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Will Any Be Affected: SSI/Medicaid Injury ClaimerHusband/SSDI/MCare/Caid/WifeOF

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CassieJo

Junior Member
I'm asking for my husband...

This will be a bit dicey but I hope I'm able to explain this properly, so I beg for your forgiveness in advanced (esp b/c I have SLE/Sjogren's/Fibro/Osteo & SLE/Sjogren's/Fibro are horrible w/regards to brain fog - I lose train of thought easily. It's super-annoying b/c I've worked as a researcher most of my life, incl'g working w/domestic spouse & custody attys & criminal attys as part of the research & transcription team, along w/working as a certified medical transcriptionist for many years. With brain fog, it's as if that life never existed)

Okay. My husband was in a vehicle accident where he was hit & hurt. We filed for SSDI for him long before this happened but after all the appeals and battles were fought, despite specialists stating he was disabled & they refused to release him to return to work b/c doing so would jeopardize his health to the point where it would have killed him. The judge in the case swore he'd never get disability even tho the judge's own advisers agreed w/the doctors that he was permanently & completely disabled, he was denied to the bitter end & we can't fight anymore for SSDI b/c his time ran out. After these years of fighting, he was only eligible for SSI (the supplemental security income, NOT SSDI like I receive). In addition, he's eligible for Medicaid.

Because he had to be hospitalized and required extensive surgery to put his shoulder back together, he fought for the settlement from the driver who hit him. He went out on a sunny, warm day with little traffic. His motorcycle isn't a heavy bike or tricked out. Regardless of the shape his heart is in, his knees have taken such a hit from the work he did for more than 20yrs that he couldn't ride a heavy or tricked-out motorcycle no matter how much he'd drool to do so. He didn't cause the accident. In fact, the driver came out of nowhere & was drunk on top of everything else. The ONLY reason he pushed for a settlement was to make sure Medicaid recovered the hospital and doctor's bills. (when he explained this to the attorney handling his case, even the attorney said he was shocked to someone say this up front & openly and that he admired him for why he pushed for the settlement - The last thing on my husband's mind was settlement beyond repaying Medicaid). We didn't know until recently that there may be personal injury settlement above & beyond what Medicaid should receive to pay them back for the medical bills. In fact, he's only recently learned that there might be injury settlement payment to him.

In addition to this, as his wife, I'm on SSDI & have been for some 23-25yrs because of blindness. The issues with Lupus, Sjogren's, Fibro, & Osteoarthritis came some 10yrs later. After he wasn't able to work, I went on Medicaid to pick up what Medicare doesn't cover & to get prescription coverage b/c quite honestly, my prescription medicines cost are extensive. In addition, I'm not sure I'd be able to make the mortgage & cover living expenses w/o Medicaid picking up the premiums and what Medicare don't cover for my own health problems.

We cannot afford to lose his Medicaid either because he is a type I diabetic, heart patient, & a post quad-bypass patient with extensive heart damage that contributes a great deal to circulatory problems that are a nightmare for a type I diabetic. It takes just 1 infection, 1 blood clot, 1 mild heart attack & I'll be left a widow. If he misses 1 insulin injection, I'd be left a widow. There are no life insurance policies to lean on, and nothing to pay off the last several years remaining on the mortgage. I've paid on the mortgage principle for many years but not enough to pay it off yet. I don't want us to lose the house. Our kids grew up here & someday I hope to have grandchildren by our 1 daughter who might give his grandkids, tho the oldest daughter may adopt but she doesn't want kids & her husband can't any.

Is there way out so we don't put his Medicaid in danger or SSI in danger? He receives SSI and I receive a spousal SSI in much the same way as a wife would rec' Social Security Retirement Income if we were both over 65 and I drew more by drawing off his SSR than what I paid in over the years. Again, the whole reason he had the attorney push for the settlement is b/c he didn't want taxpayers to have to pay for the medical care he had to receive because a drunk driver got on the road and hit him, resulting in extensive medical bills we were unable to pay out-of-pocket. The cost of rebuilding his shoulder alone was extensive. The joint was shattered, rotator cuff ripped in half, bones broken, muscle, tendon, nerve damage that had to be put back together. He needed extensive bone and skin grafts too along with physical therapy. Even with all this, he's only got back about 40% use of his arm; what makes this worst still is that it's his right shoulder/elbow/hand and he's right-hand dominant. He has no strength in the arm & can't raise his arm more than 20% - 30% and that's being generous.

This case has dragged on for sometime. And he had already lost his shot at SSDI. Now, he has heart damage to add to type I diabetes and now the loss of reasonable use of his entire right arm incl'g trouble writing & his writing was crap before the accident, which should qualify him as a doctor but he studied engineering & underground telecommunications rather than medicine. (if it wasn't for humor, we'd been dead a long time ago)

At this point in time, we have no clue what he may receive. In the beginning, we didn't expect to receive ANY settlement that included monetary payout to him that didn't go to Medicaid. He's even said now that he'd rather just endorse the check to Medicaid and let them have it rather than lose Medicaid because it's the only thing that is keeping him alive. It's expensive and dangerous to be an insulin-dependent juvenile diabetic who has lived to the age of 55. It's sad that we live in a time when pre-existing conditions where missing 1 dose or 1 injection is a matter of life & death and death will come without some form of healthcare. It's not like I haven't tried to find health insurance either. You know it's bad when a healthcare salesman calls & once you mention a pre-existing condition they hang up rather than go through their sales pitch b/c they know there's no policy available to you. I've asked for years when they'd call and every single time I brought up, they hung up rather than go thru their sales spiel.

