Does it make sense for Medi-Cal to ask for a $492 deductible per month on someone that makes $1,008 on unemployment? My mother was diagnosed in Mexicali with herniated disks. She lives on unemployment ($1,008 per month) with me and my sister. She does not have any kind of medical insurance for surgery, so we went to the Medi-Cal office in El Centro for help. She has worked in the fields for 25 years so far and needs to be good physically to make it next season. She was approved for Medi-Cal but with a share of cost (deductible per month) of $492. That is almost 50 percent. I am OK with paying it if we have to, but when I called her social workers to review it and check if there could be some mistake, they got mad and said they do not make mistakes and that it is disrespectful to doubt their work. Does that make sense? I am asking because I know of a lot of people that want to work, but their bodies need some medical help and are being denied. Please help! What do I do? — Frustrated, Imperial
The letter writer seems to be asking two questions: is it right that the amount of the share of cost should be so high and is it right that the computations cannot be questioned?
It is really difficult to even try to deal with this case hypothetically as there are some pieces of information lacking to make an informed hypothetical guess.
One of the biggest questions for us is whether the letter writer’s mother applied based on her income in a one-person household, or her income in a three-person household (son and daughter). In that case, the income of all three has to be taken into consideration, said Avery Dees, Imperial County deputy director of Medi-Cal.
Dees explained that there are a number of formulas the case workers need to deal with in determining share of cost. Ultimately they are based around something called a maintenance cost set by the state of California that does not change for the most part, but the costs subtracted from it to determine share of costs do change based on factors like income, how many people in the home, how much total income comes into that homes and even age categories.
So, as one can see, there are basic pieces we don’t have to even cross check the numbers given. Dees and Imperial County Social Services Director Peggy Price asked us questions we just couldn’t answer based on the information contained in the letter.
But, we do have some concrete advice. There is always a way to appeal the results of the determination. On the back of the notice stating approval of Medi-Cal and outlining the share of cost, Dees said there is an 800 number that anyone wanting to appeal a local determination can make. If enacted, a ruling would be set and an administrative law judge would be sent to the Valley to make a ruling.
Dees said if the letter writer cannot find that number, call the Social Services office at 760-337-6800.
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