running into BRICK WALL trying to get emergency MEDICAID HELP

Discussion in 'Fibromyalgia Main Forum' started by victoria, Jun 19, 2006.

  1. victoria

    victoria New Member

    I really need some advice... from someone who 'knows the ropes' or has been thru them as I'm going in circles here.

    My almost 19 yo son has chronic Lyme, since he is past 18 he is considered an adult, does not live with me. When he applied for SSI, SS told us he could apply for emergency medicaid, which doesn't require payback een should he be ultimately denied. He desperately needs it as current RX is over $20/pill. SS told us to go to county DCFS.

    However, the county says they only give retroactive benefits after one has been approved... and after talking to several patient assistance programs, it is stopped cold everytime because they say he IS eligible for medicaid benefits if he has applied.

    I am about to go back and furthe research the SSA website and call them...

    But just wondering if anyone knows the answer already here as to how to get emergency medicaid in this situation -- is this a federal level program not a state applied program... separated from DCFS... or is everyone at DCFS here really that unknowledgeable?


  2. victoria

    victoria New Member

    There is no 'medical' reason to go to the ER, wouldn't one need that to get beyond the admissions desk to talk to anyone?

    So far I haven't found any answers online...

    I am thinking of re-contacting the social worker who works with the 'chronically ill support group' under the auspices of the local hospital, and see who she might know that we can talk to, tho;

    last resort I think is to call our state reps' offices for help and to try to understand this moronic mess of a morass...

    things shouldn't be this hard, is all I can say!

    Thanks again,

    PS -- I don't meet requirements for SSD or SSI, but my DH is on SSD, the only possible silver lining ultimately here, but I know it is going to take a long time for our son to get approved.

  3. victoria

    victoria New Member

    Apparently the need for 'regular' Emergency Medicaid would've been indicated by the interviewer at the time of the initial SS interview, but the interviewer did not do this grrrr ...

    since it was not, SS is telling me that he does not qualify and cannot now qualify for Emergency Medicaid.

    He does have a formal letter of denial, he does tell me, now.... which really doesn't matter except that it will help cut down on time frame otherwise spent getting a formal notice.

    AND get this -- SINCE he is UNDER 19, he cannot get help from Patient Assistance programs for the RXS !!!!!

    So on one hand the gov't says you ARE an adult, and on the other hand you are NOT... aaarrrgh again!

    'Technically' he is eligible for other programs within Medicaid, specifically 'right from the start' family medicaid program...

    Gee can anyone follow this? I'm not sure I'm even making sense any more lolol..........
    Will keep you all updated, if anyone is interested.

    I cannot be the only one who is struggling with this situation, I know there have to be others...


    [This Message was Edited on 06/19/2006]
  4. victoria

    victoria New Member

    for the night owls...

  5. thirkmom

    thirkmom New Member

    My married son has some medical problems but has no insurance. My Dr. told me that since the hospital he is affiliated with is a non-profit hospital, they have to do so much charitable aid to keep their tax exempt status. He said to have my son go into their office and apply for medical assistance and they will pay anywhere from a portion to all of the bill depending on his income and other information they gather on the paper work. When he got that done my Dr. said he would see him. I asked about prescriptions and he said they could help with that but he would give him as many samples as he could. You might see if your local hospital is non-profit.

    My youngest son was dropped off of my SSI the day he turned 18. So I don't know that your husband being on a disability would be any benefit to him.

    I don't know if any of this information will be of any help to you but it's a thought. Best wishes to both of you.
  6. victoria

    victoria New Member

    One of the problems is that his lyme-literate doctor is out of state and so there's this chasm between states as to what they'll cover -

    for instance I'd looked into my son getting a SPECT scan and in order to do it locally, I would need a doctor in-state to order it - the hospital would not honor orders from out of state, and they are the only ones nearby with the equipment.

    Any child at any age will receive the same amount his parent is receiving from SSD if it a higher amount - and even if the child has not worked or is 'older' like 35 yo... so for SSI purposes my son would be considered disabled from the time of his 18th birthday since he was dx'd prior to it, and if/when he is approved, he will receive the same monthly payment my husband (who is on SSD) does.

    Well, I am back to working the phones, trying to smooth out the loopholes... wish there was one place to go to help us, I'd be happy to pay for services at this point!!!!!

    What I'm also running into is because we are loaning him money to help him get by, they are counting that - doesn't make sense as it IS a loan and he will have to pay us back out of his settlement.

    any ideas on how to solve that last problem so that they would understand?

[ advertisement ]