medicaid for my sister who has AS. I need help investigating

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Greetings,
I am new to this site and board so please bare with me.
My wonderful sister is 27 and paying 1/2 her income out-of-pocket
for health insurance yet barely makes $17,000 a year. This seams criminal
to me...shouldn't she be eligible for Medicaid?
Can anyone offer some advice? Thank you in advance!

Last edited by capekweer on 16 Aug 2009, 12:34 pm, edited 1 time in total.

I think her income may be too high--she is making nearly double the federal poverty limit in income.

i am new at ALL of this- again my appologies.
but less than $500 every 2 weeks after taxes and $350
for insurance...it just seems crazy when you factor in rent, food, car (gas insurance etc)
surely there are resources out there, no?

There might be. What I do know--one of the people I work with studies uninsured and underinsured people, and did a presentation on it--is that most of the resources out there are for people who don't have insurance at all. People who are paying a huge part of their income, or people whose insurance doesn't cover very much, have fewer resources to rely on.

Here's info on Medicaid eligibility. You might've already seen it:
http://www.cms.hhs.gov/MedicaidEligibil ... #TopOfPage

You're going to want to look at all the tabs. Under "Income & Resource Guidelines", you can see that your sister is at 157% of the federal poverty level, if she is living alone, being supported by no one else, and has no other assets (valuable property).

The problem here is that your sister is not disabled--even if she is working for only $17,000 a year. (I am assuming she is working full time for near minimum wage, but if she is working part time she might make a case for it.) Of course, supporting yourself is infinitely better than living on disability (which is less than half what your sis makes now), but being disabled does set you up to get a lot more assistance than when you're not. (Also a lot more stigma and a lot more obstacles.)

I'm not entirely sure whether she is eligible for Medicaid. She might be. She's not below poverty level, but she is low-income. What I'd suggest would be actually contacting the government office and asking. There are other programs that she could be eligible for, though, that could help do things like pay her utility bills, especially in the winter when they are probably very high; and she may be eligible for food stamps. If other parts of her income can be freed up, she may be better able to pay for health insurance.

Another idea might be to move to a lower rent area. Smaller town, probably. It's a big decision but it should be on your list if you can put it there. Finding housing assistance is going to be difficult because she isn't homeless and doesn't have kids, so go for other things first.

Long-term, she's probably going to want to hook up with a community college (grants will cover most or all of it) to get training for a better paid job. People hate having to ask for help and I'm assuming your sister's no different... depending on the government in this economy is a precarious position to take.

I applied for Medicaid due to the fact that mandatory health insurance is around the corner. I do not intend to actually use the insurance but rather wanted it to protect myself from penalties related to failure to obatin insurance. In florida, the Department of Health determines Medicaid as well as Social "Security" disability benefits. Unfortunately despite privacy laws, the agency will give out your health information to other state departments unrelated to processing a claim. In my case, the Department of health gave my private health information to the department of Highway Safety and Motor Vehicles. Now, not only do I not have health insurance (my application was denied) but I am also in danger of losing my drivers license. When I lose my license, I will have no way to way of making a living. No thanks to the government of Florida, I'm stuck between a rock and a hard place.

Since I'm diagnosed with "autistic disorder," I'm not eligible for any affordable plan that is even remotely useful for me. The only company that would insure me is Assurant Health, and they want $1250 per month and that would come with a $10,000 annual deductable. In Floriday insurance companies rule - not the people. It has come to the point where I am praying that the tropical storm that is threatening Florida destroys the Florida capital and all of the head bureaucratic offices.

Last edited by cyberscan on 16 Aug 2009, 2:35 pm, edited 1 time in total.

some states have health plans for impoverished families/disabled people. oregon has the Oregon Health Plan. you have to be making very little to qualify. unfortunately, $17k is usually a disqualifying amount for services, as I know only too well as a previously homeless mother with kids. it's still worth looking into a state-run plan to see what there might be.

I qualified for medicaid but it wouldn't pay for any of my current care, so I opted out.

I heard $21,000 per year quoted on television the other day as the current US Federal poverty level. That's actually almost double the maximum SSDI payout.

My understanding (contact your local authorities for confirmation) is that you can't qualify for Medicaid until you've been declared officially disabled for at least two years. Or maybe it's just that you have to have drawn some sort of SS for that long.

Gub'munt policy logic challenges the limits of my executive comprehension.

Uh, $21000 is federal poverty level for a large family--five people, maybe. For a single person, it is more like $10,000.

Yeah, Calista is right. The average job STILL pays about $30-$40K, so $21000 for na individual is not that bad. When I was younger, that would be enough to live on(home, car, car insurance, taxes), and STILL have over $200/month spending money. And that IS over minimum wage.

MAYBE the person posted about could have their employer go through ADP or something. MY employer goes through ADP, and I am paying HALF as much for insurance.

