Genius and giggles!
Tuesday, November 20, 2012
Sunday, November 18, 2012
Social Security Doesn't Allow the Disabled to Marry
There are multiple kinds of disability benefits. I'm going to touch on THREE (3) kinds that fall within the 'disability' benefit category.
For a disabled adult to become entitled to this “child” benefit, one of his or her parents:
SSDI disabled adult “child” benefits continue as long as the individual remains disabled. Your child does not need to have worked to get these benefits.
If you are interested in perhaps bringing attention to this click HERE.
- SSDI/DAC 'Adult Disabled Child'
The SSDI program pays benefits to adults who have a disability that began before they became 22 years old. We consider this SSDI benefit as a “child’s” benefit because it is
For a disabled adult to become entitled to this “child” benefit, one of his or her parents:
- Must be receiving Social Security retirement or disability benefits; or
- Must have died and have worked long enough under Social Security.
These benefits also are payable to an adult who received dependents benefits on a parent’s Social Security earnings record prior to age 18, if he or she is disabled at age 18. We make the disability decision using the disability rules for adults.
SSDI disabled adult “child” benefits continue as long as the individual remains disabled. Your child does not need to have worked to get these benefits.
2. Supplemental Security Income (SSI) is a Federal income supplement program funded by general tax revenues (not Social Security taxes):
 | It is designed to help aged, blind, and disabled people, who have little or no income; and |
| It provides cash to meet basic needs for food, clothing, and shelter. -- This is referred to as 'the United States biggest Welfare program' by Social Security. 3. SSDI
Social Security Disability Insurance, or SSDI, provides benefits to individuals who are disabled or blind. SSDI is funded by employees’ contributions to the Social Security trust fund, or the Federal Insurance Contributions Act (FICA) social security tax paid on yearly earnings.
In order to be eligible for SSDI, your loved one must have:
To sum it up for you SSI is out of general taxes, is for low income people only (with disabilities) and is considered welfare.
SSDI is based off taxes you paid into the system while working, and you are only eligible for SSDI disability payments after paying into the system long enough. Your SSDI payment will be based upon what you put into the program via taxes.
SSDI/DAC is an SSDI benefit that a disabled child (or adult) may claim, based upon what the parent put into the SSDI program from their earned wages (taxes)
Now for the fun stuff.
I receive SSDI from my work history AND DAC. Social security works like this:
If you get approved for benefits and meet each programs criteria, you must be individually approved for each program. So if you apply to all three and meet the criteria of all three, you will get three approval letters--one from each program.
Now you MAY collect multiple checks from a combination of these three sources. BUT, you do not get 'full benefits' from either.
For example, you are approved for 400$ a month from SSDI based upon your work history, and also approved for DAC payments based upon your fathers, with a benefit of 900$. You would receive 900$ total from social security, as that is the MAXIMUM you are entitled to. You would receive 400$ from SSDI and the remainder from DAC. You cannot collect more than the highest benefit total you are entitled to.
The reason they do this is each pool of money is different. SSI funding is from general taxes, SSDI is based of your work taxes and DAC off your parents work taxes.
Anyhoo, I get the DAC and SSDI. (I will explain why I do not get SSI at the end) Both entitle me to MediCARE, and the DAC entitles me to Medicaid as well (as a supplement of sorts) despite the income boost. (if it was just SSDI I would have to qualify with medicaid under the medicaid rules, pregnant under 21, or income guidelines)
I was researching about SSDI, DAC and its rules (I have had it since October, I am learning still) and came across a query of 'What happens if I get married on SSDI?'- The answer? Nothing will change. (From social security)
So I decided to look, what happens if you get married on SSI? Since SSI is a needs based program they could cut or remove all of your benefits, if your partner made over a certain amount of money each year, kind of like food stamps, since the program is considered welfare.
So last but not least I googled the DAC benefit. I was floored.
Direct from Social Securitys own website (HERE) I found this:
If he or she receives benefits as an adult disabled since childhood, the benefits generally end if he or she gets married. However, some marriages (for example, to another adult disabled child) are considered protected.
Something here is not right. So I did some more digging. Yep, its true. Unless I marry another adult disabled child ACTIVELY RECEIVING THE SAME BENEFIT, I will lose mine!
That means no medical, no payment, NOTHING.
Upon contacting someone I know who used to work for Disability Determination within SSA, I was told I would lose my SSDI benefit based on my work record too! (I do not know if this is true, I must find a way to link a confirmation or denial of this)
I am FLOORED. I cannot, despite days of searching, find a justifiable reason as to why this one category gets singled out.
