Author Topic: Reader Case Study - Frustrated with Medicaid Registration in Ohio  (Read 1383 times)

Zacharias

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Hello Mustachians,

This past year my family began our journey to FI by making habits of lower consumption and saving in traditional IRAs. We also decided to expand our family and have a baby (just born on Feb. 28). When open enrollment came around, we found out that our new habits lowered our MAGI to a level that we qualified for Medicaid and our application was shipped off to Ohio Medicaid on 12/28/15. We did not realize that at the time this would automatically terminate our current health plan.

When we logged in to our account pay my wife's premiums in February, we saw that her account was suspended which set off a flurry of phone calls that sent us back and forth between the marketplace, Ohio Medicaid, and our county's Jobs and Family Service department. After looking into to it a little more, we calmed down and understood that she should have presumptive eligibility being pregnant.

However, there seems to be a disconnect between MAGI eligibility and the numbers Ohio Medicaid and our County are looking at. Our 2015 MAGI was $27,107 for a family of 2 (with 1 being pregnant). Expected MAGI for 2016 is even lower as we plan to add an additional $5,500 to our IRA's this year and income will remain roughly the same.

The problem is that the Ohio Medicaid and County Jobs & Family reps that I've dealt with will not accept the MAGI numbers. They insist on using income alone to compute the numbers and have denied my wife eligibility stating we are $18 over the monthly limit.

Does anyone have experience with Ohio Medicaid? How can we proceed from here? Thanks!

Life Situation: Married filing Jointly, 1 Dependent - born Feb. 28, 2016.

Gross Salary/Wages: $36,839

Pre-tax deductions: $9,732

Adjusted Gross Income: $27,107

Taxes: Federal $643, state $278, and local $87.

Updated with some case study numbers.
« Last Edit: March 07, 2016, 02:02:37 PM by Zacharias »

Bucksandreds

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Re: Frustrated with Medicaid Registration in Ohio
« Reply #1 on: March 07, 2016, 01:03:43 PM »
Hello Mustachians,

This past year my family began our journey to FI by making habits of lower consumption and saving in traditional IRAs. We also decided to expand our family and have a baby (just born on Feb. 28). When open enrollment came around, we found out that our new habits lowered our MAGI to a level that we qualified for Medicaid and our application was shipped off to Ohio Medicaid on 12/28/15. We did not realize that at the time this would automatically terminate our current health plan.

When we logged in to our account pay my wife's premiums in February, we saw that her account was suspended which set off a flurry of phone calls that sent us back and forth between the marketplace, Ohio Medicaid, and our county's Jobs and Family Service department. After looking into to it a little more, we calmed down and understood that she should have presumptive eligibility being pregnant.

However, there seems to be a disconnect between MAGI eligibility and the numbers Ohio Medicaid and our County are looking at. Our 2015 MAGI was $27,107 for a family of 2 (with 1 being pregnant). Expected MAGI for 2016 is even lower as we plan to add an additional $5,500 to our IRA's this year and income will remain roughly the same.

The problem is that the Ohio Medicaid and County Jobs & Family reps that I've dealt with will not accept the MAGI numbers. They insist on using income alone to compute the numbers and have denied my wife eligibility stating we are $18 over the monthly limit.

Does anyone have experience with Ohio Medicaid? How can we proceed from here? Thanks!

I'm pretty liberal but I'm glad they used income. Medicaid is not a system made to help those who want to save large amounts of money for retirement.  It should be means and wealth tested. At the same time, I would pursue whatever is in my best interests as well.

Zacharias

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Re: Frustrated with Medicaid Registration in Ohio
« Reply #2 on: March 07, 2016, 01:14:05 PM »

I'm pretty liberal but I'm glad they used income. Medicaid is not a system made to help those who want to save large amounts of money for retirement.  It should be means and wealth tested. At the same time, I would pursue whatever is in my best interests as well.

I agree completely with you. It wasn't an intentional move to get on Medicaid and came as a surprise to us. We were ready to go status quo with our deductible ready to pay on our old insurance. However, our current situation is that the insurance ended in January and the baby was born Feb. 28th. While we were ready to pay the insurance deductible, we're not really in a position to pay out-of-pocket for the birth of our daughter.

Thanks for chiming in anyway.

DebtFreeBy25

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Re: Frustrated with Medicaid Registration in Ohio
« Reply #3 on: March 07, 2016, 01:17:18 PM »
Have you tried calling the Medicaid Consumer Hotline? Their number is (800) 324-8680. The state recommends either calling the hotline or contacting your county's JFS office with questions.

