It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Down Syndrome Message Board

  • Medicaid and SSI denied..?

  • Post New Thread   Closed Thread
    Thread Tools Search this Thread
    Old 08-01-2005, 03:46 PM   #1
    prjr99
    Newbie
    (male)
     
    Join Date: Jul 2005
    Posts: 5
    prjr99 HB User
    Medicaid and SSI denied..?

    My question is this... if you have DS, are you automatically entitled to SSI and medicaid no matter what type of income your family makes?

    My family's having problems with that. Not because they make too much money, but because my dad receives Social Security money for his own disability and they denied my sister's claim (she has down syndrome) for SSI... for reasons I don't understand because our income isn't high at all. My mom isn't very helpful about the whole situation. We moved to Florida about a year ago and no health insurance company will have someone with Down Syndrome

    we need Medicaid and SSI, but I've heard so many things I don't know what to believe anymore about this. Anyone got any suggestions?

     
    Sponsors Lightbulb
       
    Old 08-02-2005, 08:43 PM   #2
    Karen W.
    Veteran
    (female)
     
    Join Date: Apr 2005
    Posts: 391
    Karen W. HB User
    Re: Medicaid and SSI denied..?

    Hi,
    I don't know the laws of Florida but I do have a girlfriend who is getting SSI, She has a daughter who is 9 years old. Becuase she has a daughter who is under the age of 18 years of age, she has money added to her SSI check to help support her. So your Father is on SSI, he may be getting extra money added to his check because she is under 18. That is how it is in Wisconsin. Now I was not able to get SSI for my son because we both work and we maid to much money-( they say), frankly I felt we should have recieved something, even child care would have been nice. My son is down syndrom and I carry him on my health Insurance threw my work, I have never had a problem.
    Karen W.

     
    Old 08-03-2005, 06:45 AM   #3
    prjr99
    Newbie
    (male)
     
    Join Date: Jul 2005
    Posts: 5
    prjr99 HB User
    Re: Medicaid and SSI denied..?

    You have him on your health insurance? Hm. In Florida, I've been told (by a health insurance agent guy) that most (if any) insurance companies won't cover Down Syndrome kids. Only medicaid will. I don't understand why... maybe they think its too big a risk or something? I don't know. Weird..

    -Jose

     
    Old 08-03-2005, 10:25 PM   #4
    Karen W.
    Veteran
    (female)
     
    Join Date: Apr 2005
    Posts: 391
    Karen W. HB User
    Re: Medicaid and SSI denied..?

    Hi,
    Since my son was born, we have had compcare, bluecross/blueshield, humana and right now we have united health care, never had a problem. There is a law, If a parent carries health insurance, by law a health insurance company cannot deny him or her with a disabilty. My son is now 19 years old, The law also states that if he is unable to take care of himself, he can remain on my health insurance no matter what age he is. I recently found this out because my son was dropped from my health insurance, they said they would not cover him because he was not a full time student. Well, I was told by a social worker at the hospital, that they cannot do that, there breaking the law, She had called United health care and did a three way call so I could here it, she had a talk with them and they fixed the problem-(they said they didn't know he was DS) and now he is 100% covered. I also have a few friend who have kids with disabilities, they are also covered by insurance.
    Karen

    Last edited by Karen W.; 08-03-2005 at 10:26 PM.

     
    Old 08-04-2005, 04:59 PM   #5
    jessicap3
    Junior Member
    (female)
     
    Join Date: Apr 2005
    Posts: 18
    jessicap3 HB User
    Re: Medicaid and SSI denied..?

    Hi just wanted to give my experience with this also. I have a 2 1/2 year old daughter with DS. We live in CA and she is considered disabled however we cannot collect it for her because of my income. Also our law states that when she is 18 years old she is elible ONLY if she does not have more than $2,000.00 in assests. The whole program is not fair for our kids. My girl also does not qualify for insurance thru her disability because of that same money issue. Which makes the SSI program only useful if you are extremely poor. We definately need reform in these programs for kids. The money is not an issue for us however the insurance is. I am now going to insure her thru my work because it is an HMO and we can insure people with preigisting conditions. A private policy will not insure her because she is considered uninsurable. I know the problems so well that you all face because my daughter has had health issues realated to her Downs that have cost major $$ in hospital stays.

    Good luck to you...

