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Florida has so far still refused medicaid expansion..

According to the Herald-Tribune:

“We do have until the end of the year,” State Rep. Jim Boyd, R-Bradenton, told the nearly 300 people at the Sarasota Tiger Bay monthly meeting. “We’ll certainly have a lot of dialogue about it in going into the fall.”

Boyd said he thinks there will be “some solution” before Jan. 1, 2014, the deadline for when Florida has to decide whether to accept the expanded Medicaid program to draw down federal funds.

In the meantime, those of us living between the cracks are royally screwed. I just got my Notice of Case Action letter from Florida Department of Children and Families today. Good news: I'm still eligible for Medically Needy. Bad News: my buy in has somehow jumped from  $9 to $1075.

The explanation of the buy in, for those who don't understand how the program works states this:

Your "share of cost" is the amount of medical bills you must have before Medicaid can pay any of your other incurred medical bills for you. Your "Share of cost" works like a deductible on a health insurance policy. Your "Share of cost" is based on your family's monthly income. You must incur medical expenses equal to the amount of your "share of cost" each (bolding mine) month before you can become eligible for the rest of the month.
My other half's share of cost for his medically needy is $998. My kids thankfully both still qualify for medicaid.

One would think given this that our income has drastically increased since we re-upped last in February. One would be mistaken. Our income hasn't increased at all since the $12 COLA raise to my other half's disability last January. Our rent however has increased because we moved, it went from $500 to $795. Granted some of that has been compensated for by a reduction in transportation costs because we can now walk everywhere we need to go rather than taking a bus or a cab. But then consider that our water bill has gone from $25/month for the trailer park's water/septic/trash system to $85/month for the trash/water/sewer here through the city.
There is no explanation on the letter saying why it's jumped so high. I suppose I could try to get a hearing to fight it, but without knowing on what grounds it was raised, how do you fight it?

Florida NEEDS Medicaid expansion. I don't have $1075 a month to keep breathing. I have COPD caused by asthma/bronchitis.  I'm going to end up in the ER a LOT without my meds. And that's not counting whatever the bloody hell is going on with my neck and shoulder, that I haven't been able to get diagnosed because of this. And may the gods help  us if both my other half and I get sick. $2073 per month is almost more than we bring in.  We bring in on average $2100 per month after Caedy pays taxes and her health insurance. Oh, and we get $157 in food stamps. That's for three adults and two kids. Sometimes that number goes up and down slightly depending how many hours Caedy gets at work, but that's the average.

Essentially that's a deductible of 12,900 per year. That's a pretty crappy health insurance policy. But if it were per year, one hospital stay would cover it, and I could make payments with the hospital and get care the rest of the year. But $1075 every month before anything at all is covered is absolutely insane. I still haven't found a clinic or doctor in this county yet, not one I can get to anyway (there's a clinic about 10 miles away, but without a car...).  Luckily the hospital here will 'charity care' our monthly 'deductible' away once we qualify for medicaid to cover the rest.

This medically needy thing may be enough to keep me alive (even that is a risk, because every exacerbation could end in death or more permanent lung damage). It isn't enough to keep me functional. It sure isn't enough that I could even think of trying to improve function enough for even a part time job. Hopefully it will be enough to keep me going until the ACA kicks in and I can get some sort of coverage and/or our government gets its head out of its rear and lets Medicaid Expansion occur.

But according to Florida's dysfunctional government... Florida residents wouldn't benefit from Medicaid Expansion. I guess that works if you don't count us.

4:04 PM PT: Rescued, thank you! And for the record, yes, this diary was a rant, but I don't imagine for a moment we're the only family going through this. I'm sure there are hundreds to thousands in this state alone in addition to those who may qualify for Medically Needy and either don't know or don't bother to file for it because it's mostly useless.

Originally posted to FloridaSNMOM on Thu Jun 20, 2013 at 01:02 PM PDT.

Also republished by State & Local ACTION Group and Community Spotlight.

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Comment Preferences

  •  There's probably an asterisk ... (14+ / 0-)

    On the Florida Government's version of the word "Resident".

    Pretty much means the same as it does everywhere.

    *White, Tragically Boring, and willing to donate To Politicians

    /snark

    I don't blame Christians. I blame Stupid. Which sadly is a much more popular religion these days.

    by detroitmechworks on Thu Jun 20, 2013 at 01:50:30 PM PDT

  •  FloridaSNMOM (18+ / 0-)

    I'm gearing up for the sabotage states think in July. We can create pressure on these assholes to accept it. or face consequences. I'll message you early in July about it and maybe there's something we can do to help get the truth out there.

    To me, this is not a dem/gop divide except on the part of legislators who can afford to be ideological.

    our strategy is to educate people about the actual costs and benefits and then build a bipartisan PEOPLE'S consensus around this. republicans need this as much dems. we all are subject to getting sick. it's  the rat bastards in the leges who have public insurance who can afford to play games with people's lives.

    right now I'm looking for a publicist so if you know anyone or have a friend of a friend who can help, let me know.

