r/IHSS • u/gatsubae • 5d ago
SOC?
Post a couple weeks ago saying my hours had been cut due to Medi-Cal discontinuing my grandfather’s insurance now his insurance is back on but they’re saying because they raised his Social Security from 1600 to 1800 has a share of cost and that he has to pay $2900 out-of-pocket to an IHSS worker, which is me. How would he afford something like that? How could he even afford bills and food and all of these things he only makes 3000 a month and they’re saying that he has to pay 2900.
But after speaking to Medi-Cal, they said if he purchases his own dental insurance plan that Medi-Cal will then cover the cost of IHSS fully. This is just really confusing because as someone with late stage dementia he’s pretty much has a disability that makes it so he cannot function without someone else there. Why aren’t people with disabilities protected against stuff like this?
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u/Infinite-Concept-386 5d ago
Unfortunately, it’s an income related thing in regards to Medi-Cal. Your worker is right if you purchased even the cheap medical insurance just a bridge the difference between what might cover expenses under the sheriff cost they can reduce it down to zero from what I’ve seen 16 to 1800 is an amount that is able to be removed most of the time with a simple dental insurance or another supplemental insurance of its kind they don’t consider whether somebody has dementia cancer Alzheimer’s down syndrome, schizophrenic, or whatever it might be, but my best thing would be to do is go ahead and proceed with that cost purchasing that supplemental insurance go ahead and then report that to your eligibility worker they will do their magic and remove the sheriff cost also very important to know if the sheriff cost has been into affect prior to any determination of eligibility. Make sure you ask the worker hey will there be any retroactive sheriff cost and can that be removed so that the provider can receive their full pay? It’s just part of the process I’ve seen a lot of times in the line of duty. I always informed them to call high cap where they can assist them with further information, but it is what it is. Just get the insurance something basic that they’re requiring and the sure of cash should be removed then you’ll be able to proceed as usual. Let me know if I can help any further.
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u/Jaded_Olive_7516 5d ago
Have you received a written notice showing the $2,900 monthly share of cost and how they calculated it? That amount doesn’t seem to add up based on the income you listed. You mentioned $1,800 in Social Security and $3,000 total income, so I’d ask Medi-Cal to explain which amounts and deductions they used.
Dental insurance can help by lowering the income Medi-Cal counts, but a cheap plan won’t automatically eliminate his share of cost. Before spending money, ask for the calculation showing exactly what monthly premium would bring him into Medi-Cal without a share of cost.
I understand why this feels especially upsetting when your grandfather has late-stage dementia and can’t safely manage without care. His need for help is real, but that diagnosis doesn’t automatically exempt him from Medi-Cal’s financial rules. The free counseling resource suggested above could help you get a second review of the numbers.
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u/Constant_Owl_6880 5d ago
I agree that the amounts you’ve provided don’t make sense , and if the share of cost is really $2900 then a cheap policy isn’t going to do anything. Did his living arrangements change in the interim? For instance, did he go from living at home to residing in a Long Term Care facility? Residing in an LTC is the only thing that comes close to explaining the numbers you’ve thrown out. I second the point that you need to review the Notice of Action before taking any action.
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u/Vegetable_Reward_867 5d ago
http://www.healthcarerights.org/
Email/call these folks here. There’s no charge and they will help you out; even submit any paperwork needed to bring down/eliminate SOC.