A Maryland Medicaid Primer, Or Why The Poor Must Suffer

A concise background on Maryland Medicaid (Medical Assistance), SSI, SSDI, and the complete subjugation of these programs in my beloved Baltimore.

It is extremely difficult to understand the process to apply for Medical Assistance in Maryland, otherwise known as Maryland Medicaid. To start with, Medicaid is a program for the impoverished and indigent who otherwise cannot afford health insurance and the costs of medical care. Medicaid is a federal program, though it is jointly funded by the states and is administered differently by each. If approved for Medicaid, the program pays off all hospital and doctors bills, in addition to most medications prescribed during the covered period. However, those possessing green cards for less than five years, people in this country on a visa, or persons here illegally are all classified as being XO2 and are only eligible for Emergency Medical Services, which includes treatment for certain forms of cancer and childbirth.

In our system of government federal law is always supreme, and thus if you qualify for Medicaid under the federal rules then the state in which you live should give you benefits. Under federal law, certain conditions automatically entitle you to Medicaid coverage if you otherwise meet the income and eligibility criterion, including breast cancer, cervical cancer, endometrial cancer, and certain cardiovascular issues. However, due to the purported disarray of the economy, Maryland is making it incredibly tough to obtain benefits, to the point that almost no one is being approved at the state level.

If you are approved though, Medicaid seeks reimbursement for providing you with services. The only things that Medicaid cannot take are your primary residence and one vehicle. The rule in Maryland, in addition to a number of other states, is that Medicaid has a look back period. If you have transferred any assets or property in the five years prior to applying, Maryland Medicaid will take these, or can flat out deny you benefits if the assets have already been spent or are otherwise unrecoverable.

There are a few different Medicaid programs in Maryland. The major one is ABD, which stands for aged, blind, and disabled. This is for people 65 years or older, those who are legally blind, or persons disabled to the point that they cannot hold any paying job whatsoever. If you can sit behind a desk and stuff envelopes, then Maryland will deny your application. FAC means Families and Children, and is available to persons under 21 years of age and their primary caregivers. MCHP is the Maryland Children’s Health Program, for pregnant women of any age and children under 19, and is much easier to qualify for then FAC. LTC stands for the Long Term Care Program, and is for those people expected to be in a hospital or nursing home facility for at least six months, or for those individuals with no reasonable expectation of ever returning home. If you are married and your spouse still lives in the community, it is a very lengthy and complex process to divide up the assets between what Medicaid takes and what your spouse can keep.

In Maryland, you have 90 days from admittance to the hospital to apply for Medicaid. If you do not meet this deadline, you have no other recourse in seeking benefits. Most people choose to apply for Medicaid while still in the hospital though. If you go this route, you apply through a case worker on site who is there representing the state of Maryland. You can also apply for Medicaid at a local office of the Department of Social Services (DSS). After you turn in the initial paperwork, the case worker will send you a form 1052 which lists all documents that are still outstanding. Once the 1052 is sent, this begins the six month consideration period, where you must submit all of the information being requested. Again, if you do not complete your application within this new six month period, you are precluded from Medicaid for that hospital stay or treatment visit.

After you comply with the 1052, the case worker will send your file to the State Review Team (SRT), who makes a decision on whether or not you qualify for Medicaid under Maryland law. If you are XO2, instead of your file being delivered to the SRT, it is sent to DELMARVA, a private agency employed by the state of Maryland to make these decisions. Again, most people who initially apply for Medicaid in Maryland are denied. If you are not given benefits, you can file a form for reconsideration. However, a greater percentage of people in Maryland are denied at the reconsideration level then at the initial filing level. The majority of people who get Medicaid in Maryland are approved at the third level, where instead of appealing to DSS or DELMARVA, your claim is heard by a state administrative law judge.

A federal provision mandates that everyone who seeks Medicaid must also apply concomitantly for either SSI or SSDI, which unlike Medicaid, does give you a cash benefit. You apply to the Social Security Administration for these benefits, the application for which is processed by your local office of Disability Determination Services (DDS). However, this means that the amount of paperwork is nearly doubled, in many cases amounting to nearly 100 pages or more to fill out. Many of the forms required to apply for SSI and SSDI are the same as those for which you apply to the Maryland Medicaid program, which can obviously be extremely confusing. These forms are labeled “SSA”, instead of DHR/FIA as the Maryland Medicaid ones are.

In the rare case that Maryland does approve you, this decision can be overturned by DDS (the federal government). Again, as federal law is supreme, if DDS finds you to be not disabled, this decision is binding on the state, regardless of the decision made by the SRT or DELMARVA. Conversely though, if the SRT or DELMARVA deny you and DDS approves you, then the state is forced to give you Medicaid benefits.

Under federal law, any person who goes to the emergency room of a public hospital must be stabilized whether or not they have insurance. The hospital though does not have to provide any further treatment, and usually won’t until you are approved for Medicaid or otherwise enter into a contractual agreement with them to repay your medical debt. Needing further treatment, people often contract for a payment plan or some other binding agreement with the hospital in the hopes that they will never have to pay out of pocket as Medicaid will take care of it. The problem though, of course, is that most people are denied Medicaid. If you do not receive Medicaid and cannot pay your medical debt, you will most likely be sued even if you are judgment proof (meaning that you have no money to pay).

At least in Maryland, the hospitals employ private law firms to help you apply for Medicaid. The lawyer only nominally represents you though, as the hospital is the primary client. Further, if you die without receiving Medicaid, the hospital can employ the same law firm to open an estate on your behalf to try and recover payment. This way of doing business must end immediately, as it obviously presents inherent conflicts of interest. Under both federal and state law, no matter who pays the attorney, confidential information about the client must not be shared. In a situation like this, however, there are obviously two clients, necessitating the sharing of privileged patient information between the law firm and the hospital.

In Baltimore City, nearly every major hospital, including the University of Maryland Medical Center, GBMC, Mercy, Sinai, Johns Hopkins, Johns Hopkins Bayview, and Bon Secours, exclusively refer their patients without insurance to one law firm to help them apply for Medicaid, the law office of Fred S. London. While you are still there, the hospital will contact the law firm, who will send a field representative to help you complete the initial paperwork. This is not only anti-competitive and monopolistic, but again, it is a conflict of interest, especially given the fact that only one law firm represents all of these hospitals in such a small and specific geographical area.

This is not to say though that the law office of Fred S. London does bad work; on the contrary, from my experiences they will fight very hard for you. However, as under both federal and state law attorneys are limited to a nominal percentage of your Medicaid, SSI, and SSDI benefits as their fee, lawyers must do this work in bulk to turn any profit and remain in business. Thus under the current system in Maryland, other attorney’s are effectively precluded from taking on these cases, and in fact only a few will. For full disclosure, I used to work at the law firm of Fred S. London, but quit entirely on my own volition just a few months after being hired as soon as I realized what was really going on. I wrote this article because I dealt with people on a daily basis who were both confused and mortified to learn about how hard it is to get benefits.

The main point here is that applying for Medicaid in Maryland is not a simple or easy process. As you have 3 months to apply from the date of your hospital entry, then 6 months to complete the requested paperwork after receiving the form 1052, plus however long it takes for the state and DDS to render a decision, and then through the appeals process, most people end up having to wait years before getting any benefits. If you need further treatment, are very sick, or if you’re dying, it does not matter, as there is no way to speed up the process.

This post is contributed by a community member. The views expressed in this blog are those of the author and do not necessarily reflect those of Patch Media Corporation. Everyone is welcome to submit a post to Patch. If you'd like to post a blog, go here to get started.


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