  •  This is horrible. (14+ / 0-)

    I sure wish I were in a position to offer you more than good wishes. But that's the best I can do.

    God help us all.

    It's here they got the range/ and the machinery for change/ and it's here they got the spiritual thirst. --Leonard Cohen

    by karmsy on Thu Jun 20, 2013 at 04:10:42 PM PDT

  •  Fl government is NOT dysfunctional if you are a de (18+ / 0-)

    veloper, megarancher, utility company, friend of a legislator (they have lots of these,) construction contractor, appeals court judge who wants some really special working digs, Republican Convention delegate who wants a lap dance PLUS, et cetera, ad nauseam. And of course it's working great for Governor Skeletor, and his merry band of thieves, cons and bunco artists. Who, thanks to the sickness that is "reporting" hereabouts, is all looking good for another term because he has hired some slickly competent flacks who have polished the shit off his image, to the point that our numbnuts electorate now has granted him "improved approval numbers." APPLAUSE, reporters' and editors' heads just shaking in silent admiration for the guy... "How does he do it?"

    For all you people here who go on about how "polls turn into votes at the polls," you may have a point. Too bad you have not a prayer of moving those poll numbers in a direction that will keep the diarist in health care, or for that matter the daughter of the other nurse in my office, who was one of the first "beneficiaries" of Fu__head Scott's social-welfare assassins. The daughter, a bright young lady, has CP, and is chairbound and unable to speak or provide any kind of self-care. The Governator/Procurator General cut the full-time nurse she needs, which meant her mother would have to go on welfare and either find some kind of paid work for her daughter to do, or institutionalize her for FIVE TIMES THE COST OF HOME CARE.

    At some point, I hope, enough people will have had enough of this to maybe do something besides blog, and natter about "polls," and in a state that has a clear majority of registered Democrats, find a way to elect more than a pittance laughable minority to the legislature and keep a creep like Scott from buying an election (where the margin was maybe 50,000 out of millions of votes, so spare the smartass remarks about "FloriDUH," those of you who did nothing to GOTV and that silly stuff) with $80 million of the over $300 million he got to keep, out of the maybe $6 billion in Medicare-Medicaid fraud he managed the theft of by running HCA-Columbia like a cheap whorehouse.

    Dysfunctional? Depends on how big you can lie, cheat, and steal...

    "Is that all there is?" Peggy Lee.

    by jm214 on Thu Jun 20, 2013 at 05:38:29 PM PDT

  •  patient advocacy - FL (8+ / 0-)

    This is from their URL:

    http://www.advoconnection.com/...

    Patient advocacy - Florida

    Do you need help managing health or medical care challenges, insurance or medical billing problems for yourself of loved one?

    The government thinks it's alright to have a record of every single call that an American makes, but not alright for an American citizen to know what sovereign powers the government is negotiating away. ~ Rep. Alan Grayson

    by anyname on Thu Jun 20, 2013 at 06:08:37 PM PDT

  •  Here in TN you can ask any utility company to come (4+ / 0-)

    check you meter. Could be something wrong with the water meter at your house.

    They say that on average it's $20 per person per month.

    Tracy B Ann - technically that is my signature.

    by ZenTrainer on Thu Jun 20, 2013 at 06:26:19 PM PDT

    •  About half our bill is sewage... (6+ / 0-)

      $11 is trash, the rest is water. They did check the water meter in February when we had it turned on. And we have 5 people living here.

      "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

      by FloridaSNMOM on Thu Jun 20, 2013 at 06:46:02 PM PDT

      [ Parent ]

      •  Maybe $80 isn't bad in the long run. (2+ / 0-)
        Recommended by:
        FloridaSNMOM, Alexandra Lynch

        Though I get you that it's more than I have.

        I was going to put this "doggie dooley" thing in my yard. A bit of a septic system for dog poop, but it seeps into the depths of the yard.

        At the bottom of the yard is a creek though and I worried about the sludge going into the creek where the dogs swim.

        That led me to study sewage systems and to come to the conclusion that no price is too high to pay for sewage!

        It's not exactly soilent green, but we are drinking everyone's pee. Yikes!  

        Tracy B Ann - technically that is my signature.

        by ZenTrainer on Thu Jun 20, 2013 at 09:27:12 PM PDT

        [ Parent ]

    •  Taxes? (4+ / 0-)

      When our section of county was annexed by the local city, almost all our utility bills rose quite a lot, none more than water & sewer (which are absolutely mandatory and get billed to the property owner --not the user, if it's a tenant-- due to state health regs.)

      It wasn't like we got any new providers. The city just added a "city tax" line to our bills.

      It still annoys the crap out of me. We haven't received anything out of annexation despite all the big promises. The neighbors who were gung-ho for it? They're whining like crazy about politicians making empty promises.

      Go figure.