Steve

Persons in Family Unit 48 Contiguous States and D.C. Alaska Hawaii
1 $10,830 $13,530 $12,460
2 $14,570 $18,210 $16,760
3 $18,310 $22,890 $21,060
4 $22,050 $27,570 $25,360
5 $25,790 $32,250 $29,660
6 $29,530 $36,930 $38,260
7 $33,270 $41,610 $42,560
8 $37,010 $46,290 $40,940
For each additional person, add $3,740 $4,680 $4,300

SOURCE: Federal Register, Vol. 74, No. 14, January 23, 2009, pp. 4199–4201[15]

hi folks. medicaid is run by the individual states. the feds fund it, but due to political arguing, the states actually run it. thus, programs can vary wildly from state to state, as can the qualification requirements. if you qualify as disabled under social security guidelines (which can take 2 years to jump through) you may be covered under either medicaid or medicare (not the same program - one is for low income, one is for specific populations). however, if you are not completely and totally disabled (meaning you can't do ANY job), chances are that you are not going to qualify for social security.

when i was in grad school in texas i made a stab at trying to do a paper on the health care system there, about 15 years ago. there were so many different medicaid programs (that's the way they ran it - a different program for each target audience) that i gave up and switched topics after looking at a few other states and finding the same issues.

in good economic times, some state governments run their own programs. if your sister is in california, ... these are not good economic times. you might want to look at low-cost programs at local teaching hospitals, if there are any nearby.

in california, no matter how low income you are, there is no medicaid program for a healthy (read that not completely disabled) individual who has no children in tow, regardless of their income. they've just slashed the children's medical aid program due to the budget crisis, so i don't know where that leaves all the other services.

it always amazes me that people think there are "surely" programs and funds out there to take care of the needy, injured, or the ill. sorry, folks, it's not that way, not in the US of A. here it's if you can pay for it, you can get the absolute best care in the world. if you're down and out, you can die in a gutter and there is no national, organized system to care for you. you're expected to manage on your own.

sadly.

to the OP, the very best of luck with your sister. thank your stars she can GET health insurance at any price.

Last edited by Nan on 22 Aug 2009, 5:26 pm, edited 1 time in total.

an off-topic kind of nudge: you might want to be careful about thinking the "typical" job pays $30,000 - $40,000 a year. some stats might say "the average" income is that, but you need to check to see if that's a numerical average - are they throwing all the low income folks in with the high rollers to come out with that income - or not. you get one biotech dude pulling in $200,000 a year and that skews it for a large number of people pulling in $15000 a year. numbers can be like that....

here where i live a very large percentage of the population works several part-time and/or minimum wage jobs. that doesn't come anywhere near $30,000 a year, and housing costs are very, very high. care must be taken to not over-generalize what one "should" or "can't" afford. here, if someone is working one job at minimum wage - just a hair over $300 a week - will not be able to afford to live on their own unless they are renting a room in someone's home or have one or more roommates in an apartment, assuming a landlord will rent to them at all. (apartment landlords tend to want to see proof of steady income of 3 x the monthly rent before they will allow you to live in their property.) the cheapest rooms in private homes that i've seen advertised lately have been about $600 a month, and then there are groceries and transportation to figure in. someone earning minimum wage here does not qualify for foodstamps, so you're on your own. it's a hard life. if you have medical issues on top of it... well, it's harder. the following article link is from a story from two years ago. it ain't gettin any cheaper to live here!

http://www.onlinecpi.org/article.php?id=714 - check what they say you need to live on. $60 a month for transportation (a bus pass here now costs almost $80 and the bus doesn't go everywhere) and $50 a week for food. assuming you have access to a kitchen you can live on $50 a week for food, but you're not going to have anything to spare. etc.)

back to OP: even if the OP's sister managed to get ON medicaid, it might not be useful to her - it might only cover basic care and from 1 to 3 prescriptions per month off a very regulated formulary (or it might not cover medicine at all). if you're hoping to get some kind of mental health care for her, i don't think that a lot of states' programs cover that at all. and aspieness (etc.) tends to get categorized as a mental illness, even though it's neurologically driven. hopefully OP can look at places where the services are kinder and the cost of living is lower, and that her sister might be able to find work in one of those areas and be happy and well.

I agree with this statement 100%. In fact, those who are really needy and apply risk having more things taken from them. The working poor pay the highest percentage of their earnings in taxes and yet receive little in return. To be honest, the government of this country and of the states do not give a DAM[B]N[/B] about us. As a have written in an above post, I applied for Medicaid and am now very likely to lose my drivers license for doing so, and since I am in a rural area, there is not bus or subway for me to use. I am working on a way to divorce myself from the state and federal governments. I HATE them both.

I've been taken by ambulance to a local hospital twice within a year's time, and to the local hospital's credit, it written of the first set of fees that ran about $7500. These fees were for a 6 mile ambulance trip, a blood test, and a C.A.T. scan. I paid around $300 out of pocket for these tests. Like I said, this was done by the hospital as a charitable act rather than any service provided by the government.

Even charities are harassed by government, especially when being set up. They have numerous government (sate, local, and federal) hoops that they have to jump through before being allowed to operate especailly if the charities rent, own, or least a building to work out of. Our local autism education center had to puchase and install stuff that was not useful to autistic children and in fact could have endangered them if it were used.

In the Police States of Amerika, we desparately need local, state, and federal governments that look after the rights of the people rather than the profits of large corporations. After seeing the abuse of personal medical data by government agencies, I see very little point in a government run healthcare system. It will likely end up as being a mandatory insurance premium program in which everybody would be required by "law" to purchase insurance whether the policies offered are useful or not. In other words any type of "health care reform" will most likely be just a massive transfer of money from hardworking Amerikans to massive corporations. The Amerikan people have been bled dry and yet, the state and federal governments are looking for ever more innovative ways to suck even more from them.