So suddenly I am not disabled because I decided to get married,and instead of rewarding me like the government does with marriage (taxes, health insurance benefits, death benefits, legal rights and so on) I get dropped?!
I have some issues with this, which I am sure will raise hell in others eyes. I am sure I will hear you are bitching about free money from the government blah blah blah... save it. Read it all and then complain if you need to.
One, I can cohabitate with someone for the rest of my life, even be engaged and cohabitate indefinitely and keep my benefits but the second I get married out the window that goes?
Why does every other category of disability get to marry, without penalty?
Half the reason I am disabled is because I cannot work. I am medically needy and could not find health insurance, even through a spouse most likely, that would accept me with all of my 'pre existing conditions'
Even if I did find a company willing to take me, the premiums would be astronomical, in addition to copays, prescription benefits, deductibles and out of pocket reimbursement expenses, that would bankrupt anyone in a matter of weeks.
Without this medical care I would die.
So my spouse would be forced to take on the financial burden of my inability to contribute to household coffers, astronomical medical costs and the physical responsibility that comes with my medical issues.
I wouldn't marry myself with that kind of baggage!
So, I would like to ask social security and law makers, why do you stop Disabled Adult Children from getting married and being able to live?
|
If you are interested in perhaps bringing attention to this click HERE.
Saturday, November 17, 2012
An Update on Life
I am long, long overdue to update the details of this.
I am not 'homeless' per say anymore. Well for now.
I got an apartment, with a lease and all at the end of July and moved in August. The ONLY reason I was able to do this, is Social Security pulled their heads out of their butts and FINALLY approved me for DAC and SSDI (Social Security Disability Insurance) in early July.
I had been receiving SSI for many years, but due to my mothers filing for retirement in 2010, an automatic review was done, which included applications for benefits under SSDI and DAC.
This approval letter meant my income was going to go up.. a lot. Well a lot to me. It was to increase by 62%.. but not for at least 120 days.
I convinced my adoptive mother to 'loan' me the money, the difference between benefit amounts each month, so I could pay rent on a tiny crappy apartment.
She agreed. (I have since paid her back almost 3k by the way, I wrote that check tuesday :) )
This place sucks, its a brand new complex filled with idiots, rowdy college kids puking off balconies at 3 am (even right now) and they do NOT keep up with the place, but its a place to live!
All utilities are included in the rent for the most part, so at least I know a generally consistent number that I have to pay, even if it is 54% of my income.
My little dog and my cat are both back and happy, although *I* hate living on a third floor walk up and having to walk my dog 5 times a day (I wonder if this is an ADA thing, I didnt get to pick which apartment and I do have handicapped parking for mobility issues) and we are all generally ok.
I have decided it is in my best financial and medical interests to leave this state and move back to one with better benefits and a system that does NOT have its head up its butt (I'll touch on this in the next post) which for now is probably Pennsylvania.
I am simultaneously horrified and excited at the same time. I do not like change, and although I may hate the way this state conducts itself and treats its neediest citizens, I have become accustomed to the area I live in , as well as the people and oddly enough, the presence of the US Army.
Im not really sure when I will move, or where I will move to if at all, there are many variables (like finding suitable housing that does not mind my cat/dog, being near a medical center that can meet my needs, financially moving all my crap back up there..) but I'm working on it.
All and all things are alright. Not perfect but alright.
I am not 'homeless' per say anymore. Well for now.
I got an apartment, with a lease and all at the end of July and moved in August. The ONLY reason I was able to do this, is Social Security pulled their heads out of their butts and FINALLY approved me for DAC and SSDI (Social Security Disability Insurance) in early July.
I had been receiving SSI for many years, but due to my mothers filing for retirement in 2010, an automatic review was done, which included applications for benefits under SSDI and DAC.
This approval letter meant my income was going to go up.. a lot. Well a lot to me. It was to increase by 62%.. but not for at least 120 days.
I convinced my adoptive mother to 'loan' me the money, the difference between benefit amounts each month, so I could pay rent on a tiny crappy apartment.
She agreed. (I have since paid her back almost 3k by the way, I wrote that check tuesday :) )
This place sucks, its a brand new complex filled with idiots, rowdy college kids puking off balconies at 3 am (even right now) and they do NOT keep up with the place, but its a place to live!