      © grover


      So if you get hit by a bus tonight, would you be satisfied with how you spent today, your last day on earth? Live like tomorrow is never guaranteed, because it's not. -- Me.

      by grover on Thu Jun 20, 2013 at 07:11:52 PM PDT

      [ Parent ]

  •  "There is no explanation on the letter saying why (13+ / 0-)

    it jumped so high. I suppose I could try to get a hearing to fight it, but without knowing on what grounds it was raised, how do you fight it?"

    If no explanation was offered, you're entitled to a hearing to demand one.

    After you've heard the "explanation," challenge it on every level.

    Remember, you may be sick and you may be poor, but you're smarter than those bastards. Probably most of the people that get those notices throw their hands in the air and give up. They count on that.

    Don't fall for it. Keep after them until it's cheaper for them to do what's right than it is to keep up with you. Deal with them like you would an insurance company that's out to screw you out of a legitimate claim. It's a matter of life and death.

    This makes me so fucking mad I may have to ask BadKitties write a diary on the subject. Pardon the profanity. It's not like me. ;)

  •  So, in short, they want you to die. (8+ / 0-)

    I hadn't even heard of "buy-in", but this ain't it. In fact, the most recent table I could find at NCHSD, 2010, says Fla doesn't have the program.  Based on your experience, that's effectively the case once again;  $2073 is not so much INSANE, as a rude F.U. To everyone who's poor.

    Any idea which bill(s) are responsible for this murderous travesty? I'd like to know exactly where the blame lies, but I can't even find details on how the bureacratic process works for this mess.

    I am become Man, the destroyer of worlds

    by tle on Thu Jun 20, 2013 at 06:30:30 PM PDT

    •  I haven't been able to find much either... (7+ / 0-)

      other than the standard BS letter they send out and people complaining about the program not helping them at all. Florida definitely has the program, and according to one site I found, can set the 'buy in' up to 90% of your income. every month. Can't even get a PCP to take advantage of free screenings under the ACA with this program, because no doctor is going to see you hoping they may get money if you use enough. And every doctor's office I've been in requires money at time of service, it's not like they bill you and you can send that into medically needy to hopefully add up to enough.

      "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

      by FloridaSNMOM on Thu Jun 20, 2013 at 06:54:17 PM PDT

      [ Parent ]

  •  When you said (11+ / 0-)

    that your buy-in had jumped from $9 to $1,075, I didn't realize that you meant monthly until further down in the diary. Annually your buy-in has jumped from $108 to $12,900. Holy crap! That's an insane increase. There must be some recourse.

    Of course, our illustrious governor won't be losing any sleep over it.

    The GOP can't win on ideas. They can only win by lying, cheating, and stealing. So they do.

    by psnyder on Thu Jun 20, 2013 at 06:46:46 PM PDT

    •  The amount is only (0+ / 0-)

      relevant if you have large medical bills in a month.

      It is not quite the same as a monthly insurance premium.

      However, For some people, their monthly prescription expenses might be massive or they might have to get a $2,000 shot every two weeks.

      I haven't seen a doctor personally for well over a decade.

      If I get hit by a car and have to shell out $2,000 for a buy-in after getting hit with $150,000 in medical bills I would find it very acceptable. Right now since I don't have young children and don't get a chance at Medicaid, that $150,000 would mean my $110,000 house and my $40,000 in financial accounts would go to hospitals and doctors.

      •  Except this program is supposed to be designed (3+ / 0-)
        Recommended by:
        HeyMikey, Calamity Jean, chimene

        for people with chronic conditions who don't quite qualify for medicaid.  It's not supposed to be Accident insurance. People with chronic conditions do habitually have large medical bills, in the multiple hundreds of dollars per month. The problem comes when it doesn't cover what you need to keep you going and will only reasonably kick in when you have to go to the ER. If I had the money for up to 1075 per month out of pocket ($2073 if you add in my other half's as well) I'd be buying health insurance and wouldn't be relying on this program.

        Poverty level for a family of five is $27,570 per year. The total we bring in a year is $25,200 a year. That's if you count Caedy (which DCFS does), who is technically not related, but a room mate. If you count our family, meaning me, my other half and the two kids... we bring in $17,700 per year with poverty level for a family of four being $23,550. And at that point the amount they expect us to pay up to the point when medicaid kids in is $600 more than we bring in per month. It's absolutely insane.

        We're back to "everyone gets treated at the ER so no one really goes without health care". Except chronic conditions CANNOT be treated effectively through the ER alone.

        "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

        by FloridaSNMOM on Fri Jun 21, 2013 at 08:54:16 AM PDT

        [ Parent ]

        •  Medicaid spend-down was designed for one-time (0+ / 0-)

          catastrophes decades ago.

          During LBJ's presidency the most expensive drug probably was insulin at about $35/month.

          It was easy to get a job with medical coverage when our economy was much sounder and the income structure flatter.

