Can Tx. dept health and human services deny medicaid based on felony?

[promicarus]

What is the name of your state (only U.S. law)? Tx.

I am in dire need of medical care for an as yet undiagnosed neurological disorder, and am without medical insurance, as I am in the process of applying for disability. I made an application through the dept. of Health and Human services and was denied any assistance whatsoever based upon the fact that I have a felony conviction (for a small drug possession charge, not distribution or any violent act). Is this legitimate? Can one be denied medical care who otherwise qualifies based upon income, and all other relevant circumstances? Can this determination be challenged? It would hardly seem justifiable for a state to effectively issue a de facto death sentence to a citizen in need of urgent medical care by denying same based upon a minor felony, would it not? Any assistance or advice in this area would be greatly appreciated, as the necessity of waiting for disability determination only means that in the meantime my condition will worsen to the point that later care may be, well, too late.
Thank you for your time and consideration

 

[RedemptionMan]

they can deny you for federal student loans so I would imagine that it could apply to your application for federal money in this case. The good news is they should allow you to appeal their decision and possibly have a hearing.

 

[Ladyback1]

What is the name of your state (only U.S. law)? Tx.

I am in dire need of medical care for an as yet undiagnosed neurological disorder, and am without medical insurance, as I am in the process of applying for disability. I made an application through the dept. of Health and Human services and was denied any assistance whatsoever based upon the fact that I have a felony conviction (for a small drug possession charge, not distribution or any violent act). Is this legitimate? Can one be denied medical care who otherwise qualifies based upon income, and all other relevant circumstances? Can this determination be challenged? It would hardly seem justifiable for a state to effectively issue a de facto death sentence to a citizen in need of urgent medical care by denying same based upon a minor felony, would it not? Any assistance or advice in this area would be greatly appreciated, as the necessity of waiting for disability determination only means that in the meantime my condition will worsen to the point that later care may be, well, too late.
Thank you for your time and consideration

yes, they can deny you services. You can appeal.

The good news is, if you are approved for disability (SSDI), you may be eligible for healthcare that way. With all the new healthcare laws going in to effect, the Texas Medicaid eligibility rules may change as well...

How old are you? I ask because how close are you to 65?
Have you got a physician that will verify that you have a diagnosis that qualifies for disability? Have you been examined by a physician at the request of SSDI?

 

[commentator]

An "as yet undiagnosed neurological disorder?" Doesn't sound like you're anywhere close to applying for SSDI or that you are sure at all you have something that could potentially be fatal. There is always the appeal process, but then again A few years ago, the state of Texas contracted their whole Medicaid program out to a private contractor who screwed it up so royally that they had to take it back. I suspect that a few lives were lost in that gigantic snafu. But really, at this time, it may be a lot easier for you to obtain medical care as an uninsured individual than in the past. Are you employed? How long have you had this condition or disability? What is your age?

 

[Ladyback1]

they can deny you for federal student loans so I would imagine that it could apply to your application for federal money in this case. The good news is they should allow you to appeal their decision and possibly have a hearing.

While Medicaid may have some federal funds, most, if not all, states administer their own Medicaid programs----thus there are sometimes different standards than federally funded programs (like Medicare)

 

[promicarus]

details,responses to questions in replies, and thanks for assistance

In answer to replies to my initial post--i referred to my "as yet undiagnosed neurological disorder" not because I have not pursued treatment or diagnosis to this point--as the condition mimics Myasthenia Gravis, I have been tested for M.G. antibodies, only to receive negative results. I am under the care of a physician as part of a public assistance program for which I qualified because of my lack of personal means, but this physician's referral to a neurologist for further tests is not one I can pursue, as the expenses of these tests and workups are not covered by the same program.As far as whether I am close to applying qualifying for SSDI, I qualify based upon a long history of psychiatric diagnoses, completely separate from these neurological complications. As far as whether "I am sure it could be fatal or not", considering the fact that it is as yet undiagnosed, but my symptoms are only growing worse, I'm not sure of anything, other than the fact that I am steadily deteriorating. Generally speaking, that's a fair indication that whatever the eventual result, it is likely to be either death, or a neurological deterioration tantamount to death, effectively. Becoming a vegetable may not technically be death, but few would quibble over this as a fine point.
I have reapplied for medicaid through the "yourtexasbenefits" site, but interestingly, the only categories offered coverage are "parents caring for a child", those over 65, and the "disabled".
The term "disabled" is not defined, and I have no idea whether the reference is to one who has received a formal determination of disability from Social Security, or some other, less formal definition pertaining instead to a statewide definition based upon the specifics of one's medical condition. There is an opportunity to upload records at the end of the application---I can only hope that this is for the benefit of those whose presented medical records are deemed of substantial severity to merit this informal label of "disabled" under the terms of the dept. of health and human services, as opposed to a federal definition assigned by the formal determination process, and that my records will suffice to "earn" me this conveniently vague designation, and therefore the medicaid coverage necessary to fund diagnosis and treatment of what is apparent to even the most casual observer as a alarmingly severe disability identifiable at 100 yards. Obviously I need medical records pertaining to this condition specifically to add to my petition for medicaid coverage. Does anyone know whether medicaid reimburses retroactively for expenses related to such a condition--in other words, if I were to seek out the neurological care necessary to at least a diagnosis, with the expensive "scans" involved, etc., which would then become personal credit debt---would a later grant of medicaid then pay these medical debts, relieving me of the obligation to do so in order to remove the expenses from my credit report?
Any advice or assistance in this matter is greatly appreciated. The rock and hard place i find myself lodged firmly between are closing in steadily and rapidly, and time is of the essence, the hurdles of beaurocracy becoming
frustrating to the point of exhaustion. Thanks again for your assistance.