All utilities are included in the rent for the most part, so at least I know a generally consistent number that I have to pay, even if it is 54% of my income.
My little dog and my cat are both back and happy, although *I* hate living on a third floor walk up and having to walk my dog 5 times a day (I wonder if this is an ADA thing, I didnt get to pick which apartment and I do have handicapped parking for mobility issues) and we are all generally ok.
I have decided it is in my best financial and medical interests to leave this state and move back to one with better benefits and a system that does NOT have its head up its butt (I'll touch on this in the next post) which for now is probably Pennsylvania.
I am simultaneously horrified and excited at the same time. I do not like change, and although I may hate the way this state conducts itself and treats its neediest citizens, I have become accustomed to the area I live in , as well as the people and oddly enough, the presence of the US Army.
Im not really sure when I will move, or where I will move to if at all, there are many variables (like finding suitable housing that does not mind my cat/dog, being near a medical center that can meet my needs, financially moving all my crap back up there..) but I'm working on it.
All and all things are alright. Not perfect but alright.
Friday, November 16, 2012
I can never marry...
I'm still tweaking it but THIS is why.
:(
Not that anyone will ever read this stupid thing, but it makes me feel better sometimes to whine.
:(
Not that anyone will ever read this stupid thing, but it makes me feel better sometimes to whine.
Tuesday, November 13, 2012
On a lighter note
This has me in freaking tears. I'm not necessarily for either candidate (even though Obama won re-election) but the look on the mans face as he scoots cross the screen just makes me cry.
Humor in every day life. :)
Friday, August 31, 2012
Medicaid, TennCare, Birth Control and Welfare Babies
So I'm going to bypass posting part two of my TennCare rant for right now, to post something I find a little more.. controversial.
TennCare pharmacy benefits are run by SXC, which the state contracts.(You can read more about this HERE) Not the health insurance company you get through tenncare, SXC manages ALL TennCare prescription benefits for Tennessee.
I have touched before on the limits of TennCare prescription benefits, at 5 a month and how this really affects most disabled people.
Well, in doing some research to try to get some of my necessary medications covered (which so far hasn't happened, since no one can figure out what I'm talking about) I have uncovered some things.
Well, this irritates me. One of the categories for TennCare eligibility (within income restrictions) is being pregnant.
Ok, well. Of course you have to already BE pregnant in order to get TennCare if you do not fall into another category (like disabled) so of course that already reduces the numbers of pregnant on TennCare people.
So for the sake of numbers, lets count TANF recipients too, (Cash assistance, aka welfare cash)
In Tennessee in 2008 (yes its a slightly outdated fact sheet, I can't find a newer one) there were over 144,000 TANF recipents, which is actually less than in 2007 due to cuts in eligibility.
So, lets say 144,000 TANF recipients (which are all women here in TN) plus the 1,000,000 or so disabled people in Tennessee ALL qualified for TennCare, regardless of pregnancy status.(For the sake of numbers, I will say 200,000 receive disability and are of child bearing age with tenncare, which is a far cry from what is likely true)
So 344,000 people eligible for TennCare. OK, well. The average birth control prescription, is 25$.
So, assuming for the sake of numbers that all females are on and prescribed the pill, at 25$ a month. Well the state won't pay that much, so it will be more like 14$, because they have contracts. OK. So 14$ *344,000 people.equals 4,816,000$. Per month. So times that by twelve, you get $57,790,000 (Now many people go off welfare and lose their eligibility but for numbers sake..)
Its expensive, yes.
For other birth control options, theres the shot (about 30$ for 3 months) or an IUD (about 300$ for FIVE YEARS) but I wont go into that, for the sake of simplicity
The average maternity pay out is $3,500 for basic care (not including NICU, preemie care or high risk) in Tennessee. So again for the sake of numbers lets say 100,000 of those 350,000 people that meet our critera get pregnant. Thats $350,000,000.
So birth control preventatives - $57.75 million per year vs Maternity care for 1/3 the population that would be taking the birth control if covered by TennCare at $350,000,000.
Well, thats only a difference of $292,210,000. Thats a nice chunk of change.
Well.. what numbers don't show you is that since mom qualified for TANF/Medicaid, now her kid/kids do too.
So.. that's another 100,000 children TENNESSEE needs to cover. (TennCare covers about 1.3 million pregnant women, children and disabled people each year)
So.. for the sake of numbers.. lets say each kid is very healthy and only needs minimal care after birth (assuming newborn care in hospital is under moms maternity spending)
So 100,000 children times about 3000$ in regular yearly health care, including dental, vision, well child check ups, prescriptions and vaccinations, is $300,000,000, assuming the child is not disabled or needs ANYTHING special.
