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Indykatie

(3,697 posts)
Sat Oct 5, 2013, 12:49 AM Oct 2013

Low Income Single Childless Folks Qualify For Medicaid in All States Now Under ACA

Single childless DU members who are low income should check into Medicaid coverage now that the ACA provides this benefit. Even though many States (Red ones) did not expand the income limits many single folks will qualify at the lower FPL in place in these Red States. For a single person the 100% of FPL income is $11,490 and at 133% of FPL it rises to $15,000 or so. I saw a thread earlier tonight with a DU member relaying his experience is shopping for a plan on the Exchange in SC and finding fairly high premiums since his income was not high enough to qualify for a subsidy. The problem is that he should should not be looking to purchase a plan on the Exchange but rather signing up under Medicaid at no cost.

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Low Income Single Childless Folks Qualify For Medicaid in All States Now Under ACA (Original Post) Indykatie Oct 2013 OP
That's not correct. winter is coming Oct 2013 #1
My Childless Grand Daughter Enrolled in Indiana Indykatie Oct 2013 #3
If you'll read the footnote in the table for Indiana under "single adults", winter is coming Oct 2013 #6
Damn. Red states are harsh! Barack_America Oct 2013 #4
Interesting that red states congressers deny their constituants ACA in state and want to deny all uppityperson Oct 2013 #13
Also in PA, according to that chart. No medicaid expansion, single adults NOT eligible. (nt) enough Oct 2013 #15
how can that be right? TorchTheWitch Oct 2013 #2
People need to be aware that Medicaid is very, very limited flamingdem Oct 2013 #5
That's not true. It's not "the very most basic coverage for emergencies." pnwmom Oct 2013 #10
Thanks but this doesn't change the fact flamingdem Oct 2013 #16
It's not that way in Oregon. I know people on our Oregon Health Plan and they see Bluenorthwest Oct 2013 #28
For people over 55, it is not insurance but a loan duffyduff Oct 2013 #21
That's true for nursing home care. This is different. pnwmom Oct 2013 #29
Not true. Ms. Toad Oct 2013 #12
Not if the state didn't expand, they don't. xmas74 Oct 2013 #7
Medicaid isn't no cost. It has premiums just like regular insurance, kestrel91316 Oct 2013 #8
Only some states have premiums -- for some recipients. pnwmom Oct 2013 #11
From what I can tell, the costs (premiums and copays and deductible) are identical to the kestrel91316 Oct 2013 #17
That's not what the info at the link says. pnwmom Oct 2013 #18
CA appears to charge for Medicaid like it's private insurance. I'm appalled. kestrel91316 Oct 2013 #19
Each state has its own eligibility requirements for Medicaid Emit Oct 2013 #9
Not true, in Missouri, you have to be declared disabled, and even then... Humanist_Activist Oct 2013 #14
Message auto-removed Name removed Oct 2013 #20
No. bunnies Oct 2013 #23
Correct. If you're 55 and over and are eligible, your estate can be recovered for repayment. duffyduff Oct 2013 #24
Yeah. I just found out about that little tidbit the other day. bunnies Oct 2013 #25
This is pure bullshit. bunnies Oct 2013 #22
Medicaid was always supposed to cover marginal workers Warpy Oct 2013 #26
I think this is incorrect and misleading information quinnox Oct 2013 #27

winter is coming

(11,785 posts)
1. That's not correct.
Sat Oct 5, 2013, 12:54 AM
Oct 2013

Here's the table of what the eligibility limits will be as of January 1, 2014 in each state.

http://medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Downloads/Medicaid-and-CHIP-Eligibility-Levels-Table.pdf

Looking at the next-to-last and last columns on the far right of the table, it appears that Wisconsin is the only state not expanding Medicaid where low-income single adults (not on disability) would be eligible for Medicaid.

Using those numbers, the DUer from South Carolina wouldn't be eligible for Medicaid even if he were a parent.

Indykatie

(3,697 posts)
3. My Childless Grand Daughter Enrolled in Indiana
Sat Oct 5, 2013, 01:05 AM
Oct 2013

Indiana is one of the Red States that did not expand income eligibility but you can get Medicaid coverage now if you are childless unlike before. The Indiana Exchange system directed her to the Medicaid online enrollment after she keyed in her income.

winter is coming

(11,785 posts)
6. If you'll read the footnote in the table for Indiana under "single adults",
Sat Oct 5, 2013, 01:09 AM
Oct 2013

it says

The state has a section 1115 demonstration or a pending demonstration proposal that provides Medicaid coverage to some low-income adults. The demonstration includes limitations on eligibility and/or benefits, is not offered to all residents of the state, and/or includes an enrollment cap.


