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Unread 03-11-2017, 05:11 PM   #1
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Default Who are the advocates

For those on SSDI with JUST medicare and are under 60 yrs old?

I have an issue with my state attaching Medicaid as a secondary insurance - it has been locking me out of services for 4 yrs. I do not qualify for medicaid. I lost many providers over this issue and most recently in Oct 2016 and still can't find a "medicare" therapist for trauma. I am in a midst of a Social security review and I am scared with no provides to say I am still disabled is concerning to say the least. That medicaid error put me in a really bad spot. Not to mention it could be fraud. From my understanding the states get money for every person who is enrolled into medicaid. That would be f#$^ed up if that was the case they made $ off me and blocked my services. Which leads me to next part....

I reached out to Disability Rights in my state and they could not help me reason given "I am not what they consider a priority" That sure hurt smh....

I called the Ship (state insurance ofc who deals with medicare/medicaid) I explained what was going on however because of my age 46 I am not a part of a population they serve. They deal with the elderly.

NAMI - Wasn't helpful either. They are more concerned with another population and that is Medicaid.

Who the hell helps the younger folks who have SSDI/Medicare???
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Unread 03-11-2017, 10:18 PM   #2
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Default Re: Who are the advocates

Have you thought about joining a Medicare Advantage Program. Those are designed for low income folks. I think they have to be pretty comprehensive and offer every kind of care you could need, including mental health services.
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Unread 03-11-2017, 11:41 PM   #3
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Default Re: Who are the advocates

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Have you thought about joining a Medicare Advantage Program. Those are designed for low income folks. I think they have to be pretty comprehensive and offer every kind of care you could need, including mental health services.
An advantage plan won't help. Would be paying more for less.
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Unread 03-12-2017, 01:12 AM   #4
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Default Re: Who are the advocates

So do you have just straight Medicare? Were you covered by Medicaid in the past? Is thst what you mean by losing care providers you had previously?

I tried to get Medicaid while I was waiting for Medicare. My state had expanded Medicaid, so I still think I should have qualified during the two years I was waiting for Medicare. Having both does give you very comprehensive coverage, even covering dental and vision.

I kind of thought that, once you get Medicaid, you keep Medicaid. But I'm fuzzy on who gets it and why.
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Unread 03-12-2017, 02:38 PM   #5
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So do you have just straight Medicare? Were you covered by Medicaid in the past? Is thst what you mean by losing care providers you had previously?

I tried to get Medicaid while I was waiting for Medicare. My state had expanded Medicaid, so I still think I should have qualified during the two years I was waiting for Medicare. Having both does give you very comprehensive coverage, even covering dental and vision.

I kind of thought that, once you get Medicaid, you keep Medicaid. But I'm fuzzy on who gets it and why.
I understand things are different these days those who qualify for SSDI have to wait 2 yrs to get Medicare. Makes zero sense to grant a disability with no medical (medicare) coverage so you can get the treatment needed. I was granted way back in 2001 there was no waiting and the Medicare kicked in immediately. However the copays during that time was 50% for mental health. I think for folks these days who get the Medicaid while waiting for Medicare is dependent of the states eligibility/expansion might be dual eligible and could keep the medicaid.

I have had just straight Medicare. The state I moved to in 2010 Ohio has something called a spend down system to get Medicaid but you have to get over $400 in medical bills each month in order to unlock it for that particular month. I never met these spend downs. The state does help with my part B premiums that's it. Medicaid is far more superior than medicare could ever been in terms of comprehensive services. Mostly mental health related and the vision and dental is certainly a plus.

However the point in my post isnt about me getting Medicaid. It is how the state has screwed me by putting it as a secondary insurance that I never had and locked my services. That error is gross negligence and they need to be held accountable not to mention I do believe there is fraud involved. As I said the states get paid per person enrolled into Medicaid. I was not eligible during the times they had me on it due to my SSDI and resources being over the limits.