          Marriage was the rule and one spouse was almost always able to work and get a job with hospitalization insurance available, which was normally bought by the employee because it was cheap.

          A divorced man was typically required to maintain coverage for his wife and children.

    •  I believe that the diarist's "buy-in" (2+ / 0-)
      Recommended by:
      HeyMikey, fladem

      is a spend-down.

      The term "buy-in" in reference to Medicaid usually means that a person (who must normally be disabled and I believe need coverage to work) gets to pay a monthly premium for Medicaid coverage.

      I think only some states offer Medicaid buy-in. Not all states offer Medicaid spend-down.

      •  That still doesn't help (1+ / 0-)
        Recommended by:
        Calamity Jean

        if you are asthmatic and get bronchitis. You wait until it's bad enough that you end up in the ER instead of getting treated before it turns into pneumonia. Because you don't have $200 for a doctor's visit and another $180 for antibiotics. Not to mention the $400 for your maintenance meds. I've only been taking one of my maintenance meds for the past few months, and I'm about to run out of refills on that one. Still can't afford to go see a doctor even to get that refilled and there is no OTC version of prednisone. I'm working on weaning myself off it and hoping for the best.

        "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

        by FloridaSNMOM on Fri Jun 21, 2013 at 08:58:22 AM PDT

        [ Parent ]

        •  Wal-Mart has prednisone (0+ / 0-)

          for $4 for a 30-day supply see page 5 (which should be taken as directed by a physician since it can have nasty side effects, especially if stopped suddenly).

          http://i.walmart.com/...

          Prednisone is not OTC for good reason.

          Find a Community Health Center:
          http://findahealthcenter.hrsa.gov/...

          Family Health and Dental Center of Columbia County
            (~ 2.07 miles away)

          171 Nw Albritton Ln, LAKE CITY, FL 32055-4451
          Phone number  386-758-5552

          Others would be quite a long drive away.

          You might be getting bronchitis because you are on immune system blocking drugs like prednisone.

          •  Yep, but I'm on three pills a day (0+ / 0-)

            so it costs more. And I can't get to walmart, but it's still $11 at CVS, it was $12 at walmart when we lived closer. The community health center is too far away for me to walk to, and the only transportation there is, is if you are on medicaid so I don't qualify for it, I've checked.

            And no, I get bronchitis because I have COPD. The prednisone actually makes it less likely because my bronchi don't get inflamed as quickly.

            "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

            by FloridaSNMOM on Fri Jun 21, 2013 at 02:45:04 PM PDT

            [ Parent ]

        •  Bronchial thermoplasty (0+ / 0-)

          http://en.wikipedia.org/...

          The link is for information only.

          Arizona?

          Why do the two major cities in Arizona seem to be the worst places for asthmatics? The answer is, they aren't. I imagine that it might be a question of cause vs. result. In other words, are people who live in Arizona more prone to get asthma, or are people with asthma more prone to come to Arizona?

          In the days of smaller populations and cleaner air, people relocated to the Arizona desert in order to mitigate asthma symptoms.

          A possible reason for this ranking is historical in nature. Arizona's territorial government had a goal to make Arizona a health destination. Asthma treatment centers and attractive facilities sprung up, and asthmatics moved to the Arizona desert for relief. The fact that it was warm, dry and sunny made it that much more attractive. Asthmatics married, families expanded and a concentration of people with asthma in major Arizona cities grew.

          So, although this study may be of interest to some, it doesn't mean that those cities high on the list are the worst places for asthmatics. It just means that there are many of them there.

          http://phoenix.about.com/...
          •  my siddle dister lived in Yuma AZ for several year (1+ / 0-)
            Recommended by:
            FloridaSNMOM

            her theory was that East Coast asthmatics came for the sunny-dry, got much better, and then decided to make AZ look more like "home" -- by planting grass lawns and pollinating Eastern trees, and viola! all those Eastern allergies suddenly popped up out of nowhere (duh!)

            "real" work : a job where you wash your hands BEFORE you use the bathroom...

            by chimene on Fri Jun 21, 2013 at 02:37:31 PM PDT

            [ Parent ]

      •  Medicaid (1+ / 0-)
        Recommended by:
        FloridaSNMOM

        requires that a recipient only have a certain amount of money to get covered usually (though this amount does not include your car and your house because of a call Reagan received while on NPR in the early 80's)

  •  It seems from your comment above this (11+ / 0-)

    that you've filed for disability. Do you need help navigating through that process? I have emphysema (and a few other ailments). The first time I applied I hadn't had a pulmonary test, and my claim was denied. Then I had the test, and sent those results with my appeal. Apparently, the results from that test did the trick, as I was approved. I qualified for SSDI which meant I didn't get Medicare for two years. However, if I hadn't qualified for SSDI, I would have received SSI, and would have had Medicaid immediately. I was able to continue going to a free clinic in the interim.

