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Posts Tagged ‘Medicaid’

Beyond twists of fate and bureaucratic blunders, leukemia victim’s spirit shines on with gift for others in similar need

Tuesday, August 24th, 2010

Some current headlines reinforce the need for legal counsel and improved legislation for those needing help with disabilities–and against those who game the system. In this three-part installment, the first case we’ll look at is reminiscent of that of Heather Russell, which we covered here, a glaring example of the glacial response of the bureaucracy and the unnecessary pain it inflicts on patients when they most need help.

From one extreme to another

Diana Smith’s case adds a twist, in that one agency’s apparent quest to be helpful apparently negated another agency’s ability to help the victim of a rare leukemia.  However, well before those agencies got involved, she already was riding out a whipsaw of events.

The Sunrise, Florida woman, survived by three-year-old son, Cameron,  was pregnant with another child when she was diagnosed in July 2009. Her doctors advised terminating the pregnancy because of the chemo she would need to battle the leukemia. Cameron’s father–Smith’s fiance, Eddie Velez–stepped up ready to sell a valuable comic-book collection to go toward treatment costs, reports an Aug. 16 article in the South Florida Sun Sentinel.

Theft

In August, the comic books were stolen from Velez’s home in Ohio. In March, Smith told the paper that the thief had yet to be apprehended.

Told she needed a bone marrow transplant, according to an Aug. 20 account of a CBS affiliate, Smith was able to raise more than $100,000 with community help and maybe a Facebook campaign (we couldn’t find the Facebook page),  to get in line for the operation. Former Miami Dolphins player Kim Bokamper and other celebrities also participated.

Son gets benefits

Also in March, in what must have seemed like a stroke of good luck, “Smith was contacted by the Social Security Administration and was informed that her three year-old son was entitled to receive Social Security disability payments. Even though she didn’t ask for it, she signed the form and received her son’s first check.”

Medicaid withdrawn

But the luck didn’t hold–even though the SSA seemed to be trying to help, the new benefits put her at odds with Medicaid: “In April, Medicaid canceled her universal health care policy because her income level had risen with her son’s payments – making her ineligible for the insurance program.”

Well, at this point, we all see this coming–given the Medicaid withdrawal, the hospital also stood down:

“Jackson Memorial Hospital then informed Smith that they couldn’t go forward with the transplant because the risk was too high. The universal policy from Medicaid would help shield the hospital from liability in this kind of case; without it they are subject to liability issues.

“Even though Smith offered to cancel her son’s disability benefits, she was told it’s too late.”

Legislators intercede

To break the inter-agency logjam, U.S. Rep. Alcee Hastings, D- Miramar, and state Sen. Dave Aronberg, D- Greenacres, had to intervene, and somehow they got the Medicaid coverage reinstated. So the bone marrow transplant was performed in May, and Smith was able to visit her son at home on Mother’s Day. “She was ordered to spend forty five days in the hospital followed by three months of bed rest,” says the CBS affiliate.

She died in August–perhaps a victim of the delayed medical procedure. Most likely, we’ll never know.

Leftover funds

But the story doesn’t end there.

In the end, she added her own loving spin to the harsh twists she had faced. As it turns it, the fundraiser brought in about $90,000 more than what her procedure cost. She had it set up such that nobody “involved in Smith’s fundraising effort has access to the unused donations, according to Jason Hare, patient program coordinator for the Bone Marrow Foundation,” says the Sun Sentinel.

“The leftover money, held by the New York-based Bone Marrow Foundation, will go toward fulfilling Smith’s wish: to help another Broward County resident whose life may depend on a similar operation.

” ‘I know it was really hard for me to collect the money, so I want to help someone else,’ Smith told the Sun Sentinel in March. ‘If it wasn’t for my friends and people donating, I wouldn’t have been able to do it.’ ”

[Next: Part Two discusses revelations that a suspected serial killer has been receiving disability payments from the city of Los Angeles for 19 years. Read it here.]

Capitol Hill attention to benefits, Medicaid stalled as Congress takes another break

Friday, June 11th, 2010

Congressional action–and lack of it–is not only affecting unemployment benefits but also is intertwined with effects on Social Security programs and Medicaid.

According to a May 28 CNNMoney.com piece, “Democrats [in the House] spent much of the week trying to round up votes to extend the jobless benefits deadline,” and the “House voted Friday to extend the deadline to file for federal unemployment benefits, but not before the Senate recessed for a week-long Memorial Day break. So jobless Americans will start running out of benefits after June 2.”

“As a result,” says a May 29 BusinessWeek article, “19,000 Americans will see their jobless benefits interrupted by June 5, with that number projected to grow to more than 320,000 by the end of the second week of June, according to the Labor Department.”

Apparently, the Memorial Day break was not enough respite. One headline, from the June 10 edition of The Miami Herald, tells the tale: “Congress takes long weekend, lets jobless benefits hang.”

From that article: “Meanwhile, the National Employment Law Project estimated that 325,000 people won’t be able to collect benefits. This is the third time that Congress has missed on a deadline for extending the benefits; it’s expected that they’ll get paid retroactively.

