Medicaid?

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docdionne

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Hey guys, MS3 here trying to find a good answer for a patient.

Sweet old man, NASH, TIPS, now with hepatic encephalopathy that doesn't respond well to much besides rifaximin, which with medicare is $604/mo for this family. Way out of their price range. I spoke to the pharmaceutical company, and they said he can only qualify for "hardship" if he gets medicaid. The patient's daughter said she was told he can only qualify for medicaid if he's admitted to a nursing home.

I don't know much about their financial situation, but I know he's not well off. He owns a home, but lives with his daughter, I think he's a vet, but no service connected disability. I googled medicaid eligibility and of course it's confusing as all hell. Is there something to this only qualifying for medicaid if he's admitted to a nursing home? Is that real?

thanks for any and all input.

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Specific Medicaid eligibility requirements depend on the state where you live. It varies somewhat from state to state, although children are generally always covered.
 
Hey guys, MS3 here trying to find a good answer for a patient.

Sweet old man, NASH, TIPS, now with hepatic encephalopathy that doesn't respond well to much besides rifaximin, which with medicare is $604/mo for this family. Way out of their price range. I spoke to the pharmaceutical company, and they said he can only qualify for "hardship" if he gets medicaid. The patient's daughter said she was told he can only qualify for medicaid if he's admitted to a nursing home.

I don't know much about their financial situation, but I know he's not well off. He owns a home, but lives with his daughter, I think he's a vet, but no service connected disability. I googled medicaid eligibility and of course it's confusing as all hell. Is there something to this only qualifying for medicaid if he's admitted to a nursing home? Is that real?

thanks for any and all input.

Do you have a social worker within your program? Perhaps they could help you out.
 
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Do you have a social worker within your program? Perhaps they could help you out.

Thanks to both of you for your responses.

There is basically only one social worker and she's incredibly swamped (or at least tells everyone she is?), and I have the sense that this is the social worker who told the patient's daughter he wouldn't qualify without being put in a nursing home.
 
Thanks to both of you for your responses.

There is basically only one social worker and she's incredibly swamped (or at least tells everyone she is?), and I have the sense that this is the social worker who told the patient's daughter he wouldn't qualify without being put in a nursing home.

Something that you should learn sooner, rather than later, is that it can take an astonishing amount of poverty to qualify for Medicaid - particularly for those too old to have small dependent children, but are too young for Medicare. So you may think that he's "not well off," but he could still easily make too much money, or have too much in assets, to get Medicaid.
 
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Medicaid eligibility depends on which political half of the country you live in. http://kff.org/health-reform/state-...nding-medicaid-under-the-affordable-care-act/

As above, it also depends on citizenship, age, income and disability status. The social worker's comment seems to indicate that (a) you're in a non-Medicaid-expanding state and (b) the patient is under 65. The "nursing home" part is a common metric for whether a patient has a disability that would make them Medicaid eligible, but there are other disability metrics as well.

There's also more or less an expectation that all assets are depleted before you can get Medicaid. The patient should probably be transferring ownership of assets to his kids at this point so they're not seized to cover hospital bills. Which is where this is headed, no?

'Murica.
 
The patient should probably be transferring ownership of assets to his kids at this point so they're not seized to cover hospital bills. Which is where this is headed, no?

There's a 60-month lookback rule, so he'd have to wait for 5 years after transferring any assets before he could apply for Medicaid.
 
There's a 60-month lookback rule, so he'd have to wait for 5 years after transferring any assets before he could apply for Medicaid.
Ah. Well, he can apply with the house on the books...but it's moot in a non-expansion state anyway.

There are also locale-specific asset seizure laws, I think, and I'd be concerned that he'll lose his house by the 3rd hospitalization or so. Which is a race condition with the disability determination.

BTW if this guy is over 65 it's a completely different conversation - the drug maker will be working wicked hard to get Medicare to pay, if that hasn't happened yet.
 
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