The New York State Department of Health launched a new web page that explains how consumers can obtain Medicaid through the Medicaid "Excess Income" or "Spend-down" program.
The new page was designed in collaboration with a statewide working group of advocates, which advocated for these changes to increase access to Medicaid for those allowed to "spend down" excess income to qualify -- people age 65+, people with disabilities, and children under 21 and their parents and other caretaker relatives.
The new web page is in Q & A format. In addition to the direct link it can be found from the main State Medicaid page. In the list of bullets at the top, scroll down and click on the 8th bullet for What is the Medicaid Excess Income Program?. This launches a new web page with the Q & A., in which DOH incorporates many of the suggestions from the working group.
The working group includes the three organizations that sponsor the New York Health Access website -- Empire Justice Center, Legal Aid Society, and Selfhelp Community Services, along with the Center for Independence of Disabled of New York (CIDNY), the National Center for Law and Economic Justice, and the Medicare Rights Center.
The working group was convened when a report, Streamlining New York's Excess Income Program, was issued in May, 2009 by the New York State Health Foundation., written by Manatt Health Solutions. The working group's comments reacting to this report and urging changes in the spend-down program, issued in June 2009, were endorsed by 48 organizations, and are posted in this article: Advocacy to Improve the Medicaid Spend-down Program in New York State.
Since then, the working group has met with DOH and submitted recommendations to improve information about and procedures for accessing the Medicaid spend-down program by improving the State website, client notices, the State Medicaid Reference Guide (MRG), and the format and content of the Medicaid application.
Today's website changes significantly improve public information about the excess income or spend-down program. In particular, the website explains, for the first time:
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That even an unpaid medical bill can be used to meet the spend-down (only has to be "incurred")
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That past unpaid medical bills as well as recent paid medical bills can be used to meet the current and future spend-down.
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That bills paid BY the EPIC and ADAP programs -- in addition to co-payments paid by recipients for prescriptions paid by these programs -- can be used to meet the current and future spend-down
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That bills of certain family members can be used to meet one's spend-down
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That people with disabilities who find it difficult to go into a DSS/Medicaid office have a right to fax in bills as a reasonable accommodation for a disability, and that in some districts, including New York City, anyone can fax in their bills. (For information about faxing bills in New York City, see this page for forms and instructions).
HERE'S TWO STORIES OF WHO YOU CAN HELP WITH THIS KNOWLEDGE:
Susan, age 43, was still a year away from qualifying for Medicare, because she was in the 24-month waiting period after being awarded Social Security Disability benefits for multiple sclerosis. Her SSD check of $1500/month gave her an $800 spend-down. She was never asked if she had any old unpaid bills and her Medicaid -- which formerly had no spend-down before her SSD award -- was now being terminated because she lacked the medical bills to meet the spend-down. We asked her about her old bills, and she had a $25,000 old hospital bill that was still unpaid from when she was first diagnosed and had no insurance. While we could not get that bill paid, it was used to meet her spend-down for over 30 months -- covering her until Medicare started, and then guaranteeing her " Extra Help" with Medicare Part D costs.
Sam, age 67, has an $800 spend-down and high drug expenses. EPIC paid his drug costs when he hit the Medicare Part D "doughnut hole" in August 2010. Even if he only has enough bills to meet his spend-down for ONE MONTH, it is worth applying for Medicaid. Just getting Medicaid for August 2010 or later in 2010 for ONE MONTH will automatically enroll him in Extra Help for the rest of 2010 and ALL OF 2011. You gathered these bills to add up to the $800 spenddown in September 2010:
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$200 past unpaid medical bills, from 3 years ago before he had Medicare
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$200 medical bills he paid since June 1, 2010 (the 3-month retroactive period before his September 2010 application), and
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$400 that EPIC paid for his drugs since June 1st, while he was in the Part D doughnut hole, along with his EPIC copayments (to get this info, write to EPIC with a HIPAA release.. samples in Spend-down webpage).
For more information about the Medicaid Excess Income or spend-down program, including a PowerPoint presentation, sample forms and instructions, and an advocacy manual, see the Spend-down webpage on this site.
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