So lets do a quick breakdown of the numbers one last time
Birth Control for 344,000 people of child bearing age (assuming the pill only) =$ 57,790,000 YEARLY.
Maternity Care for 100,000 women who get pregnant while eligible for TennCare (assuming basics and singleton births only) = $350,000,000, yearly.
Basic medical care for children born on TennCare now qualifying for TennCare (assuming 100,000 babies) =$350,000,000 yearly.
So $700,000,000 a year in maternity +infant child costs (for child born through TennCare)
$700,000,000
-
$57,790,000
______________
= $642,210,000
Well, I think a little more than half a billion dollars is pretty signifigant, don't you?
Then theres the cost to the tax payer (ahem, state) on increased assistance for families of those children. Lets assume only 80% suck up their pride and accept food stamps. Well, thats 1200$ additionally a year for the first four years or so (For numbers, many people do get off assistance entirely).
1200*80,000 people-$96,000,000 yearly.
Then lets assume that 40 percent take housing assistance (which is god awful to live in, much less even apply to the waiting list for, its nearly impossible to get)
So well say average assistance amount for that is 600$ per month per family
$600*12*40,000= $288,000,000 yearly.
Lets assume that 70% of new moms take WIC with baby formula for the first year (based on national breast feeding statistics)
So not including the average food benefit, lets say WIC spends about 200$ a month in formula and baby foods per child for the first year of life.
So, 200*12*70,000=$168,000,000.
So for one year for these 100,000 preventable births, in addition to the $642,210,000, add in $552,000,000 in first year costs, thats $1,194,210,000.
Or in simple terms, 1.2 BILLION dollars per year, on completely preventable births, in the state of Tennessee.
Then there's things like transport costs (Medicaid picks this up I believe) and additional things I can't possibly think of, not including cash assistance, DNA testing, child support orders/enforcement, custody, courts and CHILD CARE. I am NOT counting in child care assistance, as that figure just blows my mind. (Average subsidy per child can be between 300-1000$ A MONTH)
Considering Tennessee has about a 16% below poverty level rate (this is an estimate link) this doesn't really surprise me, but makes Tennessee the third poorest state in the United States.
So my question, dear tax payers, legislators and beaurocrats, why on earth are you supporting the perpetuation of poverty and the burden of the tax payer dime, by denying something as basic as birth control?
Feel free to leave your opinion in comments, or via email.
TennCare pharmacy benefits are run by SXC, which the state contracts.(You can read more about this HERE) Not the health insurance company you get through tenncare, SXC manages ALL TennCare prescription benefits for Tennessee.
I have touched before on the limits of TennCare prescription benefits, at 5 a month and how this really affects most disabled people.
Well, in doing some research to try to get some of my necessary medications covered (which so far hasn't happened, since no one can figure out what I'm talking about) I have uncovered some things.
- Per health care reform law, TennCare must cover birth control services and birth control with a 0$ co-pay.
- Birth control counts against your 5 monthly prescriptions and according to SXC representatives, Walgreens pharmacists and my OB/GYN is in no way attestable or in layman's terms able to become 'exempt' from counting towards your prescription limit.
- That women on TennCare can have ONE pap/std test a year, unless they exhibit symptoms.
- That there is no readily published numbers on how many pregnancies happen by a recipent of TennCare.
Well, this irritates me. One of the categories for TennCare eligibility (within income restrictions) is being pregnant.
Ok, well. Of course you have to already BE pregnant in order to get TennCare if you do not fall into another category (like disabled) so of course that already reduces the numbers of pregnant on TennCare people.
So for the sake of numbers, lets count TANF recipients too, (Cash assistance, aka welfare cash)
In Tennessee in 2008 (yes its a slightly outdated fact sheet, I can't find a newer one) there were over 144,000 TANF recipents, which is actually less than in 2007 due to cuts in eligibility.
So, lets say 144,000 TANF recipients (which are all women here in TN) plus the 1,000,000 or so disabled people in Tennessee ALL qualified for TennCare, regardless of pregnancy status.(For the sake of numbers, I will say 200,000 receive disability and are of child bearing age with tenncare, which is a far cry from what is likely true)
So 344,000 people eligible for TennCare. OK, well. The average birth control prescription, is 25$.
