Uninsured and Ineligible for Medicaid Part II

by Ira M. Leff, Esq.

July 1, 2009

Last week I wrote about Sue, a 61 year old disabled woman, who receives around-the-clock home health care. Her COBRA health coverage is due to expire in October 2009, and she is not eligible for Medicare because she did not have enough recent work experience to receive Social Security Disability.

I was delighted to receive suggestions from several of you around the State. Hon. Marvin Rothbloom, a retired Social Security ALJ, wrote that he had a case many years ago involving a disabled DeKalb County school employee who was not eligible for Social Security Disability because the school system had opted out of that program. Nevertheless, once she proved that she was disabled, she was able to obtain Medicare benefits. Perhaps Sue can qualify for Medicare currently even though she does not qualify for Social Security Disability.

Becky Kurtz, the State Long-Term Care Ombudsman reminded me about a new program launched this year in Georgia called Money Follows the Person. This is a Medicaid program funded with a five year grant under the DEFICIT REDUCTION ACT 2005, which is intended to encourage community based care. MEDICAID MANUAL § 2939. Under it, Sue could qualify for home health care from Medicaid if she is admitted to a nursing home for at least six months and then returns home.

Additionally, under Obama health care reform, it is proposed that insurers waive the use of pre-existing conditions provisions so that the estimated 7 million uninsured Americans ages 45-54 can obtain coverage.

Thanks for all of your great suggestions! I will let you know when we resolve this matter for Sue.

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