On SSI But Got Dropped From Medicaid Over a Dispute... Need advice

[massacrew]

Yup you read that right.. I  got into a fight over coverage of something and things took a bit of a ugly turn.. First the insurance or the Coordinated Care Provider dropped me and then BAM not long after the Oregon Health Authority did as well.. When i say things got ugly i cannot underscore just how ugly it got.. I'd rather not get into details but let's just say it was bad VERY bad.. So heed this warning Medicaid is abysmal, Medicaid no matter if you are on SSI or not will do nothing more then the Bare "blank" minimum. If you complain over the denial of a claim and they grow tired of it they will drop you..  Medicaid appeals are a farce the first answer they give you is the answer you will get no matter how far up you go.. I am saying this so none who read this will ever find them selves in similar shoes to my self. Trust me no matter how unfair it may seem, no matter how unjust it is, they simply do not care and you will lose no matter what.. No i did not flip out in case you are wondering.. I disagreed with a denial of coverage took them to court over it they got admonished and as a result dropped me from the program saying i was quote "Too Much of a Liability". So that said any suggestions on what I should do moving forward? Can SSI step in? I'm at a bit of a loss and any advice would help.. thanks

[Helper]

Talk to the lawyer you used for the court case about your options.

Were you dropped by the state or by one of the private plan administrators most states use?  Because if it was the latter, you could switch to a different plan.

[Just Me]

Medicaid has limited funds. Regular Medicaid does not receive the additional federal monies Expanded Medicaid does. There are many things Medicaid will not pay for. Look at the letter you received terminating your benefits and closing your case. There should be instruction on appealing the decision. Appealing a denial of treatment is different than appealing termination of benefits. You have not appealed termination of benefits before.

If your Health Plan terminated you. You need to choose another Health Plan immediately. Without Medicaid the only choice you have is to go to a public hospital. They have clinics in their hospitals. You may or may not be able to get your prescriptions filled at the hospital pharmacy. Public hospitals have to accept those that do not have the money to pay.

[darkpurple]

Did you win when you sued them?

[Just Me]

Apparently the OP appealed the denial.of services. The OP did not sue Medicaid.

SSA has no control over how state Medicaid programs are run.

[massacrew]

It's time to clear up a few things.. Despite my belief that i was dropped from medicaid, upon further review I found out I was not.  Second you cannot sue medicaid period, this was a foolish assumption for my self to have made. You cannot be dropped from Medicaid it self, but you can be dropped from a coordinated care organization. You would retain medicaid benefits but billing would be submitted directly to the state instead of an actual insurance company. This is some ways would limit some care. Lastly this can only happen if you go before a administrative law judge.. So here's  a lesson from this.. Follow the process the state has in place when you disagree, but only do this if you know and can document you have been wronged.  Otherwise you are wasting your time.. Medicaid rules are not negotiable you will not win if u disagree.. Also screaming or yelling at them or the insurance companies helps nothing.. Remember they are just following the rules.. I hope this clears a few things up..

[realmeida]

Hello, massacrew, what you said is so true.  I worked for the state, dhs, in the Medicaid area and their guidelines are set and given by the federal government.  There's a lot of dotting "i" and crossing "t" to be done on both the part of the client and the worker.  You gave great advice about not yelling and screaming because that's the sure way not to get heard or helped promptly.  It's frowned on.