I'm putting this here because the State of Texas is f*#king with our lives.

[malokvale77]

I arrived home from work today to find my brother (legally blind) in a panic. He had received a phone call from his glaucoma specialist saying they could not keep him as a patient because they were no longer reimbursed under his new health plan. His last test and treatment was denied by Medicare.

After many phone calls (and waiting, waiting) I found out that, midyear the State of Texas, without prior authorization had switched my brother off of Medicare Original to a funky privatized Medicare+Medicaid program that didn't cover his disability or the specialist needed for his glaucoma (the only thing saving what limited sight he has).

It took me a few hours, but I got him back on his Original Medicare. I was told to watch for this sneaky shit daily throughout the year.

I understand that the state has the right to run their own Medicaid program (a mistake in my book), But what the hell right do they have to change his Medicare preference?

I hate what's going on in this state.

[Downwinder]

1. Everything I have seen says as long as you

pay your premium you can't be kicked out of Medicare part D. But somehow the State can do it and I spent three months without medication.

[malokvale77]

3. It is more than that.

The State of Texas switched him from Medicare Original A and B (his choice) to a privatized HMO that doesn't cover his disability or glaucoma specialist.

The program covered the medication but not the Doctor that prescribed it. The prescription has to be renewed every three months after exam and testing.

[Downwinder]

49. I went to the Medicare Inspector General

to get mine straightened out. Texas HHS was worthless.

[jkbRN]

2. Glad you got it sorted out!

[malokvale77]

7. I managed to, but...

Last edited Tue Oct 6, 2015, 09:49 PM - Edit history (1)

what happens to others who can't read or comprehend the notices that are sent out (after the fact)?

He received a 600 page manual that he could neither read (he's visually impaired) nor comprehend (he's neurologically impaired). He simply tossed them aside thinking everything would go along normally.

I am suppose to be his advocate, but I knew nothing about the Texas shenanigans in this matter.

[The_Casual_Observer]

4. The real mistake is that is that you live in Texas.

[malokvale77]

8. Yes that is the real mistake.

My parents dragged me here (from Minnesota) when I was 12. I've never had the means to get out.

My children and grandchildren are here. They are my only fallback when things get tough.

What would you have me do?

[Faux pas]

5. Sheesh

That's hideous!

[malokvale77]

10. Hideous indeed.

All this is slipped in under the radar. Nobody knows about it until they are individually hit with it. We are told that it is a one time mistake so most never question the policy and politics behind it.

I was lucky to get a Medicare rep to let me know that Texas could and would assign Medicare benefits to anywhere they see fit if we are not vigilant.

[C Moon]

6. Sleazy!

[malokvale77]

12. It is sleazy...

right inline with the rest of Texas politics and the whole US congress that allows this shit to happen.

[perdita9]

9. I am outraged on your behalf

[malokvale77]

13. Thank you...

but you should be outraged on "all" our behalf.

We are all being stolen from and screwed everyday.

[SoapBox]

11. Horrible!

And virtually criminal.

I absolutely agree with how hard stuff like this is on seniors and those that are vision impaired.

My beloved Mom had macular...she was blind in her right eye and had only a small amount of vision in her left. If not for her injections every few months, she would have been completely blind.

She lived with us for 5 years and often told people she would have been dead if I wasn't watching her meds, appointments and her Medicare plan.

After dealing with "everything" I had to, I find it Crime Against Americans how our seniors are treated...they need HUGE advocacy to help them.

I wish you so much luck.

[malokvale77]

14. Thank you Soapbox.

Our seniors (of which I'm one) and our disabled (of which my brother is one) need advocacy that is not available to them.

Thank you Republicans and Third Way Democrats.

[slumcamper]

15. It's a conspiracy.

A similar privatization scheme--of Medicaid in this instance--is due to take effect in Iowa in 2016. Clearly, you are well aware of the inconvenience and anger it fosters.