 

[promicarus]

additional answer

In answer to replies to my initial post--i referred to my "as yet undiagnosed neurological disorder" not because I have not pursued treatment or diagnosis to this point--as the condition mimics Myasthenia Gravis, I have been tested for M.G. antibodies, only to receive negative results. I am under the care of a physician as part of a public assistance program for which I qualified because of my lack of personal means, but this physician's referral to a neurologist for further tests is not one I can pursue, as the expenses of these tests and workups are not covered by the same program.As far as whether I am close to applying qualifying for SSDI, I qualify based upon a long history of psychiatric diagnoses, completely separate from these neurological complications. As far as whether "I am sure it could be fatal or not", considering the fact that it is as yet undiagnosed, but my symptoms are only growing worse, I'm not sure of anything, other than the fact that I am steadily deteriorating. Generally speaking, that's a fair indication that whatever the eventual result, it is likely to be either death, or a neurological deterioration tantamount to death, effectively. Becoming a vegetable may not technically be death, but few would quibble over this as a fine point.
I have reapplied for medicaid through the "yourtexasbenefits" site, but interestingly, the only categories offered coverage are "parents caring for a child", those over 65, and the "disabled".
The term "disabled" is not defined, and I have no idea whether the reference is to one who has received a formal determination of disability from Social Security, or some other, less formal definition pertaining instead to a statewide definition based upon the specifics of one's medical condition. There is an opportunity to upload records at the end of the application---I can only hope that this is for the benefit of those whose presented medical records are deemed of substantial severity to merit this informal label of "disabled" under the terms of the dept. of health and human services, as opposed to a federal definition assigned by the formal determination process, and that my records will suffice to "earn" me this conveniently vague designation, and therefore the medicaid coverage necessary to fund diagnosis and treatment of what is apparent to even the most casual observer as a alarmingly severe disability identifiable at 100 yards. Obviously I need medical records pertaining to this condition specifically to add to my petition for medicaid coverage. Does anyone know whether medicaid reimburses retroactively for expenses related to such a condition--in other words, if I were to seek out the neurological care necessary to at least a diagnosis, with the expensive "scans" involved, etc., which would then become personal credit debt---would a later grant of medicaid then pay these medical debts, relieving me of the obligation to do so in order to remove the expenses from my credit report?
Any advice or assistance in this matter is greatly appreciated. The rock and hard place i find myself lodged firmly between are closing in steadily and rapidly, and time is of the essence, the hurdles of beaurocracy becoming
frustrating to the point of exhaustion. Thanks again for your assistance.

Incidentally, I am 42, unemployable due to my condition, which began some 8 years ago, but which has dramatically worsened in the last 2 years. It involves facial spasms/contractions, left side mainly, and "lassitude", unresponsiveness of both eyelids to the point that making eye-contact is impossible, and any attempt to focus on anything near field (as in common interaction) causing my left eye to close and face to contract.

 

[RedemptionMan]

Incidentally, I am 42, unemployable due to my condition, which began some 8 years ago, but which has dramatically worsened in the last 2 years. It involves facial spasms/contractions, left side mainly, and "lassitude", unresponsiveness of both eyelids to the point that making eye-contact is impossible, and any attempt to focus on anything near field (as in common interaction) causing my left eye to close and face to contract.

so are they saying this is the result of your illegal drug use or that you do not qualify because of the previous felony conviction?

 

[Proserpina]

RD actually asks a very important question.

