After a few appeals, woman gets coverage

About a year ago, a woman contacted the Ombudsman about her Medicaid and disability financial assistance. The woman had a pending Social Security Disability application, and the State of Ohio determined she was eligible for Medicaid. When one is eligible for Medicaid but not yet determined to be disabled by Social Security, the state requires a medical review. The woman had a medical review, and was determined by the state to no longer be disabled. The woman appealed the decision, stating she had additional conditions she wanted to be considered. The woman believed she won her appeal, and that she should continue to receive her Medicaid and disability financial assistance, but reported to the Ombudsman that she was only receiving her medical coverage.

The Ombudsman reviewed the appeal, and concluded that the state hearing recommendations included the woman receiving financial assistance as well as medical coverage. The Ombudsman contacted the Montgomery County Department of Jobs and Family Services and reviewed the state hearing decision with the supervisor. Although the financial assistance was not included as part of the appeal, the supervisor agreed that it should be reinstated. The woman was grateful to receive her financial assistance while awaiting her medical review. The Ombudsman continued to maintain contact with the woman and the county in order to follow the results of her review.

About six months after the appeal and reinstatement of her benefits, the woman received notice that her medical review determined she was no longer disabled. Ombudsman staff contacted the county and learned that the medical review conducted did not include any additional medical paperwork since the previous denial. According to the appeal decision, the county was supposed to help the woman obtain the medical paperwork needed for a full medical review of her conditions. The woman had signed what she thought was the correct medical release, but apparently she needed to sign additional forms so that all necessary paperwork could be obtained for her review. The woman again appealed the denial of her medical coverage, and won her appeal. The state hearing officer recommended that the county send all necessary release forms and to assist the woman in collecting medical information for a full medical review of her conditions. The woman received the releases and promptly returned them to the agency.

Four months later, the woman was determined to be disabled by Social Security. Because of this action by the Social Security Administration, she no longer required a medical review by the state. The state was notified of this decision and closed her disability financial assistance, since she would now be receiving ongoing Social Security disability benefits. The woman was grateful to have the matter finally resolved.

The Ombudsman Column, a production of the Joint Office of Citizens’ Complaints, summarizes selected problems that citizens have had with government services, schools and nursing homes in the Dayton area. Contact the Ombudsman by writing to the Beerman Building, 11 W. Monument Avenue, Suite 606, Dayton 45402, or telephone (937) 223-4613, or by electronic mail at ombudsman@dayton-ombudsman.org or like us on Facebook at “Dayton Ombudsman Office.”

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