Medicaid Eligibility Is Based On Current Monthly Income

Just in case, you missed it,  Medicaid Eligibility Is Based On Current Monthly Income. Still do not understand? Let me try a different way to explain it, Medicaid Eligibility Is Based On Current Monthly Income.

There, I have said it three times –  once in the title and twice in the beginning text of this post. And yet people will not apply because it is something others do or they are easily discouraged or the information is hidden. If you are laid off and have no income, you could qualify for Medicaid regardless if you are collecting unemployment or received the extra $600 (not counted in calculation) or made good money beforehand. For Medicaid, you or you and your family still must be below 138% FPL in Expansion states or 100% FPL in non-Expansion states.

In an Urban Institute base scenario estimate of 20 percent unemployment; ~ 25 million people will lose ESI coverage. Of the 25 million; 12 million could gain Medicaid coverage, 6 million could gain ACA Marketplace coverage or other private coverage, and 7 million could become uninsured. What is important to understand is if you lose your current monthly income, you could qualify for Medicaid in a Medicaid expansion and non expansion states.

Some detail:

By visiting the home page of any ACA exchange, you will find the exchanges were conceived as a market place for private plans. This creates an impression it is what everyone wants, will seek, and easily find. The sites are hiding another product that two thirds of “customers” could and should end up “buying (almost free)” called Medicaid. Those who fill out an application will be routed to Medicaid if eligible and if they accurately report current monthly income and not annual income. Due to misdirection, many visitors to the exchanges may never get to the Medicaid area. Other than lack of emphasis on Medicaid, or failure to post the eligibility criteria, ACA Healthcare exchange messaging and structure can cause people to miss their Medicaid eligibility in at least two ways.

The extra $600/week in unemployment benefits provided by the CARES Act causes some to include that extra income in their income estimate. For ACA Healthcare marketplace coverage this is correct; however, for Medicaid  –  the Cares Act extra $600 does not count in qualifying for Medicaid coverage. The Maryland exchange has a page that does a nice job explaining how to handle this on the actual application:  add the $600 to the annual income estimate (ACA) , but not to the monthly income estimate (Medicaid). You have to get to this page first and decide if applying is worthwhile. The screening tool, unlike the application, does not ask for monthly as well as annual income and it may mislead. This is a problem.

The second problem is information about Special Enrollment Periods (SEPs) are relevant to the ACA marketplace coverage but not Medicaid. You have a specified 60 day period of time in which to enroll for ACA coverage after losing your job (not Medicaid). The message “Uninsured Marylanders (example) can enroll for ACA coverage by June 15” does not specify the ACA marketplace and excludes Medicaid (as it should).  Medicaid enrollment is available year-round.

States need to emphasize Medicaid enrollment more as many who are unemployed due to Covid would qualify. Make sure you visit xpostfactoid blog as Andrew expands on this topic. Also rather than going to the ACA healthcare sites, one could go to the state Medicaid sites directly and enroll.

What is Not Found on ACA Exchanges, xpostfactoid, June 14, 2020

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