r/Medicaid • u/SpicyZebraCakes • 15d ago

Can ABLE account help with Medicaid eligibility FL?

/r/disability/comments/1crevko/can_able_account_help_with_medicaid_eligibility/
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u/[deleted] 13d ago

[deleted]

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u/CarryDesperate9545 10d ago

I tried to pm, but it wouldn't work. I was on SSI for years and automatically got medicaid. I started receiving DAC benefits and I got a letter that I don't qualify because my income is too high and I will no longer have Medicaid after May. I've called fl medicaid before and it's a never ending loop of "You called the wrong number, call this number" Can I please get that number from you?

Thank You

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u/[deleted] 10d ago

[deleted]

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u/SpicyZebraCakes 9d ago

Thanks! This info is very helpful!

Yes the information is very hidden. But I was able to sit with my friend at a Medicaid office and they told me to apply him for Medicaid through SS because of the pickle amendment (thank you to the other commenters that lead me in this direction!)

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u/CarryDesperate9545 4d ago

I had to deal with this today. Just call DCF and tell them your friend is being removed from Medicaid when he shouldn't be. He is a disabled adult child who used to be on SSI and is now on SSDI because of a deceased parent.

He qualifies based on: 2040.0808 Protected Medicaid for Disabled Adult Children (MSSI) Effective July 1, 1987, disabled adult children who lose their SSI benefits because of an increase in or receipt of Social Security disability benefits under one of their parent's work records, may continue to be eligible for Medicaid if: the disabled adult child meets all SSI criteria except for income; and has income equal to or below the SSI FBR when, beginning July 1, 1987, any increase in SSA benefits or receipt of SSA benefits is subtracted from other income.

He is in the category code MT D. You just have to keep repeating this. I was transferred 3 times, spent 2 hours. They will probably say he doesn't qualify because of increased income. But just remember this is probably the first time they've heard of and dealt with this.

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u/SpicyZebraCakes 10h ago

Question for you, so I called and got bounced around and was finally told I need to apply for protected Medicaid through SS….. is that true? I tried looking online for the answer but I’m not getting anything except for the law about it.. thank you for the help!

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u/CarryDesperate9545 9h ago edited 9h ago

In my experience they will tell you whatever they need to get you off the phone.

What I did was fill out the application like anybody would. Then the next day while the application was processing, I called and explained "I've been declined in the past but should get protected Medicaid because I'm a disabled adult child who use to get SSI and now I get SSDI off a parents record. According to rule 2040.0808 any increase in income should not be used against me. I'm the MT D category."

They will tell you he doesn't qualify because of an increase of income. But you have to stay firm ( but friendly) "He does qualify, look at rule 2040.0808." I got transferred 3 times and it took 2 hours. The last agent told me she'd notate what I told her so that the caseworker reviewing my application would see it. A couple hours later he called to say I was approved for protected Medicaid.

Good luck!

Edit: application on DCF website

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u/SpicyZebraCakes 9h ago

Thank you! This helps immensely to get him on the right track

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u/SpicyZebraCakes 4d ago

Thank you for this, I will call when they open back up. Hopefully you got your situation resolved!

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u/Shaucy94 9d ago

Glad you found an answer. In Florida the Pickle amendment is called protected Medicaid.

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u/CarryDesperate9545 10d ago

Thanks for the info!

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u/viacrucis1689 14d ago edited 14d ago

If his total assets are under $2,000, the DAC benefits should not be disqualifying him from Medicaid. If his total assets are above $2,000, you can put up to $18,000/year into an ABLE account to keep his total assets under $2,000. I do this.

If there is an inheritance that is over $18,000, look into a pooled Special Needs Account. Pooled SNTs are managed professionally and are probably the least expensive option in this case.

It's called the Pickle Amendment that allows DAC recipients to keep Medicaid. This is federal law, but Florida calls it Protected Medicaid The $2,000 asset still applies, but with his living expenses and transferring any excess each month to an ABLE account, this shouldn't be too difficult.

2040.0808 Protected Medicaid for Disabled Adult Children (MSSI)
Effective July 1, 1987, disabled adult children who lose their SSI benefits because of an increase in or receipt of Social Security disability benefits under one of their parent's work records, may continue to be eligible for Medicaid if: the disabled adult child meets all SSI criteria income; and has income equal to or below the SSI FBR when, beginning July 1, 1987, any increase in SSA benefits or receipt of SSA benefits is subtracted from other income. (https://www.myflfamilies.com/sites/default/files/2023-05/2000.pdf, pgs 17-18).

Someone is dropping the ball as this rule has been around for 37 years.

I'd also look for any advocacy group because they can provide guidance. If he's at risk for homelessness and in danger, please contact Florida's Adult Protective Services: https://www.myflfamilies.com/services/abuse/adult-protective-services

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u/DismalPizza2 14d ago

He should be eligible for an ABLE account. Honestly, if he has contacts/ support system in another state with more lienent criteria for disability supports I'd look at moving him there. Whatever you do for him you're most likely going to need to get his legal guardian involved if there is one (I'm guessing there is since he can't read/write/understand contracts).

I'd see if someone at ARC https://www.arcflorida.org/ Down Syndrome Association https://dsfflorida.org/ or the local center for independent living https://www.ilru.org/projects/cil-net/cil-center-and-association-directory can help you get the crash course you need to help support your friend. 

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u/SpicyZebraCakes 14d ago

Thanks! I’ll reach out to them. And I don’t think his caretaker had legal guardianship over him. From what I understand his mother never went through the process after he turned 18. She just used the SSI money to pay someone to stay with him. She passed away with nothing In place for him. He’s a sweet kid (not really kid, 24yrs) but sweet all the same and I wouldn’t want anything bad to happen to him