    How did I pay for the pulmonary test? The hospital is  City/County owned, so they have a sliding scale to determine how much you pay. I was required to pay 10% of the cost for the hospital (room and equipment). A month later I got a bill from the person who interpreted the test. It was more than I could afford so I called to see if they could adjust the bill as the hospital had. I ended up paying about 10% of that bill as well.

    If you think I can help, you are welcome to KosMail me.

    •  I had a pulmo test... four years ago. (8+ / 0-)

      My pulmo specialist was hoping for a while to be able to get me respiratory therapy so that I could work at least part time, but medicaid wouldn't cover it. I know my pulmo in Orlando has a copy of it, as well as my other records. They'll probably want a more recent one, but sometimes SSI will cover that. I will probably Kosmail you though. I'm really struggling with focus a lot of days which doesn't help any.

      "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

      by FloridaSNMOM on Thu Jun 20, 2013 at 06:57:39 PM PDT

      [ Parent ]

  •  and yet, there's a front page diary (7+ / 0-)

    extolling the ways in which health care costs are ebbing, thanks to Obamacare.

    Hard to know what to think, isn't it, until you actually start checking into what the cost will be for yourself.

    The rest is just rhetoric.

    You know you're in Oregon when you only see people using an umbrella to protect themselves from the sun.

    by Keith930 on Thu Jun 20, 2013 at 07:00:08 PM PDT

  •  FloridaSNMom is right on target with (10+ / 0-)

    the rage.   Everything that has to do with medical needs is lacking in Florida.  EVERYTHING.  I know doctors who have said,, we tell you it is a virus unless you got money for 30,000 tests.   I know doctors even at a VA can  write for transportation pick up and a jerk who who barely has a hs education knocks down a dr's order ( that will be addressed tomorrow...) Maybe by the news papers....   and gets lost in the files....A medically mental child can be held up in a child's mental institute where no one is doing anything or it appears so to save his life.. At 7 year old child, a  little boy I know attempted suicide.   All we get here is bullshit and people don't care if it's not thier kid, their family member, or their friends... YOU ARE Truly on YOUR own.  

    People are filthy rich or stinking poor down here...There is no in between.

    We the People have to make a difference and the Change.....Just do it ! Be part of helping us build a veteran community online. United Veterans of America

    by Vetwife on Thu Jun 20, 2013 at 07:01:14 PM PDT

  •  I am so friggin' sorry. I am sorry (5+ / 0-)

    sorry sorry sorry. Your predicament sucks so much.

    And but for the grace of God go I. I'm disabled (hopefully not permanantly). Oddly enough, I too pay $9 a month for Medicaid.

    What they want you to pay now is exactly my entire disability check--well, off by $3. Surely in FL we can multiply your situation by tens of thousands of people. What a horrible freaking disaster.

    To have your health or even life threatened would be traumatizing to some people and IS a crime as far as I am concerned.

    And I've been wrapped in self pity and feeling threatened about the likely cuts to food stamps . I am reminded again of my luck at being in Massachusetts.

    •  alternative diary title (3+ / 0-)

      Life Immediately Threatened by Florida's Medicaid Decisions

      Please Recommend this diary, people. Maybe everyone will become as upset about what's happening to their fellow Americans as they were with say, the NSA spying issue.

      People will die in FL.

      •  thanks for your support (3+ / 0-)
        Recommended by:
        Alexandra Lynch, HeyMikey, chimene

        jplanner. The cuts in food stamps have been worrying me as well. That's been cut down too, by about half for us. If they cut it by another $50 (estimated by some to be what will happen) it won't even buy one week's worth of groceries. Caedy is desperately putting applications in trying to find a job that pays better.

        "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

        by FloridaSNMOM on Fri Jun 21, 2013 at 08:03:15 AM PDT

        [ Parent ]

        •  I hadn't known the calculations (1+ / 0-)
          Recommended by:
          FloridaSNMOM

          possibly different for every state?
          My fear is that they will bump people OFF completely rather than (only) cutting benefits.

          Supposedly If I were not disabled I make too much for a single  person to get food stamps. However I cannot afford to move out of state, and am disabled so need my (thin) support system here. I am in an expensive city so my rent is already 3/4 of my disablity check. That's why I get it.

          They could easily just push disabled people off. We are allowed to use some or more expenses in the calculation of our income (ie sort of a deductable) that's why I get it.

          Food stamps have been proven to be the only way I can get by now that I can't work at all. I got rejected the first time and for those six months I had to sell my mother's jewelry (she's passed) in order to pay for food. It was very sad for me.

          But again, my problems are orthopedic they don't "lead" anywhere and I am grateful for that.

  •  Kossack connections to help people in FL? (5+ / 0-)

    I wonder if your State Medical Association has plans to set up free clinics for Medicaid patients. Or maybe hospitals will get volunteer doctos to do this. Someone needs to. My friend is a nurse in CT and she volunteers with a free clinic there so this does happen in states. I know it won't be enough but it could be something. There must be community groups or groups of doctors who can volunteer for this great  need. Calling all Kossacks in FL and other states in this predicament! Someone is a doctor or KNOWS doctors who could do this. Someone can spearhead this and save lived.

