Eye-opening Website

 

NEW YORK CITY, November 29 – New York State has launched a new web-page that has simple, straightforward information about the Medicaid “Excess Income” or “Spend-down” program.

 

Thousands of individuals never apply for Medicaid, or are wrongly turned down when they apply, because their income is too high to qualify for Medicaid.  

 

“This website now explains they may qualify if they have outstanding medical bills, or if they paid for medical care recently, as these bills offset their so-called ‘excess income’ and qualify them for Medicaid coverage,” notes Valerie Bogart, health care advocate and Director of the Evelyn Frank Legal Resources Program of the non-profit organization, Selfhelp Community Services. Selfhelp is part of a team of health care rights supporters that collaborated with the State Department of Health to untangle the wording and explain the complex rules in plain language. The advocacy consortium also included the Empire Justice Center, Legal Aid Society, Center for Independence of Disabled of NY,  National Center for Law and Economic Justice, and the Medicare Rights Center.

 

Thousands of New York State seniors over 65, as well as younger people with disabilities, children under 21, and their caregiver parents, may be eligible for health insurance through Medicaid because their past medical bills offset their “excess income” that is above the strict Medicaid limits ($767 for a single person and $1117 for a couple).    

 

“Many people simply don’t realize that you can apply for Medicaid by using past unpaid hospital bills, prescription drug costs or even amounts paid by the EPIC program (New York State subsidized prescription drug programs for seniors age 65+), or ADAP (New York State subsidy program providing prescription drugs and other medical care for people with HIV or AIDS).    To many this will be a revelation that will allow them to obtain coverage they would otherwise be denied,” explains Lisa Sbrana, Supervising Attorney of the Health Law Unit at The Legal Aid Society.   “In this instance,” she added, “knowledge is power. And knowledge like this can literally change a family’s life.”

 

A recent report to the state revealed that approximately 61,000 individuals living in the community have applied for Medicaid coverage through the spend-down program because their income is too high to qualify for coverage, but of those at least 15,000 have not activated coverage because they do not submit medical bills that offset their “excess” income. Many do not know that medical bills as old as six years old, or bills that the state pays for them through the EPIC or ADAP programs, can all count to offset their excess income. Ms. Bogart believes the number could be well in excess of the 15,000 mark – perhaps affecting as many as 20,000 or more NY state seniors and people with disabilities.

 

A 43-year-old woman who was diagnosed with multiple sclerosis was told she would not be able to receive Medicaid because her Disability benefit of $1400/month through Social Security meant she had $600/month in excess income. She would not receive Medicare for another year, because she was only half-way through the 24-month waiting period for people under age 65 who are disabled.   She was referred to Selfhelp, where it was discovered that her outstanding hospital charges of almost $24,000 could be applied to “spend-down” Medicaid coverage and enable her to obtain coverage for over three years. This gave her crucial medical care and prescription drugs until Medicare started, and then qualified her for “Extra Help,” the subsidy that makes the Medicare Part D prescription drug coverage affordable that is available to people on Medicaid.    “The local Medicaid workers never told this woman she could submit the old hospital bill -- instead, they simply denied her coverage,” said Ms. Bogart. “Hopefully the improved website will educate Medicaid workers as well as consumers.”   

 

Advocacy groups have worked with the State Medicaid program for over a year to improve information about this program. The straightforward information in a Q&A format is easy to understand. 

Click on http://nyhealth.gov/health_care/medicaid/excess_income.htm

 

For additional information, individuals can contact Selfhelp’s Evelyn Frank Legal Resources hotline at

212 971-7658, or the Legal Aid Society at 212-577-3575