I am writing on behalf of my daughter, because she’s too busy sobbing in frustration to do it herself. There is a lot of backstory, but I’ll just give the facts. I also posted at r/legaladvice, because I’m just hoping to find someone who can steer her in the right direction to get help.
One of the main issues she is having is that none of the recommendations listed on the HHS (or found through any kind of google search) are helpful. They list why someone might be denied, and how to file an appeal. She has gone through the process over and over, and it’s just not helping.
Even though she is married, we kept her on our health insurance until she turned 26 last month and was legally kicked off. Because of health issues, she has been unable to work a “real” job — ie, 40-hour, benefit-eligible — since graduating from college. Her husband lost his job just before covid, and just started a new one (in the interim, he could only find part-time work). She will not be covered under his insurance unless she and her husband pay for it, and they can’t afford it with him being the only one working steadily.
She has severe asthma, and has battled an unknown autoimmune condition for a long time; she sees a rheumatologist, a pulmonologist, and a functional medicine doctor. And now, she’s pregnant. Before she found out she was pregnant, we were already talking about how to get medical coverage for her once she was removed from ours. The first time she applied for Medicaid, she was denied because she was still on our insurance. That was understandable.
But then she applied again, timing it so that there would not be a huge lapse in coverage, but not so early that she would be ineligible. She was denied again, without an explanation, so she called. The person she spoke to said they were missing a document. She said OK, and asked if that was the only thing missing. She was told yes.
This same pattern has repeated itself over and over since then. She receives a denial. She calls (as there are no in-person appointments now), gets routed all over the place, is put on hold for 40-120 minutes, explains everything to the random person who eventually answers (as there are no assigned caseworkers), and is told either “Not sure why you were denied, but I’ll look into it. You should receive an update within a week” or “You’re missing X document,” which is always a doc that has never been mentioned to her on previous calls. When she asks if she can speak to a supervisor, she is told no.
She is now almost 4 months pregnant, and hasn’t been able to pay her doctor a cent. By all accounts, she meets the eligibility requirements; it’s not even close. She has turned in every document they’ve asked for. This has become the single biggest stressor in her life, and I have no idea where to tell her to turn for help. She is not trying to game the system in any way; three years ago, she was on track to becoming an early intervention specialist or special education teacher, and now it is almost certain she will never be able to work any full-time job. She is broke and frustrated and scared about what will happen if she can’t get at least this issue figured out. Any advice is very much appreciated.
tldr: Daughter keeps being unfairly denied medicaid, and the appeals process isn’t working
submitted by /u/MerryTexMish
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I am writing on behalf of my daughter, because she’s too busy sobbing in frustration to do it herself. There is a lot of backstory, but I’ll just give the facts. I also posted at r/legaladvice, because I’m just hoping to find someone who can steer her in the right direction to get help. One of the main issues she is having is that none of the recommendations listed on the HHS (or found through any kind of google search) are helpful. They list why someone might be denied, and how to file an appeal. She has gone through the process over and over, and it’s just not helping. Even though she is married, we kept her on our health insurance until she turned 26 last month and was legally kicked off. Because of health issues, she has been unable to work a “real” job — ie, 40-hour, benefit-eligible — since graduating from college. Her husband lost his job just before covid, and just started a new one (in the interim, he could only find part-time work). She will not be covered under his insurance unless she and her husband pay for it, and they can’t afford it with him being the only one working steadily. She has severe asthma, and has battled an unknown autoimmune condition for a long time; she sees a rheumatologist, a pulmonologist, and a functional medicine doctor. And now, she’s pregnant. Before she found out she was pregnant, we were already talking about how to get medical coverage for her once she was removed from ours. The first time she applied for Medicaid, she was denied because she was still on our insurance. That was understandable. But then she applied again, timing it so that there would not be a huge lapse in coverage, but not so early that she would be ineligible. She was denied again, without an explanation, so she called. The person she spoke to said they were missing a document. She said OK, and asked if that was the only thing missing. She was told yes. This same pattern has repeated itself over and over since then. She receives a denial. She calls (as there are no in-person appointments now), gets routed all over the place, is put on hold for 40-120 minutes, explains everything to the random person who eventually answers (as there are no assigned caseworkers), and is told either “Not sure why you were denied, but I’ll look into it. You should receive an update within a week” or “You’re missing X document,” which is always a doc that has never been mentioned to her on previous calls. When she asks if she can speak to a supervisor, she is told no. She is now almost 4 months pregnant, and hasn’t been able to pay her doctor a cent. By all accounts, she meets the eligibility requirements; it’s not even close. She has turned in every document they’ve asked for. This has become the single biggest stressor in her life, and I have no idea where to tell her to turn for help. She is not trying to game the system in any way; three years ago, she was on track to becoming an early intervention specialist or special education teacher, and now it is almost certain she will never be able to work any full-time job. She is broke and frustrated and scared about what will happen if she can’t get at least this issue figured out. Any advice is very much appreciated. tldr: Daughter keeps being unfairly denied medicaid, and the appeals process isn’t working
submitted by /u/MerryTexMish [link] [comments]Read Morer/HealthInsurance