I'd venture to guess that this privatization scheme is an ALEC maneuver designed to manufacture and cultivate outrage over the general state of health care. GOP operatives will then deceptively spin this as a consequence of the Affordable Care Act and "big government," further deluding low-information citizens and shoring up their radical base. As public outrage is channeled toward the so-called "tax and spend" big gubmint" "librals," the wealthiest private investors in the health insurance sector will reap millions, laugh all the way to the bank, and channel healthy sums into the coffers of teapublicans and others who could care less about the public health and welfare and whose prime motivation is self-enrichment or retaining office. This is their playbook.

Sadly, if recent history proves correct, Democrats will be left speechless and devoid of strategy as they are pilloried by an onslaught of well-orchestrated conservative talking points. This is our playbook.

This shit is becoming SO tiresome.

[malokvale77]

17. Well said.

Tiresome it is.

I've grown weary of the Democratic Party's willingness to help the majority of citizens.

I'm getting old and not going to be around much longer. I hope to see a turn around before I die.

[slumcamper]

20. I'm getting old too. And so damned tired!

It seems like the D Party in its formal sense is one or two steps behind the GOP when it comes to messaging. That may be giving them too much credit, but I swear, if the organized parties were Kirby vacuum salespeople we'd starve and they'd grow fat. We can't sell jack-squat these days!

That said, my wife and I actually bought a Kirby nearly 25 years ago and it is still going strong. I was a student and we were working multiple, low-paying jobs, but we took the bait and paid nearly $1500 for a goddamned vacuum cleaner--AND WE DIDN'T EVEN WN A HOUSE! Fortunately that momentary lapse of reason turned out fairly well, but thankfully I'm far less gullible in matters political. Perhaps that episode was and experiential component of a broader political socialization.

Anyway, I'm feeling the BERN. I just found out he'll be here in Johnson County (ground zero of the Democratic base in Iowa) on the afternoon of Oct. 18th. HRC is sending a surrogate--Jennifer Granholm--and this is not a very prudent strategy relative to the epicenter of Democratic activism in a caucus state.

Hang in there malokvale! Hang tough.

[malokvale77]

32. I intend to hang in until I am dead.

I'm stubborn so that could be awhile.

Your story reminds me of a fire alarm scam that me and my spouse fell for (1971). Thankfully we came to our senses in time to get out of the contract. I left the mounting holes over all the doorways for years to remind me.

I will hang tough, right their with you slumcamper.

[slumcamper]

33. Backatcha!

And speaking of scams, I fell hook line and sinker for a chain letter during college. Fortunately I sold my four and broke even...but my brother in law bought one and was stuck holding the bag.

Christ...what we do to try to survive. Seems like it's been a struggle for longer than I'd realized.

Give 'em hell in Texas. I'll work on Iowa.

[malokvale77]

35. I intend to give them hell here in Texas.

Many here don't like me because of it.

Keep on keeping on slumcamper. We will do what we have to do.

to you.

[fasttense]

50. Capitalism tends to breed scam artists

Aside from the obvious advantage of crime paying handsomely. In a capatalist economy crime provides an advantage over your competitors. Just ask VW. But aside from that, capatalism creates a very desperate poor population that will grasp at most anything in order to survive. They become the prey for desperate criminals.This creates even more criminals and con men. It's a viscous cycle.

[appalachiablue]

31. +10

[SheilaT]

16. I don't understand how anyone can be

moved of Medicare.

So glad you were able to fix this, but you might want to contact your Representative, if that person is at all decent. In any case, you might want to talk to your local newspaper, because this is the sort of thing that needs articles written about it.

[tomm2thumbs]

19. yes, good idea

They hate the light of day, but it will also open up the light on others who may not know this has happened to them, and won't find out until they need some medical procedure

Go public for sure if possible....

[malokvale77]

21. My Representative has never cared to...

represent anybody but himself. He has written many times "I appreciate your input, but I think".

Jeb Hensarling is only interested in Jeb Hensarling.

I was gerrymandered (Dallas residence into a far east Texas district).

