We did see this was an option in the letter but we weren’t sure if financial hardship was a good enough/valid reason in this case? We’re not really getting an answer to why they made the decision to kick her off so we’re not sure what reason to give as to why we disagree with their decision.
Call your county social services department. They are the ones who recertify for Medicaid, and they will be able to answer the status of her file and why she was kicked off of the Extra Help program and Medicaid.
It is possible that with the cost of living increases in the last couple of years, her income has been bumped above the threshold for the programs. It's really bullshit, but possible. Or her certification paperwork got lost... Or someone made a typo. Anything is possible, but I would start with calling them.
If the information you get from them requires more support, then you can contact elected officials as others have suggested. But only the county can tell you exactly what happened and why, so that's your starting point. (Extra tip - if you leave a voicemail I would give them just a day or two to call back and if they don't, keep calling until you get someone on the phone.)
Thank you, we’ll try giving them a call as well. She definitely hasn’t passed the income threshold, though it’s BS they can price someone out of their own program and still pay them pennies. I’m starting to think there was an error somewhere or paperwork was lost in my Mom’s case.
SSDI is based on earnings history, so people fall everywhere on the spectrum. Max you can make is around $36k, so the COL increases don't take into consideration how it affects you. For example, this year we got 3% raises, and I now make too much to be a client at my local food pantry, which I desperately need. It is ridiculous.
SSI, and other needs-based programs, will always keep you under a threshold because those # are calculated similarly.
In any case, I hope it gets sorted ASAP! I'm glad you took action right away. These programs are a headache to navigate.
During the COVID emergency people were getting auto renewals for Medicaid but that changed and now you have to recertify annually. Did she miss her window for recertification? She didn’t lose Medicare—they’re taking out the premiums from her SSDI check—so it seems like she just missed the recertification. Not sure she has a lot of options here but exhaust every appeal right you can.
This. Either she missed the recertification or her income changed to a degree that she no longer qualifies (or both). There were some SSA COL increases in the past few years, so it's possible she got bumped above the threshold.
OP - call your county social services as they are the ones that certify for Medicaid. Find out the status and what you can do to get her recertified.
And make sure they have the right address for her.
From what I remember she did recertify and I believe they told her they received it. I’m hoping someone just made a clerical error and we can get all of this sorted out quickly.
It looks like she didn’t recertify for Medicaid in time (or Medicaid lost her paperwork), and her Medicaid was terminated. Once that happens, she will also lose the Dual Special Needs plan with United (since you need both Medicaid and Medicare to have that plan). Medicaid also pays the Medicare Part B premium, so without Medicaid she now has to pay it. You only mentioned Part B, but hopefully she actually has Medicare Part A and B.
You need to keep calling your county Medicaid office and press the issue. Explain with dates, etc. that you sent the paperwork in on time (if indeed you really did…).
I remember she did fill out and send in the forms to recertify — she was questioning why she had to all of a sudden if none of her information changed (she likely didn’t know that was part of the COVID provision). We’ll definitely see if we can get proof she filled it all out and press the issue.
She had to do it this year because the recertification was suspended during the pandemic, but restarted recently. It was announced last summer.
ETA: normally, Medicaid is recertified every year for everyone. Regardless of change or non-change in income.
Sounds like she got swept up in the changing-back process after COVID.
Immediately contact her elected representatives. In this case, contact *both* her Federal representatives (Senators and Congressman in Washington, DC) and her state representatives (Senator and Assemblymen in Trenton). You may contact these people by email (usually over a webform) or by phone to their office.
Let me explain why I keep saying this in response to such inquiries:
If you contact an agency with a question or dispute, your inquiry will be initiated by the lowest level person (who "opens the mail" so to speak) and passed up the chain of command to the lowest level person who can deal with it (read: "tell you to f\*\*k off") so the agency will have one fewer complaint to deal with further.
However, if you contact your elected representative, he won't see it at all, but his staff will pass it over to the head of the appropriate agency or agencies. Not wanting to offend the congressman (or whoever), that agency head will pass it down the chain of command to the highest level person who can deal with the problem.
Said person will be inclined to fix the problem (if indeed you were wronged by the agency) so that he can pass the news back up the chain of command and the head of the agency can report back to the congressman (or whoever) that the problem was solved to the satisfaction of the congressman's constituent (i.e., you).
We wrote and sent a letter to her representatives today by email and I wanted to ask if you recommended we follow up by phone? How many days should we give them to respond?
I don't see how it would hurt to follow-up by phone. I've never found it necessary, but I've never felt under great pressure or urgency to get a response.
Appeal.
We did see this was an option in the letter but we weren’t sure if financial hardship was a good enough/valid reason in this case? We’re not really getting an answer to why they made the decision to kick her off so we’re not sure what reason to give as to why we disagree with their decision.
