Help - Medicaid and SSI rapayment for preemie babies

[acr33]

What is the name of your state? NY

All- my premature babies were approved for SSI and Medicaid when they were born in the NICU. They were in the NICU for 130 days and the other one for 180 days.

The twin that was for 130 days was discharged without further needs. The other twin that was for 180 days was discharged with a feeding tube and low flow oxygen. She also had chronic lung disease. With this in mind we needed to get nurse care for watching over the weaker twin.

We did not remember that we needed to file with SSI and Medicaid to let them know that both twins were discharged from the NICU. We also had Medicaid cover for the nurse care of one of the twins which was 24 hours care.

My wife went today to SSI and they said that we should have notify them of the discharge from the NICU and that both were not eligible since the NICU so we need to refund them for any payment since the discharge. They are going to notify Medicaid and we are supposed to receive a letter in the mail where Medicaid will notify us that we are no longer eligible.

My concern now is around potential refunds. SSI will be close to $1,000 while Medicaid could be up to $630,000 (or more). Is Medicaid going to request a refund also? Given the conditions of my twin where she was high risk with chronic long disease and feeding tubes do we also need to refund them or is there a way around this issue?Should we get legal counsel and who in NYC could help with this type of legal guidance?

Thank you so much for your help and guidance on this.

 

[quincy]

Does the weaker twin still require nursing care?

 

[acr33]

We could do it without nursing which would be a big burden. She has developmental issues and also has bronquiomulnary displasia (chronic lung desease) which could put her in the emergency room with something as simple as a cold. We are up all night every night with as simple as a cough in case she chokes.

 

[quincy]

We could do it without nursing which would be a big burden. She has developmental issues and also has bronquiomulnary displasia (chronic lung desease) which could put her in the emergency room with something as simple as a cold. We are up all night every night with as simple as a cough in case she chokes.

Before seeking out legal assistance, I suggest you speak with your pediatrician about your twin's home health care needs. Your pediatrician can be an important advocate should you find yourself having to pay back services already received.

Should payments be required, you perhaps can look to charitable organizations and GoFundMe for help.

Here is a link to information from the American Academy of Pediatricians on paying for your child's home health care:
https://www.healthychildren.org/English/family-life/health-management/health-insurance/Pages/Paying-for-Your-Childs-Home-Health-Care.aspx

The first two years of a premature baby's life are the most difficult, for both the baby and the parents, but some babies can overcome their early health problems. I hope that is true for your tiny baby. I am happy to hear your other twin is doing well.

Good luck.