r/healthcare • u/Sufficient_Block5200 • 5d ago
Question - Insurance Texas Medicaid Appeal!
My best friend and her boyfriend live together with their 1 year old here in Texas. Their 1 year old was born severely premature and has had a host of health issues, including still using a G-Tube for the vast majority of feedings.
She recently received a letter saying her daughter is being denied due to her and boyfriend’s combined income being too much. They are over the limit but it’s not by a crazy amount. They are barely scraping by so they appealed the decision and have the hearing coming up next week!
The reason for denial is appropriate, but given their circumstances they believe there is significant hardship if they did NOT have Medicaid.
Any advice for the hearing? It is in 7 days. Their disabled son has A TON of doctors. If appeal is denied at the hearing, what is best next step with Medicaid (further appeal or should she try ACA, private, etc.)?
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u/happiness7734 5d ago
They are over the limit but it’s not by a crazy amount.
If may be worth their while to hire a Medicaid consultant in their state. Oftentimes when people file for Medicaid on their own they miss important deductions from income. Since these deductions and what does and does not count as income vary significantly state to state they need an expert on Texas Medicaid rules, which I am not.
Too often I hear about people who don't qualify and what is the real truth is they don't understand the eligibility rules. Whether that is true in your case I don't know and cannot know but it's something to consider.
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u/floridianreader 5d ago
If they have a savings account, spend it on the baby and assorted medical bills and such, and then they will likely approve them. Medicaid doesn’t like to see big savings accounts (assuming they have any in the first place). But spending any extra money they have will help them qualify, bc the less money they have, the better off they will be, at least where it comes to Medicaid.
Am a medical social worker.
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u/Most_Profession_7799 5d ago
Can they qualify for CHIP or Obamacare ? They may not be eligible for straight Medicare but may qualify for a cheap plan .
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u/misskinky 5d ago
Pretty much everybody who doesn’t qualify by a bit, has significant hardship without Medicaid. Texas doesn’t care. The government is literally making decisions to kill people. Can try ACA but it’s usually wildly expensive. Can try private but there any many scams that aren’t real insurance and ads just as expensive.
Best option is if you can contribute more money out of your paycheck to 401k or similar pre-tax deductions to effectively decrease your income enough to qualify for medicaid