So, assuming for the sake of numbers that all females are on and prescribed the pill, at 25$ a month. Well the state won't pay that much, so it will be more like 14$, because they have contracts. OK. So 14$ *344,000 people.equals 4,816,000$. Per month. So times that by twelve, you get $57,790,000 (Now many people go off welfare and lose their eligibility but for numbers sake..)
Its expensive, yes.
For other birth control options, theres the shot (about 30$ for 3 months) or an IUD (about 300$ for FIVE YEARS) but I wont go into that, for the sake of simplicity
The average maternity pay out is $3,500 for basic care (not including NICU, preemie care or high risk) in Tennessee. So again for the sake of numbers lets say 100,000 of those 350,000 people that meet our critera get pregnant. Thats $350,000,000.
So birth control preventatives - $57.75 million per year vs Maternity care for 1/3 the population that would be taking the birth control if covered by TennCare at $350,000,000.
Well, thats only a difference of $292,210,000. Thats a nice chunk of change.
Well.. what numbers don't show you is that since mom qualified for TANF/Medicaid, now her kid/kids do too.
So.. that's another 100,000 children TENNESSEE needs to cover. (TennCare covers about 1.3 million pregnant women, children and disabled people each year)
So.. for the sake of numbers.. lets say each kid is very healthy and only needs minimal care after birth (assuming newborn care in hospital is under moms maternity spending)
So 100,000 children times about 3000$ in regular yearly health care, including dental, vision, well child check ups, prescriptions and vaccinations, is $300,000,000, assuming the child is not disabled or needs ANYTHING special.
So lets do a quick breakdown of the numbers one last time
Birth Control for 344,000 people of child bearing age (assuming the pill only) =$ 57,790,000 YEARLY.
Maternity Care for 100,000 women who get pregnant while eligible for TennCare (assuming basics and singleton births only) = $350,000,000, yearly.
Basic medical care for children born on TennCare now qualifying for TennCare (assuming 100,000 babies) =$350,000,000 yearly.
So $700,000,000 a year in maternity +infant child costs (for child born through TennCare)
$700,000,000
-
$57,790,000
______________
= $642,210,000
Well, I think a little more than half a billion dollars is pretty signifigant, don't you?
Then theres the cost to the tax payer (ahem, state) on increased assistance for families of those children. Lets assume only 80% suck up their pride and accept food stamps. Well, thats 1200$ additionally a year for the first four years or so (For numbers, many people do get off assistance entirely).
1200*80,000 people-$96,000,000 yearly.
Then lets assume that 40 percent take housing assistance (which is god awful to live in, much less even apply to the waiting list for, its nearly impossible to get)
So well say average assistance amount for that is 600$ per month per family
$600*12*40,000= $288,000,000 yearly.
Lets assume that 70% of new moms take WIC with baby formula for the first year (based on national breast feeding statistics)
So not including the average food benefit, lets say WIC spends about 200$ a month in formula and baby foods per child for the first year of life.
So, 200*12*70,000=$168,000,000.
So for one year for these 100,000 preventable births, in addition to the $642,210,000, add in $552,000,000 in first year costs, thats $1,194,210,000.
Or in simple terms, 1.2 BILLION dollars per year, on completely preventable births, in the state of Tennessee.
Then there's things like transport costs (Medicaid picks this up I believe) and additional things I can't possibly think of, not including cash assistance, DNA testing, child support orders/enforcement, custody, courts and CHILD CARE. I am NOT counting in child care assistance, as that figure just blows my mind. (Average subsidy per child can be between 300-1000$ A MONTH)
Considering Tennessee has about a 16% below poverty level rate (this is an estimate link) this doesn't really surprise me, but makes Tennessee the third poorest state in the United States.
So my question, dear tax payers, legislators and beaurocrats, why on earth are you supporting the perpetuation of poverty and the burden of the tax payer dime, by denying something as basic as birth control?
Feel free to leave your opinion in comments, or via email.
Monday, August 20, 2012
TennCare (Medicaid) and The Taxpayer Money (WASTE) Part One
So I see a lot of people whining about 'Obamacare' and how its going to bankrupt our country, like Medicaid (insurance for the poor and disabled) and Medicare( for the disabled and elderly) already have.
I am slightly inclined to agree.
I am a liberal independent. I do not side entirely with either democrats or republicans, I am pro legalization of marijuana (especially for medical reasons) pro universal health care and pro choice. I am against immigration amnesty and fining people for not having health insurance.