    I am aware that as usual I have an idea but don't/can't actually DO anything. Sorry if that bugs some people.

    Before Boston had free primary care for very low income residents (that started 20 years ago here) people had to go to the ER for care. I belonged to a community self-help group. We used to resort to cold calling doctors to see if they'd see patients for free. You'd be surprised that some did (usually only individual doctors in their own practices could do it not doctors affiliated with larger institutions). . I even ended up calling pharmacies to donate drugs for free for desparate people. Remarkably I did have some success for my co-members.

    It nearly always works better for an advocate to be the one to ask doctors for unusual or extraordinary things, not the patient. The advocate appears altruistic (especially if it's not a family member). When patients ask doctors for extra things I find it doesn't work as well. (I am a great and successful advocate for others but get judged when it's for myself).

    I hope you get all of the healthcare you need Somehow and you will know you and your family are safe around that somehow.

  •  I hate to read diaries like this because the mere (8+ / 0-)

    idea of someone having to worry about medical care is really upsetting.  I wish we could revive the Underground Railway except this time for people without healthcare, smuggle them here to Canada and have a system to get them treatment.  I need to think about this

  •  Share of Cost (6+ / 0-)

    This is a very confusing beast. Every doctor's office and hospital handles it differently. Some bill Medicaid directly. Some want me to fax in the medical bills for my son. (But do not know where it should be faxed. Thank goodness for our caseworker with so much patience.)

    We just got the notice from the Medicaid office that it is time to reapply. OK. We'll still qualify. At least until he is 21. Or is it 22? Nobody seems to know.  (He has chronic problems and qualified for an extended program called CMS.)

    But his monthly share of cost? Well, we started at around $30. Less than the cost of his prescriptions. All good. Then it jumped to $50+ and then $103. That's more than the cost of his prescriptions so I had to pay out of pocket.

    Now, when I went online yesterday to start the renewal process, the share of cost has jumped to $333.

    All of these changes happened with no explanation. No sudden increase in our ability to pay.

    One thing is the way share of cost/medically needy works here in FL. When doctors/hospitals can agree on how it works.

    It is not a deductible. It is not a matter of meeting the share of cost before coverage kicks in. It is a matter of exceeding the share of cost before everything is covered. Everything.

    So, if you exceed your share of cost in a month, everything, including whatever met the share of cost, is covered.

    I know. It doesn't make sense. But that's how it has worked for us.

    Go to the cardiologist and the office visit and tests exceed share of cost? In other words, costs more than the seemingly arbitrary number assigned to you? You pay nothing out of pocket.

    In a different month, go to the pharmacy with some prescriptions that don't quite cost enough, do not exceed that number? You pay it all out of pocket.

    So, if you can schedule enough things to fall in the same month, you pay nothing. Not even what you would think would be your "share."  

    For the months where all you have are smaller things that don't cost as much, you are screwed.
     

  •  One thing (4+ / 0-)

    that may be helpful -- the local health dept. Since my son's share of cost has been raised so much, Medicaid may not even cover the cardiologist's office visit we have coming up in July. It may but I have to find out from the doctor's office.

    In the meantime, I found out by chance that the local health department has a doctor's office that operates on a sliding fee scale ($20-$60 depending on income, I think they said you show your income tax return).

    So, whether or not Medicaid is useless for my son, I may sign him up for the health dept doctor going forward. Because he will age out of CMS soon and have to change doctors and who knows what the share of cost will be then, if he even still qualifies for Medicaid.

    Our health department is staffed with really nice, helpful people and the facilities are nicer than some private doctors' offices I have been to. It used to be pretty seedy but was redone.

    So that may have to do, if it works, until Medicaid expansion. Which could well be until after Skelator is replaced.

  •  Republicans Usurp Another Definition (3+ / 0-)

    and mutilate it to fit their idea of "moving the country in the right direction as a party of values."

    This time it's the phrase, "war on poverty."  To them it means "war on those who are in poverty."

    There is no conservative who believes that the social ill is the abstract noun 'impoverished.'  No.  They believe the problem is the tangible 'impoverished.' Thus, for them it is the people, not the condition that must be legislated out of existence.  Even when that means increased human suffering and, yes, even death.

    Readers & Book Lovers Pull up a chair! You're never too old to be a Meta Groupie

    by Limelite on Fri Jun 21, 2013 at 06:50:36 AM PDT

  •  A Few Sources of Help in Florida (3+ / 0-)

    for paying bills and getting assistance with pharma costs.

    Florida Consumer Protection offers this website (.pdf), "wheretofindhelp."  It's a pretty basic publication, but does point out how to obtain relief with Medically Essential Electric Service (MEES).

    In another vein, there is the Low-Income Home Energy
    Assistance Program designed to help low income famiies keep the power on.  There is also something similar to the MEES called Lifeline for telephone service, I believe.