    Jessica

     
    Old 08-04-2005, 07:51 PM   #6
    Karen W.
    Veteran
    (female)
     
    Join Date: Apr 2005
    Posts: 391
    Karen W. HB User
    Re: Medicaid and SSI denied..?

    Hi Jessica,
    My son was denied SSI also, we could never get it because we both work and made to much money.My son had to wear glasses, if you are on SSi your get the medicad card, you get 3 pair of glasses for free each year, My son was always breaking his glasses, it costed me so much money. He was sick allot when he was small, I missed allot of days of work, cost of child care and medical bills, add all that up. There are so amny people out there who abuse the system and then the one's who really need it are turned down. Yes I agree with you, there is something wring with the system, that is such a sore topic with me. My son has been covered under our insurance since the day he was born, At least SSI could pay what our insurace didn't cover, but I guess we are not that lucky.
    Karen

     
    Old 08-19-2005, 07:32 AM   #7
    ermc
    Junior Member
    (male)
     
    Join Date: Jul 2005
    Posts: 35
    ermc HB User
    Re: Medicaid and SSI denied..?

    You should try speaking directly to your county's main health advisor. I'm currently on SSI due to a few health and personal problems and I doubt I would be on it unless I had the county medical advisor as my personal doctor.

    I don't have downs obviously but was told they turn down over 95% of people who apply. I never asked to be on SSI and was completely against it actually, only circumstance and having no other option led me to need it at the time. I think that was another one of the deciding factors. The bureaucracy of it all and who is selected and why isn't fair I will admit. I'm sure there are many people more needing than I.

    Last edited by ermc; 08-19-2005 at 07:37 AM.

     
    Old 09-21-2005, 08:07 PM   #8
    Drafter
    Junior Member
    (female)
     
    Join Date: Feb 2005
    Posts: 31
    Drafter HB User
    Re: Medicaid and SSI denied..?

    Hey, I agree with Karen -- it's against the law to deny health coverage for an underage child with a disability.
    I don't usually like these people, but there are law firms out there set up specifically to fight Social Security on disablitiy issues. Some of them advertise that there is no charge for a consult, so you could try there. I would also contact your local ARC group; they are usually very knowledgable about disability laws, and often have lawyers working for them who specialize in this area.

    Good luck, be persistent, and you sould like a great sibling!!

    Last edited by Drafter; 09-21-2005 at 08:08 PM.

     
    Old 10-24-2005, 05:48 AM   #9
    lilly5
    Junior Member
    (female)
     
    Join Date: Nov 2002
    Location: Prospect Park, PA , USA
    Posts: 41
    lilly5 HB User
    Re: Medicaid and SSI denied..?

    My daughter is 14. She has had medical assistance all her life because of the DS. In Pennsylvania, even if a child is not eligable for SSI, they are eligable for medical assistance if disabled. There have been times, when we made too much money to be eligable for the SSI, but she was always covered with insurance. She has been eligable for SSI and has been receiving it for the past 6 or 7 years now. Luckily I work for a man who pays me under-the-table so I don't have to report my income ( I only work 10-15 hours a week anyway, but the income would lower the amount of SSI my daughter receives). What I was told when she was first born was to go to the Social Security office first and apply for SSI, whether you are denied or given the SSI, then go to the Department of Public Welfare and apply for the medical assistance. Good luck! MONA

     
    Old 10-25-2005, 06:28 AM   #10
    feelbad
    Senior Veteran
    (female)
     
    Join Date: Dec 2003
    Posts: 10,122
    feelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB User
    Re: Medicaid and SSI denied..?

    I am just wondering about how they determine the amount of the monthly disability check in a child?not ssi,just disability.does anyone know?marcia
    __________________
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Old 10-28-2005, 06:05 PM   #11
    kylesmom
    Newbie
    (female)
     
    Join Date: Jun 2005
    Location: New Jersey
    Posts: 8
    kylesmom HB User
    Re: Medicaid and SSI denied..?

    I too, was very disappointed to hear that it is not about the child's disability but rather the income of the family. Therefore my son was denied SSI and Medicade. Until I and my spouse make less than $19,000 per year we will not qualify.

    However, I do not know that an insurance comapny denying coverage is legal. HIPAA is now protecting participants with a pre existing condition (if they even have one). Down Syndrome is not a pre-existing condition. A heart ailment, any kind of therapy related to a certain issue, is a pre existing condition.

