I am at my wits end trying to get the answers I need from the government or Washington state, so I’m turning to y’all to see if you are knowledgeable enough to give me a proper answer.
I’ve been on SSDI and SSI since 2012. I applied and was approved at age 25, therefore I was able to stay on my parents’ medical insurance, as I was considered disabled before age 26. Since 2012, my insurance was always dad’s insurance as primary, Medicare as secondary, and I technically had Medicaid/Apple Health as a tertiary (however, my Apple Health was only for “behavioral health services”, so I have never used it once).
My dad retired in August, so we all lost his incredible insurance that covered everything. Leading up to this, my assumption was that once I lost my dad’s insurance as primary, I’d have Medicare as primary and start to receive “full” Medicaid benefits as my secondary. I assumed the only thing keeping me from “full” Medicaid coverage was the fact that I had my dad’s insurance.
We’ve been trying to get this all figured out since July, prior to him retiring, and I still can’t get a straight answer from any agency as to whether I qualify for more Medicaid coverage than the “behavioral health services”.
I receive $186 from SSI and $828 from SSDI. So $1,014 monthly. I’m also on all of the special help things like a QMB and “Extra Help”. I’m a single 39 year old with no children. I also receive SNAP.
I started with trying to get answers about my qualification for more Medicaid at DSHS, but they sent me to a local hospital who they said should be able to get me the proper paperwork. The hospital had no idea why I was sent to them and said DSHS should be the ones helping me. Went back to DSHS where they “looked again” and said that because I’m on disability, my Medicaid is dealt with through a program in Washington called WASHCAP. My mom and I preferred to try to go to all of these places in person, as we find that easier than trying to figure things out on the phone. However, we couldn’t figure out a physical address for WASHCAP. When I called them, their answer was simply “if you are on disability with Medicare, you only qualify for the behavioral health services aspect of Medicaid. However, if you have more questions, you could contact SHIBA for free counseling about insurance.” From all of my research online, this seems to not be the case, as there are things called Dual Eligible Special Needs Plans (D-SNP), which I’m fairly certain I qualify for. Our next stop was the Washington State Health Care Authority to see if they could give me an answer. They couldn’t. I set up an appointment with SHIBA and it ended up being with the same lady my parents and I saw for a Medicare seminar in July. She tried to be as helpful as possible (honestly, everyone has been helpful to the extent they could and they’ve all apologized that no one can help me), but SHIBA is technically only for Medicare help. However, she still spent an hour going through as much as she could with me and looked up my financials against Medicaid coverage and concluded that there is no reason I shouldn’t qualify for Medicare and FULL Medicaid. I happened to call the people at WA healthcare finder (this may be the wrong name, I’ve talked to so many people) the other day, as I’d received a letter saying I qualify for some sort of dental plan and was asking next steps for that. While I had her on the phone, I explained my situation and how I’m getting conflicting answers, but can’t get a straight answer about WHO or WHERE to officially figure this out. She empathized and gave me one more place to try, Washington Connection. I haven’t called them yet, as it says online they are basically DSHS, who I’ve been to 3 times already about this, but have never been given a chance to actually speak to anyone there who actually handles Medicaid. They always pass me to a different agency, who have all told me DSHS should be doing this.
So long story short, my question is basically, “as a disabled person with Medicare, do I only qualify for the behavioral health services through Medicaid or do I qualify for a full Medicaid plan?” I’m trying to see how much more effort I should be putting into this, as it’s been months of back and forth with no solid answers. If I only qualify for the behavioral health, I’ll stop pushing the issue. If that’s not the case, I’ll keep pursuing this. If I qualify for a full plan, WHO should I be talking to and do you have any other advice to get this moving forward? Is there a special code word or phrase to use at DSHS to talk to someone? 😅
Thanks in advance, everyone! I’m especially hopefully that Blossom chimes in on this. She’s always so knowledgeable. I’m an open book, so ask any other questions that will help get me the answers I seek. Have a good day everyone!