Going from ACA Medicaid to “Regular” Medicaid Can Be a High Wire Act Without Legal Assistance

New Jersey has a lot of roads to eligibility for Medicaid, and that’s a good thing.  All of those roads are called NJ FamilyCare, and that’s a confusing thing.

Medicaid in New Jersey is provided by five Managed Care Organizations (MCO) now through NJ FamilyCare.  You must choose one to get services, including long-term services and supports (LTSS), which will be coordinated by the MCO care manager.

If you began to receive Medicaid/NJ FamilyCare benefits because you were income- eligible and without other creditable health coverage (in other words, you receive Medicaid through the Obamacare Medicaid expansion), you could lose your Medicaid coverage if you have a change in your modified adjusted gross income (MAGI) or you obtain other coverage (like Medicare). Unless you are eligible for Medicaid through another pathway (called Aged, Blind or Disabled, or ABD) you will lose services.

For example, if a person with limited income and no insurance had an unexpected illness and spent time in the hospital, it is likely that the hospital got the person on Medicaid through Obamacare, enrolled the person in an MCO, treated that person, and then discharged that person to a rehabilitation facility, where long-term care would also be covered.  However, if there is a later increase in income which would allow that person to purchase subsidized insurance, Medicaid will be discontinued and there will no longer be a payor for the nursing facility or other long-term care setting.  Hence, the need to scramble for ABD, which can co-exist with other insurance coverage.

Planning for ABD Medicaid could include:  spending down resources, establishing a Qualified Income Trust for income, establishing a Special Needs Trust for assets, or other planning that could involve a spouse or disabled or minor child.  In the case of a special needs trust, this type of planning must be done before your 65th birthday.

New Jersey’s Medicaid expansion benefit package does include, via federal waiver, MLTSS–so you must always think about how your eligibility category might change and how to maintain the benefits you currently have.  It can be a very difficult process, but we can help–call us at 732-382-6070.

Get help with your paperwork when you struggle with illness

I recently had the occasion to make a house call to meet with a client who had stopped working about 4 years ago in his early 50’s. He became gravely, permanently  ill and eventually needed to apply for Social Security Disability benefits, which were approved. He had to endure the two-year wait until he could receive Medicare. As he got caught up in the throes of his illness, with repeated hospitalizations and ongoing difficult treatments, there were things that he overlooked that could have been very beneficial. However he was usually so ill that he couldn’t see his way clear to realize what needed to be done.

For instance, it turned out that he could have applied to receive his pension early once he was approved for disability by the Social Security Administration. Since the pension can’t start paying until the application is made, several years of benefits were lost. Also, once the Affordable Care Act went online in 2013, perhaps he could have gotten himself some health insurance through an Exchange while he waited for his Medicare to begin. It was all just tragic.

The start of a period of debilitating illness is the time to make sure you have someone lined up as your power of attorney and paper-work helper, who can start investigating what you may be eligible for, make sure your bills are paid ontime, and help you get everything prepared and filed on time. Phone a friend – create a lifeline.

Call for advice on disability benefits & estate planning …



Affordable Care Act (Obamacare) Coverage – Automatic Renewal Available

More than 5.4 million people enrolled in health insurance plans through the federally subsidized health insurance exchanges that were established by the Affordable Care Act (ACA), and 86% of them were eligible for subsidies, according to the NY Times on June 27th. The Department of Health and Human Services has issued regulations that enable most ACA enrollees to have their policies automatically renewed without a need to reapply. If there has been a material change in income or the person wants their premium and subsidy to be recalculated, they would need to re-apply through www.healthcare.gov.

The next open enrollment period begins November 15th, and anyone who isn’t presently insured should certainly make plans to enroll in either an ACA insurance plan or the expanded Medicaid plan if their state is participating. This is especially useful if you are awaiting a decision on your Social Security Disability claim or have been approved  but cannot yet receive Medicare benefits (because there is a 2-year waiting period from the start date of your disability benefit). ACA Subsidies are based on the Modified Adjusted Gross Income (MAGI) reported on the most recent federal income tax return, and are available if household income is up to 4x the poverty level — i.e., if your income is up to $45,960 in 2014 you may qualify for a subsidy to keep your premiums affordable. The Times reports that “The Congressional Budget Office estimates that subsidies this year will average $4,400 for each person who receives a subsidy.”  http://www.nytimes.com/2014/06/27/us/most-will-be-able-to-automatically-renew-coverage-under-health-law.html?_r=0 This may amount to 50% of the cost of the insurance, depending on where you live.

In keeping with my recent comments about the need to continue treatment or health care monitoring to maintain documentation of your ongoing disabling conditions, it is critically important to do whatever you can to maintain some kind of health insurance coverage.

For representation on Social Security Disability Appeals, contact us at 732-382-6070

Lauren Marinaro Will Talk Obamacare at the Y on October 23rd

I will be at the YMCA of Scotch Plains at 12 pm and 7 pm on October 23rd to discuss the Affordable Care Act and answer questions about the Medicaid expansion, access to health insurance subsidies and the ins and outs of the health insurance mandate.  At noon we will also be talking about Obamacare’s impact on Medicare.  Come one come all!!

Affordable Care Act – Important Dates and Deadlines

By now you know that you can start shopping for affordable health insurance at www.healthcare.gov, where you will learn about the insurance policies available on the New Jersey exchange as well as whether you qualify for government subsidies to offset the cost of insurance, and if you qualify for the Medicaid expansion. Considering the catastrophic cost of even one uninsured trip to an emergency room for medical treatment, getting insurance now through the exchange or through the Medicaid expansion should be a real lifesaver for your family. Whether you are employed without insurance, or receiving unemployment or Disability Income benefits, such as Social Security Disability — or your case is pending — get started with this enrollment process and find a plan that works for you.

1.       We are in a six-month open enrollment period that began October 1, 2013 and runs to March 31, 2014, to get insurance that will start in 2014.

2.        If you want to have coverage effective Jan. 1st, 2014, be sure to enroll and pay your first premium by Dec. 15, 2013. If you do so after Dec. 15,  your start date for coverage will be delayed by as much as 6 weeks.

3.         Most people who don’t have insurance coverage by Jan. 1, 2014 will face a tax penalty of $95 for individual adults or 1 percent of their income, whichever is higher.

4.         After Mar. 31, 2014, you can only enroll in the exchange’s insurance if you have a “qualifying life event,” such as losing your job, having a child, or getting divorced.

5.          Each year there is another 6-month opportunity to enroll, from October 15 to March 31, but if you haven’t enrolled by December 7th, there will be tax penalties that go up each year as of the upcoming Jan. 1.

6.          The tax penalties will be $325 for individual adults or 2 percent of income, whichever is higher, if you’re not enrolled by Jan. 1, 2015. They will be $695 or 2.5 percent of income, whichever is higher, if you’re not enrolled by Jan. 1, 2016.

Source/more:   http://www.cnbc.com/id/101065523