Author Topic: NJ FamilyCare - how do I make sure I follow all the rules and stay eligible?  (Read 341 times)

tenant13

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I (55) stopped working in May after making around 50k this year. Due to losing a job (it was a gig with an end date) I enrolled in an ACA plan but then almost right away had to leave the country for 4 months to take care of my mother in Europe. So I cancelled ACA and bought travel insurance for that period - ACA wouldn't cover me in Europe anyway. When I came back it turned out that I'm unable to re-enroll because I cancelled the coverage voluntarily. So I'd have to wait until open enrollment. The exchange specialist told me however that since my monthly income (interest + dividends) is less than $1463 I would qualify for Medicaid which is called NJ FamilyCare here. Sure enough I did qualify (waiting for my Horizon card and paperwork). So that's the back story.

Questions about the future. I have no plans of going back to work so I'll live off my savings. That's not income - and they don't care about assets, the application did not ask about that. But I'm not quite sure what qualifies as income when it comes to Medicaid, specifically stocks and bonds. Their application lists interest and dividends as "examples" of income. I reported those and they asked for recent brokerage and bank statements. I supplied those. But what happens if I decide to sell stock? Is that income (I mean the "realized gain")? What about traditional IRA to ROTH conversion? It's taxed as regular income on 1040 but is it income for Medicaid purposes? What about tax return if it exceeds 1500? I don't expect any random gifts or inheritance but I really would like to see some kind of checklist that would allow me to stay compliant and report everything correctly.

Secondly, how do I report those possible infusions of cash? Selling stock or converting tIRA to ROTH are one time events that would take me over the limit in the month they occur but the following month I'm eligible again? So do they wait with kicking me off until they decide that extra income was temporary or it happens automatically, my coverage runs out at which points I report low income again? I read on another forum that you only get kicked off if your monthly income exceeds the monthly limit two calendar months in a row. That would make sense but who knows...
I keep hearing that paying out of pocket for medical services while being on Medicaid is illegal. But only 39% of doctors in NJ accept it. What if I want to go to one that doesn't? What if I want to do something that Medicaid doesn't cover? Specifically Invisalign. That's not something than any Medicaid related dental plan covers.

As to the ethics of being on Medicaid: I did not choose to be on it. I simply followed the rules and that's where I ended up. I'm not sure that I want to stay on Medicaid but I'm also not sure that I want to manipulate my income upwards just to get on an ACA plan. As of right now I have no immediate plans to sell any stock or do ROTH conversion so my income for next year is expected to be below ACA qualifying threshold.

CrustyBadger

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Tenant, do you have children or heirs?

One thing about Medicaid is that if you use it to pay for your health care, the state can come after your assets after you die for repayment.

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If I enroll in the new expanded NJ FamilyCare program, when I die and try to leave something to my kids, can the government put a lien on my assets to repay the benefits I received? (Estate Recovery)

In the case of an NJ FamilyCare beneficiary who became deceased on or after April 1, 1995 for whom payments for services were made on or after October 1, 1993, a lien may be filed against and recovery sought from the estate of the deceased recipient for assistance correctly paid or to be paid on his or her behalf for all services received when he or she was 55 years of age or older. There are some exceptions. For more information see:


tenant13

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I do know that Medicaid is basically a loan. Fine in my case. No children, significant others or heirs (that could change obviously but it's highly hypothetical - I'd rather deal with situation at hand). I don't even have a will or designated beneficiaries assigned to my accounts. In other words: they can totally go after my assets after I'm dead - I don't care.