Pennies shy of cutoff, Gardiner appeals denial of Medicare payment
It’s more than a financial consideration – $104.90 a month – that Elmer Gardiner is fighting for. It’s a matter of principle and it is also, says Gardiner, a matter of saving Rhode Island taxpayers hundreds of thousands of dollars, if not millions, annually.
On Dec. 13, Gardiner took the battle to the Superior Court. As he doesn’t have the money to hire an attorney, nor apparently has he been able to find representation, he filed the one-page hand-written document himself.
He is appealing the Nov. 19 ruling by the state’s Department of Human Services denying him Part B Medicare premium payment of $104.90 on the basis that he fails to meet the monthly income eligibility of no more than $1,292.63. According to the state’s calculation, Gardiner’s “countable income” is $1,293.
Gardiner sees it differently.
He starts with the $1,313 cutoff set by Medicare and submits that his gross income is $1,312.90 or 10 cents below the threshold at which he would be ineligible to receive the payment. His suit calls for the state to pay the Part B premium.
Gardiner, 79, ran his own insurance agency until he retired at the age of 62 and went on partial Social Security, which is his source of income. He lives in Cowesett at the home of his ex-wife. He does not own a car and, because of disability, relies on a friend to drive him to where he needs to go.
That quite frequently is to the State House or the Public Utilities Commission (PUC) where Gardiner often joins the ranks from the George Wiley Center.
“It’s an organization that stands up for the financially challenged,” he said of the center.
Most recently, Gardiner has been battling for the expansion of the moratorium on the shutoff of utilities for non-payment for families with children not yet in kindergarten. The current provision known as the “Henry Shelton Act,” which is named for Henry Shelton of the Wiley Center, that exempts families with children less than 3 years old from shutoffs.
“You don’t grow a winter coat when you’re 3 years old,” Gardiner says.
Gardiner also takes offense to PUC efforts to revise provisions of the law. The commission has looked at reducing the period for the moratorium. If expanding the moratorium to older children would require legislative approval, as he has been told, then, he argues, it should also require legislative approval to reduce the time.
While Gardiner said not having to pay the Part B premium “would make life a little more pleasant,” he maintains state payment could save taxpayers thousands in medical expenses. Citing his own case, Gardiner said his recent admission to Kent Hospital cost $22,000. The bill was paid under Part B, since Gardiner has the coverage and pays the premium. However, if he had not had the coverage, the state would have been faced with the bill. Multiply his situation by others not covered with Part B and Gardiner reasons it could be in the millions.
In his complaint, Gardiner notes that the federal government pays 52 percent of Part B premium with the state picking up the 48 percent. Based on the fact that the federal government is paying more than half, he says the state should recognize the federal threshold of $1,313.
In calculating Gardiner’s eligibility, the state took his monthly income of $1,312.90 and deducted a $20 “disregard” to arrive at $1,292.90. The state’s income policy is 135 percent of the Federal Poverty Level, or $1,292.63, which is less than what Gardiner gets.
Gardiner presented his argument to the appeals office for the Department of Human Services on Sept. 12. In his ruling of Nov. 19, hearing officer Michael Gorman says he “does not have the authority to change the income limit amounts used by the agency in determining eligibility for the Medicare Premium Payment Program” and therefore denies Gardiner’s request for relief.
Gardiner said he was denied representation from Rhode Island Legal Services at his appeal hearing. He said he was told they didn’t think they could win his case.
But that doesn’t bother him.
“Maybe I’ll sing in court,” he suggested.
“Yes, I’ve sung in more than 60 musicals,” Gardiner answered. “‘Guys and Dolls’ has got to be one of the best. I played Nicely Nicely.”
Unlike Nicely, however, Gardiner likes rocking the boat.