Will there be any fall-out for SSI/Spousal SSI and/or Medicaid (his being full-Medicaid & as the wife who won't receive settlement but am married to the person who will, with Medicaid picking up what Medicare doesn't cover)? Is there anything that can be done? I'd love to pay down more on the house payment's principle or use it to replace the central unit/gas pack b/c the air conditioning is broken & has been for 3yrs now b/c we can't afford to have it repaired and/or replaced.

The other issue is will it hurt our daughter who still lives at home but is a student on campus in campus housing as a 3rd-year, Dean's List, undergrad who will be losing her access to Medicaid in January & the college requires health coverage & she needs it to cover medication & counseling for anxiety disorder w/panic attacks, which she sadly inherited from me. Keeping her grades so high is the only reason she is eligible for so many grants. This kid graduated w/high honors & a member of the National High School Honor Society & as a member in good standing w/National Middle School Honor Society. After she had the last of her ropes, sash, and pins on her graduation gown from high school, I told her she would either choke herself or fall-down forward with all the extras she had to wear with her gown thru the commencement ceremony. We were so proud of her. The last thing we want to happen is for her to lose out for grants after the many years she has worked so diligently and did so without sniping about it. She's never complained once.

So there it is. And yes, my husband is truly THAT altruistic. He'd give someone the shirt off his back if they needed even if he didn't have one to replace it with. I know he'd do this in a heartbeat & I'd never try to stop him.

Forgive me for including so much but there are a lot of moving pieces for us. And, the last thing we want is to lose access to healthcare. SSI isn't as important as keeping Medicaid. Any settlement would help tremendously for us; hwr, my husband's 1st and most important reason for filing was to see the Medicaid recovered what was paid through tax dollars, to put him back together again for an accident he didn't cause and couldn't avoid.

FWIW, this wreck spooked him. He still has nightmares of this wreck playing over and over in his head. I seriously doubt he will ever get back on one again even for short hops around town. This one spooked him to the point where he's wary even driving his mother's car. And there's the issue with his right arm being so debilitated. The chronic & debilitating pain has hit & he's having a tough time dealing with this new level of disability. He's a tinkerer. It appeals to his meticulous nature & tinkering on a motorcycle was his thing. It was mine too before I lost my sight & we shared. I never wanted him to lose this, but he has.

Thank you in advance to anybody who takes on this question. I apologize in advance; it's tough making it through the Lupenese & Fibronese as a friend on the support group for autoimmune diseases calls our lost ability to form & filter sentences. Know that I appreciate any assistance that can be offered. My husband says he doesn't want Medicaid to lose out, and while any extra settlement is welcome, he doesn't want to lose Medicaid & he doesn't want to end up in Leavenworth Prison either. :)

What is the name of your state (only U.S. law)? NC/USA
 


commentator

Senior Member
No one is going to give you some hidden way you can keep your Medicaid and other needs based public assistance if you actually wind up getting a settlement, no matter how deserving you may be.

All we can say is that regardless of his motivations and your needs, you will need to report EXACTLY what you receive in this settlement to your Medicaid and SSI caseworkers (they'll find out all about it anyway.) And let them shake it out in regard to your on-going eligibility for assistance. Your house is toast if they choose to take it whether you'd prefer to leave it to your daughters or what. Commit fraud and they surely will. It's only right.
 
Last edited by a moderator:

Janke

Member
There really isn't something called "Spousal SSI" but there is a couple computation and since you are two disabled people whose combined income is under the couple limit, you both qualify for SSI as disabled individual and a disabled spouse. If you were not disabled, you would not get SSI. If you were single, your SSDI would put you over the SSI limit for a single person.

The month the settlement is received, both you and he will be overpaid on SSI. No matter what. So put aside one month of SSI to be repaid.

For SSI, the countable amount of resources needs to be under the $3000 limit before the first of each month in order to qualify the next month. Paying off a mortgage or making home repair is a perfectly acceptable method of spending the money. It may be difficult to accomplish that before the first of the next month so there could be an overpayment for the month following receipt as well.

Medicaid has its own rules. Usually if SSI is suspended, Medicaid continues for an additional month or two.

Your daughter is a smart girl and she will figure out how to pay for and finish college if for some reason her aid is affected by this settlement. And even though she is your child, at this point, I think securing your own future and that of your husband is the most important. She is young and strong. She can bounce back. Neither of you are any more.

Be above board with SSI. Report it all. Take notes on what you are told. Ask multiple times if you are confused.
 

CassieJo

Junior Member
Janke:
Thank you so much for the information. It helps. We don't know if he'll get anything or how much; hwr, the attorney says that b/c it was such an extensive wreck, my husband being permanently disabled by it, and the fact the driver was drunk, the insurance may very well offer a settlement for injury to make this case go away, if you know what I mean. The fact there'd be an option for not being penalized for paying down the mortgage will ease his mind and take some of the stress off. Our greatest fear is losing Medicaid b/c we are both on medications that mean the difference between life & death. And, we want to be around for when 1 of our 2 daughters decide to have grandbabies. Lol! Our oldest daughter doesn't want children, but she hasn't ruled out possibly adopting at some point but right now she's still enjoying her marriage, which is nice. Our youngest isn't even dating. Her head is in the books, which is a great thing & we are not complaining. She's right much younger than the older two so we tend to worry more about her b/c I was older when we had her. (Genetic testing, higher risk for birth defects & spina bifida is part of my biological family history... and both pregnancies were high-risk. The oldest child is actually a baby brother I raised).

This helps so much. We were just hit with this recently. That's why there was such a scramble to find out more.

Thank you again. And, Happy Holidays.
 

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