Medicaid Melee

It is with great sadness that we inform you of the passing of Lisa Moran on June 6, 2023.  As a cherished member of LungCancer.net and a source of inspiration, Lisa generously and bravely shared her journey, touching and inspiring many in our community. Her courage fuels our mission, and her legacy will endure in our work. Her absence will be deeply felt, and we extend our heartfelt condolences to all who held her dear. We consider it a privilege that Lisa allowed us into her life, leaving an indelible mark on our hearts and our community.

I moved to Ohio in October 2021. Before the move, I was enrolled in Medicare and a Colorado Medicaid healthcare program.

I was automatically enrolled in Medicare due to my Social Security Disability (SSDI) approval.

Enrolling in Medicaid

Medicare is a federal program that doesn't cover 100 percent of medical bills. There are co-pays and costs that are the patient's responsibility. Medicaid is generally an income-based benefit. Buy-in programs allow higher income and asset levels.

I enrolled in a Medicaid program, Health First Colorado's Buy-In Program For Working Adults With Disabilities to help with the additional costs. There's a similar Medicaid program in Ohio, Medicaid Buy-In for Workers with Disabilities (MBIWD). I met the program requirements and submitted my application in November 2021.

Waiting for my application to be approved

Meanwhile, I was receiving invoices and past-due notices. They were for hospitalizations, emergency room visits, and follow-up appointments dating back to October 2021. Accounts receivable and collections were contacting me by mail, text, and phone.

I knew when my application was processed and approved, the coverage would be retroactive. I told everyone my Medicaid application was in process and still pending. I stopped paying copays and deductibles out of pocket.

Three months after applying, I had not received a decision. Either I would never be reimbursed those funds. Or there would be tons of red tape, paperwork, effort, and time to fight for my refunds.

My application was denied

I received assistance from an in-home healthcare social worker and the hospital financial aid department. They both contacted Medicaid to check on my application and helped me submit documents and information that was needed beyond my application.

I finally received a Notification of Action (NOA) letter in March 2022 regarding my Medicaid application status. I was denied benefits. But for a program I didn't even apply to.

The letter stated the decision was made from my November 2021 application. I had the original application and fax cover sheet. Both clearly stated I was applying for the MBIWD program.

Requesting an appeal hearing

I followed the instructions in the NOA to request an appeal hearing. I also requested a pre-hearing mediation to see if it was possible to settle my case without a hearing.

The mediator called a few days before my scheduled hearing date. It was a cut-and-dried case. I applied and definitely qualified for the MIWD program. I should be approved without a hearing. What I got was a mediator that was so unfamiliar with MBIWD that she told me she didn't even want to be involved in my case. She sent my case back to Job and Family Services.

I received a call from a Medicaid caseworker a day before my scheduled hearing. She said she was approving my MBIWD application and I could withdraw from the hearing.

Persistence pays off

I received my Ohio Medicaid number and card the first week of April 2022, five months after applying. Persistence pays off, literally. Now I can reply to the invoices and past due notices to submit my Medicaid information. The secondary coverage should pay a majority, if not all, of the balances.