SSI and Medicaid for Preemies

AustinGurl · January 2012

Did your child qualify for SSI and Medicaid strictly by low birth weight? I'm on the phone trying to get the benefits for my little guy. O. M. G....the questions!!!

jacque_z · January 2012

Yep. C qualified based strictly on birth weight. We skipped the SSI altogether as the benefit would have been roughly $30 a month. Not worth the stack of paperwork we would have had to fill out.

Mrs. Alice · January 2012

Yes we did. The paperwork wasn't too bad. They gave me an appt at the local office and I just had to bring pay stubs and the hospital social worker send over the medical records. Took less than 1 hour.

HJOHNSTON411 · January 2012

Hi,

Bless you, it's such a pain!! My LO is almost 8 months, and I literally got the certified approval letter TODAY. We had to go through an appeals process, etc.

When we were in the NICU, the social worker said that our best bet was to apply to the General Hospital Medicaid program. This is NOT income based and doesn't pay anything while the child is in the hospital. It provides 1 year of insurance, usually secondary. If you opt to receive disability or SSI while the child is in the NICU, you cannot apply to this program.

I was told that our LO met the criteria based on 1) over 30 days in the NICU and 2) low birthweight or SGA. We applied in July after discharged and were told about 3 months later that were denied because he had no lasting disabilities etc.

We appealed. There was one other family from our NICU with a similar case who appealed also. Their decision was reversed in December. I got a call one week before our hearing saying that it was cancelled and the decision was being reversed. That was three weeks ago.

I don't know how much this will help you, but I sympathize with you! It's a pain but stick with it. Write letters and bug people if need be.

They may try to tell you that there are gray areas, that low birthweight alone doesn't qualify etc. NOT TRUE! They are supposed to base the decision on the SSI Criteria. We did our own research to verify what our NICU social worker told us, and it's very easy to find and clear. If a child is SGA, is considered a functional equivalency for disability and therefore eligible.

If you have more specific questions, where to find the statutes etc, email me: hrowanj@gmail.com

We were very lucky. I have friends who had triplets (SGA, NICU for 60 days) and they were denied. They didn't pursue an appeal, and Medicaid as a secondary insurance provider would have been worth $30k in balances left after their private insurance.

bhilyer · January 2012

My boys qualified based on low birth weight alone. While they were in the NICU, they received $30 a month, but upon discharge they got lump sum.

The paper work was a pain, but in my state SSI = Medicaid for 1 year. With all the pedi appts, specialists, surgeries, etc. it has been well worth my headache from dealing with them

adrielegorburu · January 2012

We got SSI and Medicaid applications in the NICU - we got the $30 a month while she was in hospital and a single lump sum payment when she was discharged, after that we didnt qualify due to our financial situation. SSI= one year medicaid coverage here also and we also automatically are eligible for next year Medicaid because of the amount of medical expense she incurred this year. HOWEVER - because our Medicaid was tied into our SSI - the medicaid adopted the inception date for SSI which was roughly one month after DD was born, so right now (and for the past 8-9 months) I have been TRYING to change the eligibility date on her Medicaid to her birth date to cover the co-insurance, uncovered portions etc. of her hospital and NICU stay that first month! its been awful trying to get it done! but all in all it was very worth it. We qualified for both due to her ELBW -

AustinGurl · January 2012

Thanks ladies! I know it will be a pain, but I want the Medicaid benefits to cover what our insurance doesn't. I can't even fathom what these bills will be like. I finally finished the phone appt and I still have to fax stuff in. Blah.

lwmooney87 · January 2012

Yep, My DD qualified while she was in the NICU based on low birth weight and gestational age. I didn't have to fill out anything...the hospital social worker handled it all.I just had to sign some stuff and have the phone interview.

I'll tell you it was a God send though because of the Medicaid. We have private insurance (Cigna) which is really good and we don't have a deductible to meet but even with good insurance we still owed $64,600 AFTER insurance paid and the Medicaid covered that. So, I'm SO thankful for that. She doesn't have it now and they determined she didn't need SSI (which I agree with...she's not disabled) The $30 checks are pretty pointless but it's so worth it to fill out the paperwork just for the sake of medical bills and for all of those follow up appts in the couple of months after discharge.

Good luck!

ETA: DD's Medicaid coverage started on the date she was born, even though we filled out the paper work and everything a couple weeks after. (I'm in NC)

spain116 · January 2012

LO qualifies and our hospital social worker did all the paperwork. We received a confirmation packet in the mail to verfiy that our preemie was not a felon, had not been married or used other names or SSI #s. We got a laugh from that. She's not a felon, so I guess we're good to go.

Benefits are supposed to start with her date of birth. I hope there are no delays. Good luck to you in the process. I am sure it's daunting.

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