    Now if you sister had a condition that went into a lapse for more than 59 days that is different. The insurance company can deny claims related to that condition only. However, Down Syndrome is not her condition. The thing that insurance companies do not realize is that Down Syndrome is just an extra chromosome.

    Please follow up with the HIPAA laws. The Clinto administration put these in place for a reason. I would fight this one to the bone. Go to your local adminstrator if you have too. You can be the advocate for your sister. She really is no different than you and I .

    I had a situation after my son was born where my insurance did not want to pay for his circumcism because he was disabled. I threatened to sue...for DISCRIMINATION. People with Down Syndrome are human beings, requiring the same care as anyone else. My father was a smoker for years....every bought of congestive heart failure is not denied by the insurance company...why should my son, whose 'syndrome' is no fault of his own.

    Also...look into the catastrophic medical plan in your state. They will usually pick up up any medical expense above and beyond 10% of the household income.

    I am a benefits consultant and can help if you need. This has helped me greatly in protecting the rights of my son and his medical coverage.

     
    Old 11-13-2005, 12:03 PM   #12
    MsSnowgirl
    Newbie
    (female)
     
    Join Date: Mar 2005
    Location: Denver
    Posts: 9
    MsSnowgirl HB User
    Re: Medicaid and SSI denied..?

    Hi! If you make too much to qualify for SSI and Medicaid, apply for a HCBS waiver (Home and Community Based Services Waiver) It allows your child to have Medicaid regardless of your income....but there is a waiting list.

    http://www.dhs.state.ia.us/MedicalServices/hcbs_waivers.asp

    My daughter is in line for one now....waiting lists vary from state to state.

    Hope this helps!!

     
    Old 01-08-2006, 12:11 PM   #13
    roy holbrook
    Newbie
    (male)
     
    Join Date: Nov 2005
    Location: marietta
    Posts: 5
    roy holbrook HB User
    Re: Medicaid and SSI denied..?

    Hello,I do not know about Fla. but Ga. has insurance called peach care for children only who have no other options for medical insurance.
    I myself have a 12 yr. old and to answer a post earlier in the string. I have never had any problem insuring my son w/ downs with the policys my present or past employers.This includes three different insurers.
    I believe in Ga. that the insurance companys are bound by this under law.
    Good luck

     
    Old 01-09-2006, 06:47 PM   #14
    specialbabies
    Member
    (female)
     
    Join Date: Dec 2005
    Location: northeast
    Posts: 69
    specialbabies HB User
    Lightbulb Re: Medicaid and SSI denied..?

    Quote:
    Originally Posted by prjr99
    My question is this... if you have DS, are you automatically entitled to SSI and medicaid no matter what type of income your family makes?

    My family's having problems with that. Not because they make too much money, but because my dad receives Social Security money for his own disability and they denied my sister's claim (she has down syndrome) for SSI... for reasons I don't understand because our income isn't high at all. My mom isn't very helpful about the whole situation. We moved to Florida about a year ago and no health insurance company will have someone with Down Syndrome

    we need Medicaid and SSI, but I've heard so many things I don't know what to believe anymore about this. Anyone got any suggestions?
    I live in FLA and have been denied once, am appealing it and if get denied again will get a lawyer. The lawyer only takes a cut from the 1st payment from SSI,if you win. Try It. Good Luck

     
    Old 01-09-2006, 06:49 PM   #15
    specialbabies
    Member
    (female)
     
    Join Date: Dec 2005
    Location: northeast
    Posts: 69
    specialbabies HB User
    Lightbulb Re: Medicaid and SSI denied..?

    You can reappeal online. [url]www.myfla.gov[/url], I believe My child gets SSI for a seperate disability, I was told by them, different disability, reapply. also you can apply online for welfare until SSI kicks in, they do that online too, most offices here are closing down. I get stamps and medicaid. keep me up to date

    Last edited by specialbabies; 01-09-2006 at 06:54 PM.

     
    Closed Thread

    Related Topics
    Thread Thread Starter Board Replies Last Post
    Medicaid janart Bipolar Disorder 4 12-29-2009 07:28 PM
    Medicaid Application Denied polina Alzheimer's Disease & Dementia 28 10-09-2009 07:26 AM
    Medicaid approved but SSD denied pjammies Disabilities 4 01-17-2008 02:29 PM
    Anyone else have problems getting their meds approved by Medicaid? momchelle Pain Management 8 12-16-2005 09:03 AM




    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 07:13 PM.





    2019 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!