OP - read this with regards to SSDI.

http://www.disabilitysecrets.com/get-disability-if-felony.html

 

[Ladyback1]

In answer to replies to my initial post--i referred to my "as yet undiagnosed neurological disorder" not because I have not pursued treatment or diagnosis to this point--as the condition mimics Myasthenia Gravis, I have been tested for M.G. antibodies, only to receive negative results. I am under the care of a physician as part of a public assistance program for which I qualified because of my lack of personal means, but this physician's referral to a neurologist for further tests is not one I can pursue, as the expenses of these tests and workups are not covered by the same program.As far as whether I am close to applying qualifying for SSDI, I qualify based upon a long history of psychiatric diagnoses, completely separate from these neurological complications. As far as whether "I am sure it could be fatal or not", considering the fact that it is as yet undiagnosed, but my symptoms are only growing worse, I'm not sure of anything, other than the fact that I am steadily deteriorating. Generally speaking, that's a fair indication that whatever the eventual result, it is likely to be either death, or a neurological deterioration tantamount to death, effectively. Becoming a vegetable may not technically be death, but few would quibble over this as a fine point.
I have reapplied for medicaid through the "yourtexasbenefits" site, but interestingly, the only categories offered coverage are "parents caring for a child", those over 65, and the "disabled".
The term "disabled" is not defined, and I have no idea whether the reference is to one who has received a formal determination of disability from Social Security, or some other, less formal definition pertaining instead to a statewide definition based upon the specifics of one's medical condition. There is an opportunity to upload records at the end of the application---I can only hope that this is for the benefit of those whose presented medical records are deemed of substantial severity to merit this informal label of "disabled" under the terms of the dept. of health and human services, as opposed to a federal definition assigned by the formal determination process, and that my records will suffice to "earn" me this conveniently vague designation, and therefore the medicaid coverage necessary to fund diagnosis and treatment of what is apparent to even the most casual observer as a alarmingly severe disability identifiable at 100 yards. Obviously I need medical records pertaining to this condition specifically to add to my petition for medicaid coverage. Does anyone know whether medicaid reimburses retroactively for expenses related to such a condition--in other words, if I were to seek out the neurological care necessary to at least a diagnosis, with the expensive "scans" involved, etc., which would then become personal credit debt---would a later grant of medicaid then pay these medical debts, relieving me of the obligation to do so in order to remove the expenses from my credit report?
Any advice or assistance in this matter is greatly appreciated. The rock and hard place i find myself lodged firmly between are closing in steadily and rapidly, and time is of the essence, the hurdles of beaurocracy becoming
frustrating to the point of exhaustion. Thanks again for your assistance.

http://www.hhs.state.tx.us/OMB/

Contact the ombudsman program
They are going to be able to further answer your specific questions regarding Texas Medicaid.

I do not know if Texas Medicaid will retroactively pay medical claims. I doubt it. My state (MT) does not. Retro'ing benefits could be too costly and a huge amount of paperwork---at what point would you start (when you began having mental illness diagnoses? At age 21?)

And it sounds like your credit rating is the least of your problems

 

[promicarus]

answers to specifics, and again many thanks for valuable assistance to date

To answer "RedemptionMan", the first representative with whom I spoke stated frankly that I did not qualify expressly due to my felony conviction. As to whether my symptoms are related to drug use, that's highly unlikely, as my drug use was never that severe--and I did not share my drug history with my interviewer at the time of my initial denial. However, a new factor has arisen, in that, motivated by the encouragement I've received from this board, I contacted the Dept. again, today, by phone, and managed to elicit a contradictory statement of position from a supervisor, to the effect that my felony would not, in fact, interfere with my qualification for medicaid. Interesting that my first interviewer was...well that's immaterial at this point.
The problem now is instead the fact that the application process provides options of coverage only for those over 65 (I'm 42), parents of children under 6 (I believe it was six), and "the disabled"---without offering any description of their terms defining disability, leaving me unsure as to whether this is a reference to one who has received a determination of S.S.I, or S.S.D.I, or instead some more relative, subjective use of the term subject to broad interpretation without binding parameters obligating the state to extend coverage in any given instance.
If anyone at all familiar with the Texas Dept. of Health and Human services treatment of "disability" as qualifying for coverage under medicaid, please advise. Is this determined on a case by case basis based upon one's unique medical history? I've been unable to find any binding definition of the term as used by the application process.
Many Thanks,again, for all posts in response. And yes, Ladyback1, my credit rating is far down my current list of priorities. I think, however, that continuing to think in terms of an average responsible citizen is one of the few things that keeps my head up high enough to maintain a forward momentum. Thank you for the ombudsman contact info--that does seem to be my next move.