Let me tell you about a few things I have noticed as a recipient of Medicaid.
As a disabled person actively receiving social security benefits, I am qualify for Medical Assistance, which I do utilize.
Here in Tennessee its called TennCare. Tenncare is a joint funded 'project' by the state and Feds.
TennCare is one of the WORST Medicaid providers in the country.
This is what my benefits look like (which is standard)
5 Presciptions a month, unless on the 'exempt list' (Which comprises of mostly retrovirals for AIDS drugs) 3 generic and 2 Brand Name, with a 3$ copay. Certain medicines such as Benzodiazapines, Pain Killers, Controlled Substances (narcotics usually) and certain sleeping pills, amongst others are NOT covered.
Weight Management program IF qualified (must be over weight or have a comorbitiy like diabetes, high blood pressure.. so on) which can include, nutrition classes, a gym membership to the YMCA, counseling, and weight loss surgery.
12 visits to a Primary Doctor a year, unless you have a medical exemption (I do)
Limited in-patient hospital care
No dental
No vision
No chiropractic care
Pre-authorization required for most testing, such as CT scans, MRI's, and so on. Basics like blood work, EKGs and xrays are usually covered with just doctors orders.
Emergency Room Care
Thats about it. Now that seems like A LOT to someone without any insurance, and by all means it is.
Personally, I am grateful I have any insurance at all.
However, I have MANY MANY MANY issues with TennCare.
First and foremost the prescription benefit limit, as run by SXC.
I am on disability. Don't you think I need more than 5 prescriptions a month? I usually blow through that in antibiotics a month. Yes, they have something called an exemption waiver, where a doctor tells the insurance company why that medicine is medically necessary and should not be counted towards your prescription limit. Out of the 23 current practitioners that I have, not a single one knows what I am talking about or how to do this. The insurance company insists that the doctors should and will not tell me how to have them go about this.
So each month, I regularly choose between antibiotics, heart medications, lung medications (asthma, allergies, so on) kidney medications, skin creams (usually for skin infections) auto immune suppressants, allergy medicines (like an EpiPen, or a cream for hives) GI drugs (for my stomach/intestinal issues) ear medicines (for whatever) and birth control.
Usually the antibiotics win. Sometimes a mental health medication may win a spot, but rarely.
I was told by the pharmacy and by SXC that they do not consider an EpiPen to be an emergency drug and thus it counts towards my benefit.
So if I got stung by a bee, used my EpiPen (and saved my life) received medical care and a prescription for a new one, and I had already used my 5 for the month (or 2 brand names) then I could NOT get another life saving EpiPen until the next month.
Thats some bullshit.
I find it ludicrous that not a single practitioner knows how to fill out these forms, or jump through the right hoops, and I completely believe each practitioner when they say they cant figure out HOW to do them, or that they ALWAYS get denied.
Second, perhaps I was more spoiled by Medicaid in the north (Access, in Pennsylvania, where I hail from) where I had somewhat limited dental and limited vision care, as well as unlimited prescriptions each month. (Some did require prior auths, which were easy to get) However, I find that as a disabled person, that Access actually met my needs 98% of the time, versus TennCare which meets them about 40%, if that.
In Pennsylvania (not saying they are perfect, they are not) there were different 'classes' of Medicaid, and Medicaid eligibility, just as there are here. You could be:
Pregnant
On cash assistance (welfare, TANF)
Under 21
Disabled
Elderly
or other, which usually meant waiting for disability
OR a cancer patient
Each category usually had its own rules and benefits.
I can only really speak to unider 21 and disabled, since I have received both.
Medicaid for disability is supposed to be life sustaining, health sustaining. They put these lovely little provisions in 'appeals' (Ill get to that later) where if it could cause damage, death or hospitalization, its considered an emergency.
Well, usually if you are on disability a lack of care or medication could cause any of the above to happen.
Benefits in all states are far better for CHILDREN on Medicaid. Usually those on disability have something similar to that, as again, its expected to be health/life sustaining.
Not so here in great old Tennessee.
I get the SAME exact insurance pregnant moms get, welfare recipents get and so on.
Mom who lost her job or had to flee domestic violence and lives on Cash Assistance, probably does not need to see 23 doctors and take 18 prescriptions a month.
I do. I am not alone.
