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Lessons to Learn: Medicaid Applicant Appeals

Iris Rio Rancho, Albuquerque created on Wed March 19, 2014

I first started getting interested in applying for Medicaid when I heard that CSI was going to end and that there would be something called extended Medicaid. Which would allow people, including myself, to get enrolled. So I went to a meeting in October the south valley, for Centennial Care and I got all the information and though, “this is looking really good.”

So on November I went on to my computer and applied on the yes.nm state website. I gave all my information and that was sort of the beginning of the process. I hadn’t heard anything by December. And I was wondering because my insurance was going to end. I had heard that I needed to call by January 2 to choose my MCO. However, I was worried that I wouldn’t be insured for a few days. When I called they told me they still didn’t know if I was eligible for Medicaid or not.

Eventually after a few more weeks, the ISD office called and said that they had received my application. Again, after a few weeks I finally received a letter from Medicaid saying that I was eligible for Family Planning Medicaid. Everywhere down the line I kept figuring out that Family Planning was all that I was eligible for.

I tried to get a tooth extracted that was almost an emergency and the provider wouldn’t take the Family Planning card, because it was indeed only for Family Planning.

I found out from ISD that I could either “keep waiting, or I could start looking around to the Health Exchange, or I could do a fair hearing.” So, I put in a couple of calls for the Fair Hearing. And then contacted Health Action NM, for help. They connected me with Dorianne Mason with the Center on Law and Poverty for backup or support. I didn’t think I needed a whole lot, but I needed something.

So I had a meeting with Dorianne and she looked in to a few things. I’ll say, it was never very clear what the income level was. It became evident that because of my unemployment checks, I actually fell below the monthly FPL (federal poverty level).

In a matter of a couple of months, I received 6 or 7 different things from the ISD office, and at age 63 Family Planning is completely useless to me.

I don’t think it’s a good reflection on the program to have fair hearings all the time. Dorianne Mason filed the appeal for me, and we ended up not having to not go through with the fair hearing. Sure enough, a few days later I went on the NM Medicaid Portal and it said I was Adult Magi eligible; essentially full Medicaid coverage.

One of things I’m looking forward to is joining United Healthcare, which is a different MCO than I have right now. I feel like knowing and reading about the Medicaid Expansion is I can take care of my teeth, get new eyeglasses, and I might be able to get some help for an issue I’ve been struggling with for years, which is Fibromyalgia. I just feel more encouraged with the Medicaid Expansion here in NM.

I do a lot of self-care; I try. I don’t think it will help with some things, but the stress of not being able to see a doctor having health coverage was difficult. Not having health coverage is bizarre at this age.  I just really hope that, with it getting close to the time to sign up for healthcare, that they do. I just think that there are people who need the help to get into these programs, and if I can help someone I would.


Photo.jpg, by stephanie