in October 1997, there were about 614,000 MN Medi-Cal recipients.

    The medically indigent (MI) Medi-Cal program offers Medi-Cal coverage to low-income children under 21 years of age who do not qualify for cash aid and who are not eligible for MN Medi-Cal. They either do not meet the requirement needed for SSI disability benefits or CalWORKS deficiency requirements. This program also includes low-income adults needed long-term care or pregnant women. According to the Medi-Cal Policy Institute, there were about 252,000 MI Medi-Cal recipients in October 1997.

    Although not all MN and MI Medi-Cal recipients are subject to paying a share of cost because their incomes are low, many have to pay a share of cost that is unreasonable. For instance, a single mom with a four year old has an income of $1,200 and an alimony payment of $250 (Total income of $1,450) would be allowed a $50 per month deduction for alimony and a $90 per month deduction for her job. Although she may pay more in childcare (e.g., $300 a month), she is only allowed to deduct $175 for childcare because of the age of her child. After deductions (net income=$1135) and a set maintenance need for a two person family size of $750 per month, she has a share of cost of $385 per month. So, she must pay the health care provider $385 per month before Medi-Cal can provide the remaining health care costs per month (California Health Care Foundation 2007). Medi-Cal policy makers do not take into account whether the recipient is paying more than $750 in rent a month. If so, then that leaves nothing for food and clothing or ability to pay the share of cost, for that matter.

    The Medi-Cal Policy Institute states that 1.4% of MI recipients and 15.5% of MN recipients met a share of cost in October 1997 whereas 200,000 Medi-Cal recipients did not meet that share of cost. They suggest the reason for those recipients not meeting the share of cost was due to not having medical expenses that surpassed the share of cost in a given month. Therefore, these recipients did not need Medi-Cal’s assistance. However, it doesn’t occur to the institute that maybe recipients are not seeking medical attention because they cannot afford the share of cost.

    The rising cost of housing and stagnant wages in California has made it very difficult for families to make ends meet. Medi-Cal has imposed a share of cost for healthcare that is often at times impossible to meet, especially with California’s high median rental rates. Additionally, federal guidelines suggest an unrealistic monthly maintenance need that does not coincide with the rental rates. If federal and state policy makers were to incorporate the median rental rates, they will come to see that almost all Medi-Cal recipients may be eligible for “free” services without a share of cost. Under Medi-Cal’s current policy, many may benefit from purchasing private insurance as a cheaper route.
  3. TwoCatDoctors

    TwoCatDoctors New Member

    Everyone can easily become disabled in an accident, a fall, or an illness, and end up in the growing group of poor this country has. I really think they need some poor and disabled on these committees that come up with these decisions so they realize how stupid they are before they risk implementing them. Take care and hugs.
  4. daylight

    daylight New Member

    We have a share of cost 1234 . . My husband called our case worker and she says that we'll have to pay the co pay for the doc. and meds until that 1234.00 is paid off for the year. I also have iehp and medicare part A . So any inpatient hospital stays are free. But we still aren't clear about this share of cost thing or if we have to pay extra for labs. Doctor may not give me the meds i need if they can't monitor my liver functions. I wish that they would tell us more but this case worker is so vague about the details . Like how much will we have to pay for a doc. appointment? How much are meds going to cost? What about labs? Will we be getting billed extra for services until the full 1234. a year is paid?
    I sure we are not the only ones asking these questions . They should be able to get us answers are direct us to someone who can.
    This is a royal pain.
  5. daylight

    daylight New Member

    My new RD's office just called to schedule me for an earlier time on the 5th.
    So I asked what the copay is going to be and it's 250.00 a visit. They then apply these to the share of cost until it's paid off . So it looks like I'm be just getting one visit with him (if I can) until the Medicare is started next January. Plus we'll have to pay labs and meds but I'm not sure how much that will be.

    Ain't life grand.