So, instead of say, TennCare covering a 2x a year dental cleaning at 40$ a piece, I dont get it done. In turn I get abcesses and infections and need antibiotics, at about 40$ a pop per antibiotic. Surgical removal of the abcess is quite expensive I'm sure, however I dont have the money to get that done so I dont know.
Another dental example: My wisdom teeth are coming in, at nearly 25 years old. (I turn 25 on Wednesday)
My jawbone is currently exposed, and will likely cause all kinds of problems, from infections of the bone to abcesses and distorment of my jaw and teeth.
So instead of paying 300$ to remove my two wisdom teeth (Medicaid pays WAY WAY WAY less than standard private insurance, in case you are wondering why my figures are so low) Medicaid will pay to have my jaw surgically fixed, and bone removed, in addition to the antibiotics, hospitalization and care required, as well as prescriptions, at about 30-40,000.
That makes sense right?
Heres an example:
ABout a month ago I started randomly passing out. I was seeing colors, had a headache to bad I wanted to die, was vomiting non stop, slurring my speech and had lost my appetite and had severe sensory hallucinations (smelling, tasting things that were not there)
I went to my primary who suspected a migraine, but wanted to make sure by ordering a head CT and called in a migraine prescription. Well, dont you know I reached my benefit limit, so no migraine medicine.
At 6 pm on a friday I had no other choice.. I wanted to die. So after I passed out, I went to the local ER.
That bill was probably about $2000 that the state PAID.
Well the ER here sucks and they gave me more prescriptions I couldn't fill.. so I had to go back when I passed out again.
Probably another 3k in work done, at the er.
Well three days later it still hadnt gone away, I had just stopped going to the ER, and I went one last time, this time in Nashville. That probably cost about 300$, since they did NOTHING.
So, instead of covering a 50$ prescription that *might* have solve the issue, thy just paid at minimum $6000 for medical care for me, and still didnt treat or solve the problem.
it took two weeks and five antibiotic prescriptions (and a bag of antibiotics in the ER the second time) to get rid of that. I still dont know what caused it.
They denied the head CT saying it was medically unnecessary. So... those symptoms that scream STROKE or TUMOR mean nothing, I guess.
This is just one example.
This post is already getting too long so I will have to do a part 2.
I am slightly inclined to agree.
I am a liberal independent. I do not side entirely with either democrats or republicans, I am pro legalization of marijuana (especially for medical reasons) pro universal health care and pro choice. I am against immigration amnesty and fining people for not having health insurance.
Let me tell you about a few things I have noticed as a recipient of Medicaid.
As a disabled person actively receiving social security benefits, I am qualify for Medical Assistance, which I do utilize.
Here in Tennessee its called TennCare. Tenncare is a joint funded 'project' by the state and Feds.
TennCare is one of the WORST Medicaid providers in the country.
This is what my benefits look like (which is standard)
5 Presciptions a month, unless on the 'exempt list' (Which comprises of mostly retrovirals for AIDS drugs) 3 generic and 2 Brand Name, with a 3$ copay. Certain medicines such as Benzodiazapines, Pain Killers, Controlled Substances (narcotics usually) and certain sleeping pills, amongst others are NOT covered.
Weight Management program IF qualified (must be over weight or have a comorbitiy like diabetes, high blood pressure.. so on) which can include, nutrition classes, a gym membership to the YMCA, counseling, and weight loss surgery.
12 visits to a Primary Doctor a year, unless you have a medical exemption (I do)
Limited in-patient hospital care
No dental
No vision
No chiropractic care
Pre-authorization required for most testing, such as CT scans, MRI's, and so on. Basics like blood work, EKGs and xrays are usually covered with just doctors orders.
Emergency Room Care
Thats about it. Now that seems like A LOT to someone without any insurance, and by all means it is.
Personally, I am grateful I have any insurance at all.
However, I have MANY MANY MANY issues with TennCare.
First and foremost the prescription benefit limit, as run by SXC.
I am on disability. Don't you think I need more than 5 prescriptions a month? I usually blow through that in antibiotics a month. Yes, they have something called an exemption waiver, where a doctor tells the insurance company why that medicine is medically necessary and should not be counted towards your prescription limit. Out of the 23 current practitioners that I have, not a single one knows what I am talking about or how to do this. The insurance company insists that the doctors should and will not tell me how to have them go about this.
So each month, I regularly choose between antibiotics, heart medications, lung medications (asthma, allergies, so on) kidney medications, skin creams (usually for skin infections) auto immune suppressants, allergy medicines (like an EpiPen, or a cream for hives) GI drugs (for my stomach/intestinal issues) ear medicines (for whatever) and birth control.