“In addition, people laid off after June 1 won’t be eligible for government help with their health insurance, and the government’s program to fund summer jobs – which had been expected to provide an estimated 330,000 jobs for at-risk youths – remains unfunded and thus stalled.”

Also up in the air is what happens to needed legislation for Medicaid.

According to the May 28 CNNMoney.com piece, “The final version, approved by a 215-204 vote, extended the deadline to file for unemployment benefits through November, but jettisoned sending $24 billion in Medicaid assistance to the states and extending the 65% federal subsidy for COBRA health insurance premiums.”

The May 29 BusinessWeek article reports: “Lawmakers also left without Senate action on forestalling a long-scheduled 21 percent cut in Medicare payments to doctors, set to take effect at the end of this month. The Centers for Medicare and Medicaid Services said it will delay paying physicians’ claims to give Congress more to time to act.

“ ‘This is complete mismanagement of a health-care program that America’s seniors and disabled rely on,’ said American Medical Association President J. James Rohack in a statement.”

Now–two holiday breaks later–says an MLive.com piece posted today, the  Senate “measure does not provide state aid for Medicaid and welfare nor does it include any of the revenue-generating tax increases in the Democratic bill.”

And various states are plenty concerned. Here’s some snippets from a roundup at today’s Kaiser Health News:

From The Boston Globe: ” ‘The Massachusetts delegation sent letters yesterday to House and Senate leaders urging them to support an extension of Medicaid funding that officials in Massachusetts and other states say is vital to prevent drastic cuts in services and increases in layoffs.’ Newly elected Republican Sen. Scott Brown did not sign the letter because the proposal would add to the federal deficit. But the 11 Democrats in the delegation were adamant that the extension be approved. ‘Governor Deval Patrick and state lawmakers have been counting on the extension to fund about $800 million of next year’s budget.’ “

From the Charlotte Observer: “Legislators are at odds about what to do regarding ‘a $500 million hole that may appear in that budget if Congress doesn’t act on a Medicaid extension. Both the state Senate and the House have adopted versions of the budget that include the Medicaid money. … Now lawmakers are nervously waiting to hear whether Congress will approve the Medicaid extension bill that at least 30 states are counting on to help avoid teacher layoffs and other cuts’ “

From The Denver Post: “If Congress chooses not to approve a six-month extension of Medicaid help to the states, Colorado could face a $211 million budget hole and the prospect of another cut to K-12 education or other programs. Medicaid, a state and federally funded program that provides health care for the poor, now covers about 500,000 Coloradans. During the recession, the federal government has increased its share of Medicaid funding to the states, which have seen tax revenues plunge as Medicaid enrollment rose.”

More Benefits of Supplemental Security Income (SSI)

Thursday, October 15th, 2009

Another benefit of receiving Supplemental Security Income (SSI) is that you may qualify to receive Medicaid. It is important to remember that Medicare and Medicaid are not the same thing. Medicaid is a federally-funded, state-run program that provides medical assistance for individuals and families with limited incomes and resources. Medicaid pays for your health care costs, including doctor’s visits and eye care.

If you receive Supplemental Security Income (SSI) and you get Medicare, your state may pay your Medicare premiums if you have low income and few resources. In some cases, your state may also pay Medicare expenses like deductibles and coinsurance.

Only your state will know if you are qualified. Your state or local welfare office or Medicaid agency can tell you whether you are qualified to receive these benefits.

You also may be able to get extra help paying for the annual deductibles, monthly premiums and prescription co-payments related to the Medicare prescription drug program (Part D). You may qualify for extra help if you have limited income (tied to the federal poverty level) and limited resources. These income and resource limits change each year and are not the same as the SSI income and resource limits. You can contact Social Security for the current numbers.

If you have both Medicaid with prescription drug coverage and Medicare, Medicare and SSI, or if your state pays for your Medicare premiums, you automatically will get this extra help. You will not need to apply for it.

As you can see, there is a worthwhile monthly cash benefit that you will receive if you qualify for Supplemental Security Income (SSI). In addition, there are the additional benefits listed above that you may qualify for because you are receiving Supplemental Security Income (SSI). It is certainly worth the time and effort to apply for SSI.

You may have applied and been denied for Supplemental Security Income (SSI). What can you do now? What options are open to you?

If you decide to appeal the denial by the Social Security Administration, you are probably going to need the help and advice of a good disability attorney. People who have an experienced disability lawyer are approved more often than those without an attorney.

SocialSecurityHome.com is the Web site where you can get in touch with a disability lawyer who can help you get the Supplemental Security Income (SSI) benefits that you are entitled to.

Appealing the denial by the Social Security Administration can be a long and trying process. The disability attorney at SocialSecurityHome.com can counsel and assist you in your efforts to win your claim.

Do not put this off. Do not wait or delay. This is something that is vitally important to you and your future. Contact the disability lawyer at SocialSecurityHome.com, today.

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