Did anyone get Medicaid for a second year?

t1nkfan · March 2012

We just got an application in the mail since DS will be 1 next month. I'm wondering if anyone has actually had success with getting medicaid for a second year? If you did, what was the criteria - or did they explain why?

I know it differs from state to state, but I'd still be interested in hearing!

HJOHNSTON411 · March 2012

I'm not sure, but I think the second year the criteria for disability or income based Medicaid changes. Our LO qualified because he was under 1700 grams @ 35 weeks and spent 31 days in the NICU. Under this 'functional' equivalency for disability, we won the appeal for Medicaid. However, it's only General Hospital Medicaid, and it's secondary to our private insurance. I was told that, after his first birthday, the functional equivalency wouldn't apply to him anymore. And we wouldn't qualify based on income.

Medicaid has been a nightmare for us anyway. DS is 9.5 months and we just got the cards and info in late January. They still haven't settled the few claims we submitted to them because they can't seem to get the our private insurance policy figured out - even though we've faxed the information to them 3 times:). Sorry for the rant ha, but I have no faith or hope whatsoever in our LO getting any extra coverage from them.

Hope you have better luck though!!

iristony · March 2012

We did not even bother applying for second year. It was great to have for first year to use as our secondary. It covered all of our co-pays- which was a lot the first year. I believe the doctor needs to deem your LO as having special needs or chronic problems and/or you need to be financially poor.

jacque_z · March 2012

PPs are right. To qualify, your LO either needs to be deemed 'disabled' or you have to meet the income eligibility guidelines which are very low.

Irishsapphire · March 2012

We did not qualify for Medicaid for a second year because of our income being too high.

shanlubey · March 2012

We haven't had another medical review, but he is still considered disabled based on his CLD through the Medicaid office. We'll keep it for as long as they give it. With multiple appointments some weeks and medical equipment, we've saved THOUSANDS in co-pays in the 10 months he's been out of the hospital.

lwmooney87 · March 2012

My LO didn't even get it the first year and she was born at 29 weeks and was 1219 grams ...She qualified while she was in the NICU and she came home June 19 and her Medicaid ended in October. I didn't bother appealing it because we have pretty good private insurance and I was thankful that she had the Medicaid for as long as she did and I knew she wasn't "disabled". It covered the hospital bills and after discharge follow ups at first. It did suck because she didn't qualify for Synagis based on our insurance company's guidelines. I always wonder if Medicaid would have covered it. But it any case, we have been fine without it.

ijustcantthinkrightnow · March 2012

Ditto what the previous posters said.... Our DD qualified because of a medical diagnosis (cleft palate & feeding tube) for year 2. She will keep it until her 21st birthday or longer if she has ongoing issues with the Celft.

My advice is that it would not hurt to apply. The worse tha can happen is they say no.

Kate621 · March 2012

We didn't qualify based on income.

aegarrettrn · March 2012

Agree with previous poster. DD did not qualify under the disability standards but did because of our income. Its worth a try to just do the paperwork & see what happens.

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Did anyone get Medicaid for a second year?

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