You are correct. Federal guidelines now require states to utilize MAGI when calculating Medicaid eligibility. Did you apply directly through Ohio Benefits or submit an application through your county JFS? If it's the later, you may want to resubmit an application yourself to ensure your income is being reported correctly.

Zacharias

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Re: Frustrated with Medicaid Registration in Ohio
« Reply #4 on: March 07, 2016, 04:02:21 PM »
Have you tried calling the Medicaid Consumer Hotline? Their number is (800) 324-8680. The state recommends either calling the hotline or contacting your county's JFS office with questions.

You are correct. Federal guidelines now require states to utilize MAGI when calculating Medicaid eligibility. Did you apply directly through Ohio Benefits or submit an application through your county JFS? If it's the later, you may want to resubmit an application yourself to ensure your income is being reported correctly.

Thank you for the response. We may have called the hotline at some point in the back and forth of it all, but with a clearer picture of what applies I'll give them another ring this evening.

Our application was sent from the marketplace eligibility center automatically. I'm not sure if that goes to Ohio Benefits or JFS.

DebtFreeBy25

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Re: Frustrated with Medicaid Registration in Ohio
« Reply #5 on: March 07, 2016, 04:54:11 PM »
Have you tried calling the Medicaid Consumer Hotline? Their number is (800) 324-8680. The state recommends either calling the hotline or contacting your county's JFS office with questions.

You are correct. Federal guidelines now require states to utilize MAGI when calculating Medicaid eligibility. Did you apply directly through Ohio Benefits or submit an application through your county JFS? If it's the later, you may want to resubmit an application yourself to ensure your income is being reported correctly.

Thank you for the response. We may have called the hotline at some point in the back and forth of it all, but with a clearer picture of what applies I'll give them another ring this evening.

Our application was sent from the marketplace eligibility center automatically. I'm not sure if that goes to Ohio Benefits or JFS.

Hmm. Sounds like the marketplace sent your data directly to the state, which is neither of the above. If you need to reapply, submit your own application through benefits.ohio.gov.

Your experience with losing marketplace eligibility when you qualified for Medicaid is also standard. If an individual or family qualifies for Medicaid, they automatically lose eligibility for marketplace subsidies. There are only three options for someone who is qualified for Medicaid: insurance through Medicaid, insurance through an employer (if offered) or purchasing coverage independently without a subsidy. Almost everyone in this situation chooses coverage through Medicaid for cost reasons.

Source: I'm a fellow Ohioan who has worked in public service and am knowledgeable about the ACA.

teen persuasion

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Re: Reader Case Study - Frustrated with Medicaid Registration in Ohio
« Reply #6 on: March 07, 2016, 08:41:11 PM »
I don't know how much help my experiences will be to you, but here goes. 

In 2014 DH  left his job, and thus our insurance thru his employer.  He expected  to get a new job quickly, but a hiring freeze slowed things down.  We applied thru our state website (NY), and were told we have to go on Medicaid, with the kids on CHIPS.  I learned that while the federal side uses AGI, the state looks at monthly income.  Since at that moment DH was earning zero, and I work part-time, we were eligible for Medicaid per the state, despite knowing that our annual AGI would be higher.

Things were always massively messed up.  They insisted DS4 was in their system already (incorrect) and that held things up.  They issued cards for 2 of the 3 kids at home, none for the rest of us.  I never figured out how to add our college age son (gray area - not our tax dependent, so can't add thru marketplace, but by ACA eligible to be on our plan if under 25 years old).  When we finally got employer coverage, I tried to notify the state thru the website, as directed, but it locked up on the info.  I called them for assistance, and everything the assistant told me to do refused to cooperate on my side.  She eventually reset data from her side and said we were good.  I asked about the tax forms, and was told they'd automatically be sent.  We never received anything.  DS2 had a small fine for the few months he had no coverage.  We are all just lucky we didn't need to make any medical claims during that period.

The important things that learned were: the differences in viewpoint (monthly vs annual income), you must apply at least a month in advance (if you are approved before the 15th of the month, coverage may begin the 1st of the next month; if later, then coverage begins a month later; the quality of phone assistance varies greatly, so keep trying until you get a great one.  Oh, and the NY website is, or at least was, so problematic as to be unusable.  If I ever have to do it again, I will go thru a Navigator.