My local newspaper (The Dallas Morning News) is a RW rag that has little to offer in the way of news. The editorial section is handpicked (90% - 10%) to agree with their philosophy.

So now what?

[SheilaT]

41. Your State rep or State Senator?

Although they probably won't be very likely to help.

I take it Dallas has only one newspaper?

Maybe go straight to the Governor's office. I know, another person not very interested, but write real letters to everyone. Keep photocopies. At least you can have made the effort, rather than letting this slide by. Oh, and do write a letter to the editor, as well as contact whichever news desk (local? health coverage?) seems appropriate. If you have any sense of any reporters who might actually be slightly interested in this sort of thing, contact them directly.

I've taken up paying attention to the by-lines in my local paper, The Santa Fe New Mexican, and I know which reporters I'd be inclined to contact over different things. But my state is different, I know.

I think the most important thing is to be willing to scream bloody murder about this to as many people as possible. And make sure the Medicare people know. Maybe this is happening enough (I'm thinking someone here within the past week or so reported something similar in some other state, but forget the details) that it could be a national story.

[malokvale77]

46. Oh wow...

A Governor who thought it was okay to steal child support when he was AG!

Abbott is worse than Perry who was worse than W.

I've been screaming bloody murder for years. No one seems to care.

[SheilaT]

55. Any chance a local TV station

has some sort of consumer support group, the Five on Your Side sort of thing?

[No Vested Interest]

44. A city the size of Dallas likely has one or more alternative newspapers, often a weekly

and often distributed free in delis, bookstores, etc.
They are usually more liberal politically and may welcome the info you can provide.

[DhhD]

54. I think that every recipient of Medicare and Social Security has a Case Review every seven years.

Last edited Fri Oct 9, 2015, 09:29 PM - Edit history (1)

You or you advocate have to do the review. There is a huge file of paperwork at the Social Security HHS office, so they will not do the review but make you do it by having a meeting, using a letter, or acknowledging the documents from the state workforce commission, and much more. The recipient of the benefits will gather the information for the review to present to Medicare and/or Social Security.

Yes, you have to do the Review work, for them or they will just cut you off. And I believe that if you are getting, lets say expensive shots for your eye, then the state (legislature) wants to terminate their Medicaid part in order to let you heel! Sounds like an ALEC decision, to be accepted now, instead of making a law, it is a, Promising Practice, used in state agencies in all kinds of, Health and Human, care.

[SheilaT]

56. Huh?

every recipient of Medicare and Social Security has a Case Review every seven years.

I NEVER heard of that before. Ever. Maybe they review those on Medicare before age 65, or on SS before age 62, but those things are called entitlements for a reason. My mother was on both for about 17 years, and I was never aware of her being reviewed for either. My younger brother, now 66, retired on disability from blindness at age 50, and I have never known of his having a Case Review either.

What makes you think this happens?

[Dustlawyer]

18. Thanks for the heads up, I have an elderly mother who lives with me and a brother and sister,

both totally disabled and on Medicaid.

[malokvale77]

23. You are welcome.

Pay attention to every communication they get. Read them carefully.

My brother never showed me any of those mailings because he thought his choices had already been set.

The State of Texas is involved in a privatization scam that we should all be aware of.

Privatization does nothing more than take our tax dollars. It gives us nothing in return.

[Dustlawyer]

24. Mom and sister are still sharp, we all look out for my little brother! Helps to know what to look

for though!

[SheilaT]

42. I can't imagine the state itself can privatize Medicare.

Did he have an Advantage program before through some provider? They might not be happy about people being switched away from them, because surely they are making money on their side.

[malokvale77]

43. No!

He had Medicare Original, Medicaid, and a PDP.

They can not privatize Medicare. But they damned sure stuck him in an Advantage HMO plan that didn't include his specialist. They did this midyear after he had already decided to stay with Medicare Original.

Spin this any way you choose. The State of Texas is trying to screw my blind brother from his Federal benefits.

[SheilaT]

57. What's a PDP?

Is he over 65?