    If you need emergency cash and again, financially qualify. you might want to look into the TCA program.

    You may apply for TCA through your local office of the Florida Department of Children and Families or online at www.myflorida.com/accessflorida.  Applications for TCA can also be treated as applications for Medicaid and food stamps. For more information, call 1-866-762-2237.

    Proof of residence in FL mostly devolves to documenting Homestead exemption, providing a current utility bill, and/or possessing a lease contract or rental payment receipts.  You may also have to qualify for most assistance programs on the basis of income, sometimes age.  Of course, photo ID is necessary, too.

    Do any of your children qualify to receive SSI benefits due to their medical conditions?

    Keep up the good fight.

    Readers & Book Lovers Pull up a chair! You're never too old to be a Meta Groupie

    by Limelite on Fri Jun 21, 2013 at 07:12:21 AM PDT

    •  Assurance Wireless offers 250 minutes (1+ / 0-)
      Recommended by:
      HeyMikey

      of cell phone service a month under the Lifeline program.

      http://www.assurancewireless.com/...

    •  Thanks... I do have assurance wireless already (2+ / 0-)
      Recommended by:
      HeyMikey, Limelite

      And we have so far managed the utilities and the rent. We just can't manage the prescriptions. And we're not likely to get enough help with the utilities every month to actually help with that because the cost of the scripts and the pulmonologist to keep getting them is so high in the first place. The clinic/PCP I had in Orlando started refusing to deal with my lungs because it was way out of his experience/expertise. I pretty much have to have a specialist at this point. A pcp would probably continue the scripts I have, but wouldn't be able to manage tweaking them as things change. Maybe it will be different with a different doctor, I can hope, if I can find one I can actually afford to see at all.
      All the doctors and specialists I saw in the hospital here told me to go to the health department and hope for the best. None of them were willing to work with the Medically Needy even when it was at a $9 share of cost, not even for a follow up appointment.

      LIHEAP down here only allows 3 months a year, so we're saving that for when we are desperate. Probably in August or September when our electric bill will spike because of the heat and AC costs.

      TCA will give us about $40 per month with what our income is right now and has a 2 year lifetime limit. I've already used about 9 months of that 2 year span in the past during pregnancies and right after when I couldn't work. I'd really rather not waste it on $40 per month when we are managing to scrape by.

      "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

      by FloridaSNMOM on Fri Jun 21, 2013 at 09:13:03 AM PDT

      [ Parent ]

  •  Hate to say this (2+ / 0-)
    Recommended by:
    Alexandra Lynch, HeyMikey

    But the Medically Needy better either get out there and vote or vote absentee against any and all Republicans.  They didn't do that in 2010 and now suffer the consequences of it with Rick Scott.

    It will be at least one more year of the Florida Republican Healthcare Plan - which is "Don't get Sick.  If you do get sick - die quickly."

    •  Some of us did vote in 2010 tyvm. (3+ / 0-)
      Recommended by:
      Nance, Alexandra Lynch, HeyMikey

      Rick Scott won by a very small margin, and I really wish Alex Sink hadn't done a concession and had forced a recount, because I wouldn't put it past him to have done something hinky to get in. I've only met a handful of people who admit to having voted for him.

      "Madness! Total and complete madness! This never would've happened if the humans hadn't started fighting one another!" Londo Mollari

      by FloridaSNMOM on Fri Jun 21, 2013 at 08:00:16 AM PDT

      [ Parent ]

  •  I have proposed that (0+ / 0-)

    the Florida hospital tax,
    which pays hospitals $1 for each $1 of hospital property tax
    be replaced with a state-wide tax that would leverage each $1 of replacement tax with $9 of federal Medicaid expansion money.

  •  Many drug companies (0+ / 0-)

    have patient assistance programs for their expensive drugs.

    This site has links to the drug company websites:
    http://www.needymeds.org/

  •  Find a legal aid program to help you appeal. (1+ / 0-)
    Recommended by:
    FloridaSNMOM

    Find the program that serves your area here:

    http://lsc.gov/...

    "The true strength of our nation comes not from the might of our arms or the scale of our wealth, but from the enduring power of our ideals." - Barack Obama

    by HeyMikey on Fri Jun 21, 2013 at 09:21:19 AM PDT

  •  Sarasota Healthcare Access (0+ / 0-)
    Sarasota County Health Department locations offering Sarasota Healthcare Access (SHCA) Services:
    ◾Ringling Health Center (downtown Sarasota)
    ◾North Port Health Center
    ◾Child Health Center

    Adults 55 years of age and older are referred to Senior Friendship Centers, when appropriate.

