Uninsured and Ineligible for Medicaid

by Ira M. Leff, Esq.

June 23, 2009

I represent a 61 year-old married woman who we will call Sue. Sue suffered a severe stroke in 2007.After a three month hospital stay, she was able to come home with much assistance.

She is currently covered under her husband's group medical plan. However, he retired in April 2008, and their 18 month COBRA coverage is due to expire in October 2009.

Sue is not eligible for Social Security Disability (and Medicare) because she failed to work enough quarters of coverage in the recent past. Sue is not eligible for Supplemental Security Income (and Medicaid) because the couple's resources exceed $3,000. Sue will be eligible for Medicare at age 65, but cannot afford to be without health insurance until then.

Sue would like to extend her COBRA coverage an additional 11 months under a provision of COBRA which provides extended coverage for disabled persons. However, in order to qualify, Sue has to be considered disabled under Title II or Title XVI of the Social Security Act. That means that she has to qualify for Social Security Disability of Supplemental Security Income, which she does not.

Sue is also pursuing home health benefits from Medicaid under the Community Care Services Program and the Independent Care Waiver Program. In order to qualify she has to meet the nursing home financial criteria, which she does. However, neither of these programs currently has any funds for new patients.

Sue could easily qualify for Medicaid assistance in a nursing home. But she does not want to live out her life in a nursing home.

Sue's family and I are terribly frustrated by this seemingly unfair result. If any of you have any suggestions of how we can obtain health insurance for Sue, please let me know.

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