I know Advantage Plans vary widely, depending on where you live, but you may want to see if you can enroll him in one that includes his specialist.

[malokvale77]

58. Prescription Drug Program.

He's 47. His specialist will only accept Traditional (I was calling it Original) Medicare.

Sorry for not answering sooner.

[SheilaT]

59. Thank you.

Sometimes I just can't quite figure out these things.

[madfloridian]

22. Time for...

another or maybe 2

[malokvale77]

26. I love the hugs.

We must fight this on every level.

I saw the dumbing down in education many decades ago. Texas was the test ground.

I saw the stolen elections (no questions allowed). Texas was the test bed.

I saw a yellowdog (no doubt) democratic state turn into a cesspool of RW nuttery almost overnight.

and more .

[Ilsa]

25. Please write a letter to your state rep and state senator.

It needs to be on the record what the bastards in Austin are doing to people with disabilities while they line the pockets of golddigging corporations and their flunkies.

[malokvale77]

28. What makes you think any of that would help?

We have been gerrymandered out of every decent rep we ever had.

[Ilsa]

29. It probably won't help. But at least

They'll need to reply to your letter, althiugh it may be so filled with lies that it may spontaneously combust.

[malokvale77]

39. Yup...

No reply ever came from my rep that ever acknowledged my concerns, much less put forth a policy to address them.

[Blus4u]

53. All well intentioned suggestions....

....people seem to forget we are the state whose gifts to the national scene include Ted Cruz and Louie Gohmert.
I am approaching Medicare age and will be vigilant due to you post.

Thank you

Peace

[No Vested Interest]

45. Perhaps it would help to notify Wendy Davis what is going on.

I guess she's out of public office now, but she shows up on TV every so often, and it can't hurt to let her know this is going on.
She may also be able to point you in the right direction who to notify that's still in public office.

Also, the Democratic minority leaders in the Texas House and Senate.

[malokvale77]

47. Wendy Davis...

was informed on many issues when she ran for Governor. She didn't care then and she is now a shill for Hillary Clinton.

[Squaredeal]

27. Hey, he lives in Texas...

...what did you expect? Decency?

[malokvale77]

30. Decency?

No, not something I ever expected from Texas.

I did, however, expect his Medicare choice to be sacrosanct.

[passiveporcupine]

34. Privatization

The real death panels.

[malokvale77]

36. Yup.

I just can't find the legislation that allows any state to override ones "Medicare" choice.

If somebody would post that I would at least know where to begin my bitching.

[passiveporcupine]

38. Did your brother throw away the documents,

or might they still be tucked away somewhere?

Maybe they explained it in the info that was sent to him. Check with your congressman...maybe they can inform you of the legislation that was passed to allow this so you can look it up.

[malokvale77]

40. We have all documents received.

There is no info stating how Texas can override a Medicare choice.

That became obvious when I called 1 800 MEDICARE.

Texas is very busy pushing our tax dollars into private (favored) enterprises.

I will, however write Jeb Hensarling and ask him about the legislation that allowed this.

I suggest everyone from all states to look into this. If Texas can do this, all states can do this.

[malokvale77]

37. Bump...

because I'm looking for some answers.

Where are you Gothmog and thinkingabout?

I know what Bernie Sanders would like to do.

What would Hillary do to fix this atrocity?

[Enthusiast]

48. Kicked and recommended to the Max!

This is awful!

[Gothmog]

51. The State of Texas and the Texas Republicans like to screw poor people

The above story does not surprise me. It is tough living in Texas sometimes.

[DhhD]

52. Revenge against those that are the most helpless.

Texas was scheduled to have most federal Medicaid grants removed this year, federal HHS response was, move to ACA Expanded Medicaid. Also, groups handling Medicaid like CIGNA are selling out to other carriers. Lines of communication between Medicare and Medicaid are going to be loose. Old information like old phone numbers, to set up the continuing care, will cause delays.

Is the State issuing new Medicaid cards with the new phone numbers of contact? Oh Texas, still taking advantage of those that cannot pull themselves up by their bootstraps.