    Eligibility and Costs:   Costs are on a sliding fee scale based on family size and income.   Medical care is provided to all eligible persons regardless of place of residence.   To be eligible for SHCA, individuals must:
    ◾Have been hospitalized within the last 30-days  
    ◾Be low-income and uninsured (or be Medicaid-eligible)

    To enroll in SHCA, follow these simple steps:
    ◾During your ER or hospital visit, ask a case manager to refer you to SHCA.
    ◾If you have been discharged, go to the Sarasota County Health Department Eligibility Office nearest you to complete the SHCA Client Referral Form
    ◾Bring the following along with you:◾A picture ID
    ◾proof of address
    ◾SS#
    ◾verification of income for the past 4 weeks
    ◾The most recent bank statement(s) from any household member
     account(s)

    ◾At the Eligibility Office, sign in and wait for an eligibility specialist to meet with you
    ◾Ask to speak with a SHCA case manager, who may make an appointment for your medical services
    ◾Bring your prescribed or over-the-counter medications, plus any new prescriptions, to your appointment

    http://sarasotahealth.org/...

    Adult Health services from the health department

    Locations & Hours:
    ◾Ringling Health Center (downtown Sarasota)
     To make an appointment:  (941) 861-2859
          Mon, Wed, Thurs, Fri: 7am - 12pm & 1 - 6pm
          Tues:  7 - 11am & 3 - 6pm
          Sat (walk-ins welcome):  8am - 12pm
    ◾North Port Health Center
     To make an appointment:  (941) 861-3820
          Mon-Fri:  7am - 6pm
    ◾Health In Motion (mobile medical unit)
     (941) 861-5000
    ◾After-hours contact:  (941) 861-2900

    Costs & Eligibility:  Cost of services is determined by your eligibility and a sliding fee scale.  For details and contact information, please visit our Eligibility page.

    Accepted Insurance Plans:
    ◾Medicaid, Medicaid HMOs, Medipass, Medicare
    ◾Blue Cross / Blue Shield

    Adult Health Services:
    ◾Primary Health Care  
    ◾Specialty (Follow-up) Care
    ◾Mental / Behavioral Health Care
    ◾Dental Care (On Site)
    ◾Laboratory (On Site)
    ◾Evaluation and care of acute and chronic health problems
    ◾Communicable disease and health screening
    ◾HIV testing, counseling and disease management
    ◾Health education
    ◾Refugee  Screenings (Immigration Physicals)
    ◾Mammogram and breast health education
    *Also available at Women's Health Center
    ◾Immunizations for adults & travelers, overseas travel counseling
    ◾Pharmacy (On Site)
    ◾STD tests and treatment
    ◾Cancer screenings (breast & cervical)
    *Also available at Women's Health Center

    The Manatee County version:
    All Clinical Services are done by appointment. To schedule an appointment please call (941) 748-0747 x1456. Clinic Fees for Clients  

    The office hours are Monday through Friday 8:00am to 5:00pm except on the 3rd Wednesday afternoon of each month
     from 1:00pm till 5:00pm due to Staff Meeting and In-Service Training.

    http://www.doh.state.fl.us/...

    There's also Manatee County Rural Health Services that also serves developed areas of the county that might be useful:

    https://www.mcrhs.org/...

  •  Even in liberal NY, my mother-in-law's (2+ / 0-)
    Recommended by:
    FloridaSNMOM, Calamity Jean

    spend-down on Medicaid was a monthly 500.  That means we had to come up with 500. every month so she could get Medicaid and home attendants and wound care.  Lawyers told us off the record not to pay it because they never check and they never collect. Trust me, they fucking do.

    (And this was a bed-bound woman with no ability to move and no speech capability, living on SS only, of about 1200. per month.  She also qualified for about 75. in monthly SNAP benefits. AND THIS IS IN NY STATE).

    I feel for you, in FLA!

    Ayn is the bane! Take the Antidote To Ayn Rand and call your doctor in the morning: You have health insurance now! @floydbluealdus1

    by Floyd Blue on Fri Jun 21, 2013 at 11:01:44 AM PDT

  •  We were forced to move from Vegas (3+ / 0-)

    back to Ca. when my wife got Cancer. Neither of us had any problem getting MediAid or Medicare. Beth finally passed away a couple weeks ago, but by moving to Ca. we had a extra 9 or 10 yrs together. She died of COPD, and Cancer though it was the advanced COPD that really caused her death.

     Moving may not be the answer but Ca. is the best state I have found for healthcare for the poor and working poor. I would be willing to bet at least 1 6th of the city lives in subsidized housing. They are just now finishing a 3 story apt building for single adults with at least 49 apts. I am living in a 2 bedroom apt and live in the living room and kitchen only. They haven't made me move yet since Beth's death as if I could.

    "the government's role should be to uplift, enlighten, educate and ennoble the citizen, not oppress them with taxation and intrusive laws," Gatewood Galbraith, Historic Marijuana Advocate, aka "The Last Free Man In America," RIP 1-3-12

    by SmileySam on Fri Jun 21, 2013 at 12:11:35 PM PDT

  •  The PPACA temporary insurance program (0+ / 0-)

    was closed to new applicants in early 2013.

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