MassHealth and Disability (Brookline: 2015, health insurance, credit)

[BrooklineBiker]

Hi everyone,
I am trying to figure out how to handle the following issue with MassHealth. I use MassHealth Standard for my health insurance. They cover my family as well. (My wife is unemployed and we have two young children.) I have a number of long-term medical conditions that could be considered chronic. Put together, these conditions have turned my life upside down. When I applied for MassHealth, I put down that I was disabled. I was not seeking disability status and have not applied for SSI. I was unemployed when I applied for MassHealth and now work 20 hours per week.

I recently received a lengthy questionnaire from UMass Disability Evaluation Services on behalf of MassHealth. The questionnaire is entitled "MassHealth Adult Disability Supplement." It requires substantial medical documentation. One of the opening sentences in the instructions states: "to get MassHealth based on your disability, you need to . . ." I called MassHealth to learn what is up. I was told that I qualified for MassHealth based on my work status and having children. (I am due to update MassHealth on my finding part-time work and my wife losing her job.) The CSR told me that if I was found disabled I would eventually qualify for Medicare. I asked what would happen if I was not found disabled or did not complete the forms. The CSR said there were no consequences and that our eligibility was based on our economic circumstances.

I remain concerned. I am troubled that my working part-time might put us on a more expensive plan. That would crush us financially. So maybe I should pursue disability status. However, many of my conditions have only been successfully diagnosed and treated by non-traditional integrative medicine practitioners. I am not sure the state would accept their treatments and diagnoses as valid. How do people recommend I proceed? For example, because I am working part-time, do I need to make a demonstration of disability to continue to receive MassHealth Standard?

[parried]

I feel bad for saying this, but what you are experiencing is the main problem with so called "assistance" programs in this country. They aren't really meant to help "lift people up" so to speak. They are setup to keep people in an idle mode of not doing anything with themselves.

[Utopian Slums]

Originally Posted by BrooklineBiker

Hi everyone,
I am trying to figure out how to handle the following issue with MassHealth. I use MassHealth Standard for my health insurance. They cover my family as well. (My wife is unemployed and we have two young children.) I have a number of long-term medical conditions that could be considered chronic. Put together, these conditions have turned my life upside down. When I applied for MassHealth, I put down that I was disabled. I was not seeking disability status and have not applied for SSI. I was unemployed when I applied for MassHealth and now work 20 hours per week.

I recently received a lengthy questionnaire from UMass Disability Evaluation Services on behalf of MassHealth. The questionnaire is entitled "MassHealth Adult Disability Supplement." It requires substantial medical documentation. One of the opening sentences in the instructions states: "to get MassHealth based on your disability, you need to . . ." I called MassHealth to learn what is up. I was told that I qualified for MassHealth based on my work status and having children. (I am due to update MassHealth on my finding part-time work and my wife losing her job.) The CSR told me that if I was found disabled I would eventually qualify for Medicare. I asked what would happen if I was not found disabled or did not complete the forms. The CSR said there were no consequences and that our eligibility was based on our economic circumstances.

I remain concerned. I am troubled that my working part-time might put us on a more expensive plan. That would crush us financially. So maybe I should pursue disability status. However, many of my conditions have only been successfully diagnosed and treated by non-traditional integrative medicine practitioners. I am not sure the state would accept their treatments and diagnoses as valid. How do people recommend I proceed? For example, because I am working part-time, do I need to make a demonstration of disability to continue to receive MassHealth Standard?

You probably mean you have not applied for SSDI- Social Security Disability Insurance, not SSI. (You might be eligible for both, but people who are found to be disabled get SSDI if they have enough work credits and SSI if not.)

Whatever form they sent you is inconsequential to the financial eligibility requirements for free Medicaid (Masshealth) in MA.



http://www.mass.gov/eohhs/docs/massh...v-brochure.pdf (It's a brochure regarding HIV but the info is the same for everyone.)

The income limit per month for a household of 3 is $3,349. So as long as you and your (currently unemployed) wife are making under $40,188 per year, your Medicaid will remain free.

Trust me when i tell you that you are very lucky to be able to work 20 hours per week with a disability. I have no idea how much you make, but the average amount that a disabled person on SSDI receives is less than 1/3 of this monthly maximum amount. And even less on SSI. In other words, you can make up to three times as much money being employed vs being on disability and either way, you will still get free Masshealth.



So to answer your core question:

"For example, because I am working part-time, do I need to make a demonstration of disability to continue to receive MassHealth Standard?"

Absolutely not.

.

[BrooklineBiker]

Originally Posted by Utopian Slums

You probably mean you have not applied for SSDI- Social Security Disability Insurance, not SSI. (You might be eligible for both, but people who are found to be disabled get SSDI if they have enough work credits and SSI if not.)

Whatever form they sent you is inconsequential to the financial eligibility requirements for free Medicaid (Masshealth) in MA.

http://www.mass.gov/eohhs/docs/massh...v-brochure.pdf (It's a brochure regarding HIV but the info is the same for everyone.)

The income limit per month for a household of 3 is $3,349. So as long as you and your (currently unemployed) wife are making under $40,188 per year, your Medicaid will remain free.

Trust me when i tell you that you are very lucky to be able to work 20 hours per week with a disability. I have no idea how much you make, but the average amount that a disabled person on SSDI receives is less than 1/3 of this monthly maximum amount. And even less on SSI. In other words, you can make up to three times as much money being employed vs being on disability and either way, you will still get free Masshealth.

So to answer your core question:

"For example, because I am working part-time, do I need to make a demonstration of disability to continue to receive MassHealth Standard?"

Absolutely not.

.

Hi UtopianSlums,
Thank you very much for an incredibly helpful response. I am feeling much better about the situation and will skip the forms.

[Utopian Slums]

I do a lot of insurance finance consulting for individual citizens and nonprofits all around the US. I came here to use this post as a reference and realized that it was incorrect!! My sincere and humble apologizes! I am going to DM the OP but for anyone else who is interested and/or for my own future reference......




Income Bracket- FAMILY (2 Adults Plus One Child)

% of Fed.Poverty Rate ______ INCOME _____ MAX MONTHLY PAYMENT


0000 - 100% ________ $000000 - $19,801 ________ $0
100.1 - 150% ________ $19,801 - $29,689 ________ $0
150.1 - 200% ________ $29,689 - $39,589 ________ $1 - $80
200.1 - 250% ________ $39,589 - $49,477 ________ $81 - $160
250.1 - 300% ________ $49,477 - $59,377 ________
300.1 - 350% ________ $59,377 - $69,277 ________
350.1 - 400% ________ $69,276 - $79,164 ________


SOURCE: https://www.mahealthconnector.org/wp...Sheet_2015.pdf



As long as you and your (currently unemployed) wife are making under $29,689 per year for a family of 3, your Medicaid will remain free.

If you make between $29,689 - $39,589 per year, you will pay from $1 to $80 per month for health insurance for your entire family depending on if you are closer to 29k or 39k.


Having a family of 4 will *probably* make payments or brackets lower- working in your financial favor- but i'm unable to locate this info right now.



Again, my humble apologies!

.