I hope she will qualify for Medicaid under those special conditions, but it's not a universal thing.

uppityperson

(115,681 posts)
13. Interesting that red states congressers deny their constituants ACA in state and want to deny all
Sat Oct 5, 2013, 03:46 AM
Oct 2013

of us via this shutdown blackmail thing. They deny their state by not expanding medicaid, or is that by the governor? Musing here. And yet the voters voted for them, enough to get into office. Wonder how many regrets there are.

TorchTheWitch

(11,065 posts)
2. how can that be right?
Sat Oct 5, 2013, 01:02 AM
Oct 2013

States run their own Medicaid how they see fit. If certain states aren't expanding Medicaid due to ACA then there is no money to provide for all these people single or otherwise.

flamingdem

(39,328 posts)
5. People need to be aware that Medicaid is very, very limited
Sat Oct 5, 2013, 01:05 AM
Oct 2013

For instance I know someone who needs to see an eye doctor. The choice is to go to the emergency room or wait 6 months to 1 year to see a doctor via referral.

It's the very most basic coverage for emergencies though I think for women it covers more for childbirth and gynecological.

pnwmom

(108,995 posts)
10. That's not true. It's not "the very most basic coverage for emergencies."
Sat Oct 5, 2013, 02:12 AM
Oct 2013

It's actually more comprehensive than Medicare.

http://www.webmd.com/health-insurance/medicaid-health-care-people-low-incomes


How Much Do Medicaid Programs Cost?

The cost of a Medicaid program depends on the state. Some programs require you to make a small co-payment for medical services in addition to what Medicaid pays.

What Does Medicaid Cover?

In general, Medicaid programs offer more comprehensive medical coverage than Medicare. They usually include hospital stays, visits to doctors, tests, some home medical care, and more. Again, the specifics vary from state to state.

flamingdem

(39,328 posts)
16. Thanks but this doesn't change the fact
Sat Oct 5, 2013, 09:35 AM
Oct 2013

that in some states, in this case California, it's not possible to get a visit to a specialist in a reasonable period of time. This program I'm referring to is a transitional program to Medicaid, known as Medical in CA. Maybe they have more restrictions.

 

Bluenorthwest

(45,319 posts)
28. It's not that way in Oregon. I know people on our Oregon Health Plan and they see
Sat Oct 5, 2013, 04:02 PM
Oct 2013

specialists as needed with not much fuss or muss. And no cost. Medical IS Medicaid, just as the Oregon Health Plan is Medicaid. Not 'transitional to Medicaid, it is Medicaid.
It's pretty much as good as my own insurance only they don't pay for anything and I pay for everything!

 

duffyduff

(3,251 posts)
21. For people over 55, it is not insurance but a loan
Sat Oct 5, 2013, 02:59 PM
Oct 2013

You MUST sign a statement that in effect your estate is collateral for the government to "recover" all payments made on Medicaid at the time of your death. This includes any monthly premiums paid by the government, even if you never use Medicaid.

It is called "estate recovery." Many poor people have assets, such as a house, that the government can seize when they die or their widowed spouses die.

I don't know the deal with people under 55 is who are not currently under the categories for current Medicaid eligibility, and what repayment they are subjected to, if any.

What you don't understand is that few doctors will see patients on Medicaid, so it is not "all that."

pnwmom

(108,995 posts)
29. That's true for nursing home care. This is different.
Sat Oct 5, 2013, 04:18 PM
Oct 2013

It used to be Medicaid was only for single parents and their children, but not single, childless adults; and very poor elderly people. The Medicaid expansion will allow low-income people to receive standard Medicaid benefits even if they have no minor children. And the income maximum to qualify for Medicaid is being raised substantially.

Unlike Medicare, Medicaid also pays for long term nursing care, so some Medicare recipients in the past would give their homes and other assets to their children in order to qualify for Medicaid. The purpose of the documents you mention is to prevent middle class or even upper middle class people from divesting their assets to their children, in order to have their nursing home bills covered by Medicaid. It allows people who have too much equity in a home for Medicaid to receive Medicaid anyway -- as long as their estate paid back the cost at the person's death. This is a benefit to the person because if their health improves, they still have a home to return to. The repayment won't be till after their death.