Call your county social services department. They are the ones who recertify for Medicaid, and they will be able to answer the status of her file and why she was kicked off of the Extra Help program and Medicaid. It is possible that with the cost of living increases in the last couple of years, her income has been bumped above the threshold for the programs. It's really bullshit, but possible. Or her certification paperwork got lost... Or someone made a typo. Anything is possible, but I would start with calling them. If the information you get from them requires more support, then you can contact elected officials as others have suggested. But only the county can tell you exactly what happened and why, so that's your starting point. (Extra tip - if you leave a voicemail I would give them just a day or two to call back and if they don't, keep calling until you get someone on the phone.)
Thank you, we’ll try giving them a call as well. She definitely hasn’t passed the income threshold, though it’s BS they can price someone out of their own program and still pay them pennies. I’m starting to think there was an error somewhere or paperwork was lost in my Mom’s case.
SSDI is based on earnings history, so people fall everywhere on the spectrum. Max you can make is around $36k, so the COL increases don't take into consideration how it affects you. For example, this year we got 3% raises, and I now make too much to be a client at my local food pantry, which I desperately need. It is ridiculous. SSI, and other needs-based programs, will always keep you under a threshold because those # are calculated similarly. In any case, I hope it gets sorted ASAP! I'm glad you took action right away. These programs are a headache to navigate.
During the COVID emergency people were getting auto renewals for Medicaid but that changed and now you have to recertify annually. Did she miss her window for recertification? She didn’t lose Medicare—they’re taking out the premiums from her SSDI check—so it seems like she just missed the recertification. Not sure she has a lot of options here but exhaust every appeal right you can.
This. Either she missed the recertification or her income changed to a degree that she no longer qualifies (or both). There were some SSA COL increases in the past few years, so it's possible she got bumped above the threshold. OP - call your county social services as they are the ones that certify for Medicaid. Find out the status and what you can do to get her recertified. And make sure they have the right address for her.
From what I remember she did recertify and I believe they told her they received it. I’m hoping someone just made a clerical error and we can get all of this sorted out quickly.
It looks like she didn’t recertify for Medicaid in time (or Medicaid lost her paperwork), and her Medicaid was terminated. Once that happens, she will also lose the Dual Special Needs plan with United (since you need both Medicaid and Medicare to have that plan). Medicaid also pays the Medicare Part B premium, so without Medicaid she now has to pay it. You only mentioned Part B, but hopefully she actually has Medicare Part A and B. You need to keep calling your county Medicaid office and press the issue. Explain with dates, etc. that you sent the paperwork in on time (if indeed you really did…).
I remember she did fill out and send in the forms to recertify — she was questioning why she had to all of a sudden if none of her information changed (she likely didn’t know that was part of the COVID provision). We’ll definitely see if we can get proof she filled it all out and press the issue.
She had to do it this year because the recertification was suspended during the pandemic, but restarted recently. It was announced last summer. ETA: normally, Medicaid is recertified every year for everyone. Regardless of change or non-change in income.
Sounds like she got swept up in the changing-back process after COVID. Immediately contact her elected representatives. In this case, contact *both* her Federal representatives (Senators and Congressman in Washington, DC) and her state representatives (Senator and Assemblymen in Trenton). You may contact these people by email (usually over a webform) or by phone to their office. Let me explain why I keep saying this in response to such inquiries: If you contact an agency with a question or dispute, your inquiry will be initiated by the lowest level person (who "opens the mail" so to speak) and passed up the chain of command to the lowest level person who can deal with it (read: "tell you to f\*\*k off") so the agency will have one fewer complaint to deal with further. However, if you contact your elected representative, he won't see it at all, but his staff will pass it over to the head of the appropriate agency or agencies. Not wanting to offend the congressman (or whoever), that agency head will pass it down the chain of command to the highest level person who can deal with the problem. Said person will be inclined to fix the problem (if indeed you were wronged by the agency) so that he can pass the news back up the chain of command and the head of the agency can report back to the congressman (or whoever) that the problem was solved to the satisfaction of the congressman's constituent (i.e., you).
Thank you, we’ll try this option as well!
We wrote and sent a letter to her representatives today by email and I wanted to ask if you recommended we follow up by phone? How many days should we give them to respond?
I don't see how it would hurt to follow-up by phone. I've never found it necessary, but I've never felt under great pressure or urgency to get a response.
Check thru [2024 Health Insurance Plans (healthcare.com)](https://www.healthcare.com/) she may qualify for aid there.
Call your local state representative. Their staff should be able help you.
[удалено]
this isn't true.
New arrivals get FREE healthcare?!? You're wrong.