Disabled and elderly people are easy prey for those who would take advantage of them. Moreover, many assume just because someone is disabled or elderly, they are not as smart – which is untrue. Caregivers play an immense role in not only being guardians, but often, also dear friends. Just know what you do matters more than it may often feel.

In Part 2, we covered questions from the perspective of an individual on Social Security Disability Insurance (SSD/SSDI). In this article, we look at SSI and veterans (often overlapping as many veterans are either on SSD or SSI). If you have not read Part 1 and Part 2, click on the highlighted links (Part 1 and Part 2) to read these articles. They do not need to be read in order.

In this article, we will discuss the following questions:

1. My SSI care receiver needs help with medical care. What are his or her options?
2. My SSI care receiver was denied Medicaid. Can I appeal the decision?
3. My care receiver received a hospital bill they can’t afford. What can I do?
4. My care receiver is a veteran and goes to the VA, but still needs help with other needs like dental. What are his or her options?

Let’s get started!

My SSI care receiver needs help with medical care. What are his or her options?

If you are lucky enough to live in one of the following 33 states and are on SSI, you should have been enrolled in Medicaid automatically. The states are:

My SSI care receiver was denied Medicaid. Can I appeal the decision?

If your care receiver receives a denial notice, you have the right to appeal. You will receive a denial notice within:

• 90 days if applying due to a disability.
• 45 days for all other reasons (financial, etc.)

This notice is very important and you will want to make sure you don’t lose it. Keep it until the process is completed. In this notice, it will state:

• How to request your appeal.
• Why you were denied.
• What the deadline is for applying.

Make sure you DO NOT miss the deadline, otherwise you will have to jump through hoops to justify a late appeal.

Keep in mind this is a trial before a judge. Also remember that the judge is human, and you are not just appealing to the legal statutes, but to his or her humanity as well, so prepare well.

Federal Medicaid rules state you have a right to:

• View all the files and evidence they used to determine your ineligibility. Request those.
• Call witnesses. If you have any, have them testify on your behalf.
• If the judge references a medical question and you do not have medical documentation to answer sufficiently with you, request and extension so you may produce the evidence before making a decision.
• Have an attorney present. If you can’t afford one, reach out to legal aid. Many law universities offer this kind of service so their students get to practice under a lawyer. Reach out to them as well, if necessary.

IMPORTANT! If the denial was because they did not accept you were disabled, they may order additional medical exams. You must accept those or your appeal will be denied. Do not worry about cost; they will pay for the exams.

My care receiver received a hospital bill they can’t afford. What can I do?

If you care receiver received a bill and you have not applied for Medicaid yet, and the bill is for a service provided recently, you can apply for Medicaid and request a 3-month retroactive effective date. Typically, Medicaid will pay any bills for services provided within three months of being approved. The problem is, if the bill is from a service provided more than three months prior to your approval, Medicaid won’t cover it.

If this is case, you can also reach out to non-profit charities. You would want to start first with a charity specific to what caused the medical bill (arthritis, diabetes, lupus, lungs, kidneys, etc.). You can also look for charities by groups (veteran charities, religious charities, etc.).

My care receiver is a veteran and goes to the VA, but still needs help with other needs like dental. What are his or her options?

The VA is a wonderful organization. However, like most government entities, they have limitations. One of those is dental. Only 1 in 17 veterans receive dental benefits and dental insurance is out of reach for many veterans, because it’s cost prohibitive. But if your care receiver veteran is eligible for Medicare, due to either being on SSD/SSDI for 25 months or greater, or they are 65 or older, they can get a Medicare Advantage plan that will provide dental. Most plans will also provide additional benefits that will fill other gaps left in VA benefits.

Understand the VA benefits are not insurance; hence they are not creditable coverage when it comes to Medicare. Medicare and the VA do not talk to each other, nor do they pay for the other’s bills. The exception is the prescription drug benefit, which IS considered creditable coverage. Therefore, your care receiver can have both, Medicare Advantage and VA benefits, for a more complete benefits portfolio.

Many veterans choose not to take Part B, because they do not wish to pay for the Part-B premium, which is $148.50 in 2021 (it increases annually). Not doing so will only incur lifetime penalties when they decide to take it. Few veterans investigate if there are ways to diminish this premium or eliminate it.

You have two options:

1. Apply for Medicaid. Medicaid will pay Part-B premiums and depending on what level he or she is approved, it will cover deductibles, copays, and coinsurance as well.
2. If they do not qualify for Medicaid, many Medicare Advantage plans offer Part-B premium credits or givebacks that range from $30 to $144, depending on where one lives.

You will want to speak with a fiduciary agent, like YourCareRep.com (Eddie Vélez is a veteran specialist and a veteran himself) who only represents your care receiver. He or she can check pretty quickly what your care receiver is eligible for and help you apply.

We have one more article in this series. Next week we will discuss the PACE program, benefits while traveling, how to ensure no mistakes are made medically if you (the caregiver) are not present, and what to do in the event of an overdose on prescriptions (which happened with my mom). Stay tuned!