Usually the antibiotics win. Sometimes a mental health medication may win a spot, but rarely.
I was told by the pharmacy and by SXC that they do not consider an EpiPen to be an emergency drug and thus it counts towards my benefit.
So if I got stung by a bee, used my EpiPen (and saved my life) received medical care and a prescription for a new one, and I had already used my 5 for the month (or 2 brand names) then I could NOT get another life saving EpiPen until the next month.
Thats some bullshit.
I find it ludicrous that not a single practitioner knows how to fill out these forms, or jump through the right hoops, and I completely believe each practitioner when they say they cant figure out HOW to do them, or that they ALWAYS get denied.
Second, perhaps I was more spoiled by Medicaid in the north (Access, in Pennsylvania, where I hail from) where I had somewhat limited dental and limited vision care, as well as unlimited prescriptions each month. (Some did require prior auths, which were easy to get) However, I find that as a disabled person, that Access actually met my needs 98% of the time, versus TennCare which meets them about 40%, if that.
In Pennsylvania (not saying they are perfect, they are not) there were different 'classes' of Medicaid, and Medicaid eligibility, just as there are here. You could be:
Pregnant
On cash assistance (welfare, TANF)
Under 21
Disabled
Elderly
or other, which usually meant waiting for disability
OR a cancer patient
Each category usually had its own rules and benefits.
I can only really speak to unider 21 and disabled, since I have received both.
Medicaid for disability is supposed to be life sustaining, health sustaining. They put these lovely little provisions in 'appeals' (Ill get to that later) where if it could cause damage, death or hospitalization, its considered an emergency.
Well, usually if you are on disability a lack of care or medication could cause any of the above to happen.
Benefits in all states are far better for CHILDREN on Medicaid. Usually those on disability have something similar to that, as again, its expected to be health/life sustaining.
Not so here in great old Tennessee.
I get the SAME exact insurance pregnant moms get, welfare recipents get and so on.
Mom who lost her job or had to flee domestic violence and lives on Cash Assistance, probably does not need to see 23 doctors and take 18 prescriptions a month.
I do. I am not alone.
So, instead of say, TennCare covering a 2x a year dental cleaning at 40$ a piece, I dont get it done. In turn I get abcesses and infections and need antibiotics, at about 40$ a pop per antibiotic. Surgical removal of the abcess is quite expensive I'm sure, however I dont have the money to get that done so I dont know.
Another dental example: My wisdom teeth are coming in, at nearly 25 years old. (I turn 25 on Wednesday)
My jawbone is currently exposed, and will likely cause all kinds of problems, from infections of the bone to abcesses and distorment of my jaw and teeth.
So instead of paying 300$ to remove my two wisdom teeth (Medicaid pays WAY WAY WAY less than standard private insurance, in case you are wondering why my figures are so low) Medicaid will pay to have my jaw surgically fixed, and bone removed, in addition to the antibiotics, hospitalization and care required, as well as prescriptions, at about 30-40,000.
That makes sense right?
Heres an example:
ABout a month ago I started randomly passing out. I was seeing colors, had a headache to bad I wanted to die, was vomiting non stop, slurring my speech and had lost my appetite and had severe sensory hallucinations (smelling, tasting things that were not there)
I went to my primary who suspected a migraine, but wanted to make sure by ordering a head CT and called in a migraine prescription. Well, dont you know I reached my benefit limit, so no migraine medicine.
At 6 pm on a friday I had no other choice.. I wanted to die. So after I passed out, I went to the local ER.
That bill was probably about $2000 that the state PAID.
Well the ER here sucks and they gave me more prescriptions I couldn't fill.. so I had to go back when I passed out again.
Probably another 3k in work done, at the er.
Well three days later it still hadnt gone away, I had just stopped going to the ER, and I went one last time, this time in Nashville. That probably cost about 300$, since they did NOTHING.
So, instead of covering a 50$ prescription that *might* have solve the issue, thy just paid at minimum $6000 for medical care for me, and still didnt treat or solve the problem.
it took two weeks and five antibiotic prescriptions (and a bag of antibiotics in the ER the second time) to get rid of that. I still dont know what caused it.
They denied the head CT saying it was medically unnecessary. So... those symptoms that scream STROKE or TUMOR mean nothing, I guess.
This is just one example.
This post is already getting too long so I will have to do a part 2.
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