There has to be some type of advocacy group that fights for people who are disabled SSDI with a mental illness under the age of 60 with Medicare only. What frustrates me to no end is there are many groups fighting for Medicaid beneficiaries with this new administrations repeal of the ACA/Medicaid. Not that I am for the repeal or anything like that and trust me I made many calls to tell congress/reps to vote against it. I am frustrated by the lack of inclusion for folks with SSDI and Medicare we are at risk too of losing services not right this second but would be nice if groups like NAMI were easing our minds. Those with SSDI (mental health) + medicare are forgotten and that is sad. Points back to the fraud I was mentioning and why they don't fight hard for the forgotten is because the states are making $ off those with the Medicaid they don't make anything from Medicare folks.

Last edited by anxiety247; 03-12-2017 at 04:04 PM.
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Unread 03-12-2017, 10:37 PM   #6
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Quote:
Originally Posted by anxiety247 View Post

I have had just straight Medicare. The state I moved to in 2010 Ohio has something called a spend down system to get Medicaid but you have to get over $400 in medical bills each month in order to unlock it for that particular month. I never met these spend downs. The state does help with my part B premiums that's it. Medicaid is far more superior than medicare could ever been in terms of comprehensive services. Mostly mental health related and the vision and dental is certainly a plus.

\.
Not that this is your point, and I'm sorry I can't help with your situation (I'm fighting a year long battle to get what I should have had covered my Medicaid covered) but Ohio no longer has spenddown for disability. It stopped last summer. I was in the program and wasn't notified so I think they kept it as low key as possible to avoid protests etc.

I hope you get this worked out soon.
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Unread 03-13-2017, 03:39 AM   #7
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Default Re: Who are the advocates

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Not that this is your point, and I'm sorry I can't help with your situation (I'm fighting a year long battle to get what I should have had covered my Medicaid covered) but Ohio no longer has spenddown for disability. It stopped last summer. I was in the program and wasn't notified so I think they kept it as low key as possible to avoid protests etc.

I hope you get this worked out soon.
I am also in Ohio. You are right there is no longer a spend-down. That ended in July. There is a new program in it's place called SRS (specialized recovery services) If you were seeing a community mental health provider you would have to a referral into this program if not then try Jobs and Family services for the referral. From my understanding medicaid reached out to those who consistently met this spend-down each month to get them enrolled in this SRS program. SRS is 3 services in addition to full medicaid. The income eligibility isnt bad either $2200 I think a month. Some other requirements. Give them a call.
The 3 services in SRS:
Case Management
Peer Support
Employment Services


http://medicaid.ohio.gov/Portals/0/I...DR/FAQ-SRS.pdf
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Unread 03-13-2017, 06:57 PM   #8
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Default Re: Who are the advocates

I tried applying for the SRS program and somehow they thought I was applying for long-term care. I definitely did not check that box. My office is VERY difficult to deal with and VERY unhelpful. I'll try again though.
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Unread 03-13-2017, 08:43 PM   #9
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Default Re: Who are the advocates

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Originally Posted by BeyondtheRainbow View Post
I tried applying for the SRS program and somehow they thought I was applying for long-term care. I definitely did not check that box. My office is VERY difficult to deal with and VERY unhelpful. I'll try again though.
The local offices are very inexperienced at getting folks enrolled in SRS. If you go through a community mental health agency that might be a easier route for you to get signed up especially if you have a case worker. If you don't call the Medicaid consumer hotline #(800) 324-8680 explain you are disabled and had the spend-down and want to get enrolled into the SRS program. Or call NAMI Ohio they can help too 614-224-2700
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Unread 03-13-2017, 08:47 PM   #10
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Default Re: Who are the advocates

My local office is inexperienced period. They are overworked and it is just chaos dealing with them. My caseworker didn't even mention this when I finally got her to tell me spenddown was gone (6 months of calls).

I don't have community services; I have a private therapist and pdoc.

I'll try the hotline. It can't be worse than my community services. (I'm always a little bitter because my previous county was on top of everything and this one I can't get an answer to a basic question).

Thanks for the info!
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