Question


littley...

NY Medicaid with spend down?

I now have a spend down with Medicaid. After trying to get an answer for over two months the CDPHP representative at my local Social Security office told me I no longer have CDPHP because I have a spend down, not eligible for managed care. I was told I can still go to medical appointments I just need to give my Benefit (Medicaid) card instead of the CDPHP one that I used to give them. I am disabled and unable to work, receiving Social Security Disability (SSD) for my only income. I have to pay $140 a month to be able to have Medicaid. SSD wants me to call them and tell them what my bills are (rent, phone, heat, electric ect) so that they can give me more money a month. This would just mean any extra money they give me would go right to Medicaid. I have to see a social worker/therapist/psychiatrist at least once every two weeks. I also need to see a nurse practitioner/psychologist around once a month, some times more. I have 7 prescriptions for medication that I need to get filled every month. Does anyone know what if any the co payments are for these things with just having Medicaid? Not that I would see any point in co payments being that Medicaid would just but them towards my next months spend down. When/if I have to be emitted for inpatient care due to mental health I have to pay the spend down for 6 months ahead for it to be covered by Medicaid. Is this before or after I get emitted? If it is before, how do they expect me to get down to their office and pay it when I need to be in the hospital? Also, I doubt it but is there any health insurance out there that I could get myself that would cost me less than what Medicaid is but still cover everything I need? Thank you for any information you can give me. I would call Medicaid to ask them but I'm sure that the lovely people here would answer me long before I would get even one answer from Medicaid being that it took me 2 months just to get them to tell me I don't have CDPHP any more. Thanks everyone!!! Oh and the 6 months payment is because I pay my spend down at the start of each month directly to Medicaid, like you would for the premium of "normal" insurance. The "deductible" for a hospital stay is equivalent to 6 months of my spend down payments.

5 months ago - 3 answers

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As long as the providers you use accept medicaid, you would pay them the contracted rate for whatever services you received and that would be put towards that months spend down. It works like a deductible on insurance. Once you have paid the $140 for that month, medicaid picks up the balance. I don't understand why you would need to pay the spend down 6 months in advance of a hospital admission. Perhaps you misunderstood? There is no insurance you would be able to qualify for. However, after you recieve SSDI for 24 consecutive months, you would be eligible for medicare.

by Lori

5 months ago

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by Pravash- 5 months ago

No private health insurer is going to want to swap the cost of seven prescriptions and three doctor visits every month, for less than $140. Insurance companies that did that, would go broke. Being disabled, pretty much will exclude you from buying a private health insurance policy. Unless you can find a job you can do and get on a group plan, this is what you'll be stuck with for the rest of your life - until Medicare/Medicaid implode.

by mbrcatz- 5 months ago