Ms. Toad

(34,092 posts)
12. Not true.
Sat Oct 5, 2013, 02:21 AM
Oct 2013

My daughter was on Medicaid from age 0 to 5. It was comprehensive coverage from the first penny, without any additional wait time because the "insurer" was Medicaid rather than a commercial carrier. (And partway through that period, they forced everyone from traditional Medicaid into a plan provided by a commercial insurance company (with the premium paid by the state). There was no difference in coverage - except for the normal insurance type limits.)

xmas74

(29,676 posts)
7. Not if the state didn't expand, they don't.
Sat Oct 5, 2013, 01:16 AM
Oct 2013

Missouri did not expand. There is no Medicaid for adults unless you are poor, blind or pregnant. A family of 2 in Missouri cannot make more than $250 a month to qualify, an amount that hasn't changed since the early 90's.

 

kestrel91316

(51,666 posts)
8. Medicaid isn't no cost. It has premiums just like regular insurance,
Sat Oct 5, 2013, 01:23 AM
Oct 2013

and they stick you in an HMO. I looked into that today here in CA. Same HMOs as the exchange plans. You don't really get any details, either, just the names of the companies involved.

pnwmom

(108,995 posts)
11. Only some states have premiums -- for some recipients.
Sat Oct 5, 2013, 02:14 AM
Oct 2013
http://www.nolo.com/legal-encyclopedia/medicare-medicaid-whats-difference-29615.html

Costs to Consumer: In some states, Medicaid charges consumers small amounts for certain services.


http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Cost-Sharing/Cost-Sharing.html

States have the option to charge premiums and to establish out of pocket spending (cost sharing) requirements for Medicaid enrollees. Out of pocket costs may include copayments, coinsurance, deductibles, and other similar charges. Maximum out of pocket costs are limited, but states can impose higher charges for targeted groups of somewhat higher income people. Certain vulnerable groups, such as children and pregnant women, are exempt from most out of pocket costs and copayments and coinsurance cannot be charged for certain services.

Premiums

States can charge limited premiums and enrollment fees on the following groups of Medicaid enrollees:

Pregnant women and infants with family income at or above 150% FPL ($22,065 for a family of 2 in 2011)
Qualified disabled and working individuals with income above 150% FPL ($16, 334 for an individual in 2011)
Disabled working individuals eligible under the Ticket to Work and Work Incentives Improvement Act of 1999 (TWWIIA)
Disabled children eligible under the Family Opportunity Act (FOA)
Medically needy individuals
States have the option to impose higher, alternative premiums on other groups of enrollees, if their family incomes exceed 150% of the federal poverty level. Certain groups, such as institutionalized individuals and most children, are excluded from higher cost sharing.


 

kestrel91316

(51,666 posts)
17. From what I can tell, the costs (premiums and copays and deductible) are identical to the
Sat Oct 5, 2013, 01:02 PM
Oct 2013

subsidized plans. I wonder how the poor are going to cope.

Oh, no I don't. They'll all be lined up at the ER and the local community health center by the hundreds as usual. Sigh.

pnwmom

(108,995 posts)
18. That's not what the info at the link says.
Sat Oct 5, 2013, 01:13 PM
Oct 2013

Some states don't charge any premiums or other costs at all.

Emit

(11,213 posts)
9. Each state has its own eligibility requirements for Medicaid
Sat Oct 5, 2013, 01:56 AM
Oct 2013

I believe the best thing for each individual to do is talk with a representative from ACA, their Health Insurance Marketplace or at their local Medicaid office. I work in the social services field and while we often give guidance on available benefits and services, we use caution in making assumptions of eligibility for various programs because each program has their own 'hoops' that individuals must jump through to become eligible. For programs such as housing assistance, food stamps and Medicaid, it has been my experience that it is best left to the individual to actually go through the application process to know for sure if they are eligible.

That being said, here are a couple of .gov links that discuss Medicaid eligibility, but I caution readers to examine their own state's Medicaid websites and apply in person:

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Eligibility.html

https://www.healthcare.gov/do-i-qualify-for-medicaid/

 

Humanist_Activist

(7,670 posts)
14. Not true, in Missouri, you have to be declared disabled, and even then...
Sat Oct 5, 2013, 04:35 AM
Oct 2013

if you have an income that's too high, you have to "spend down" to the level of someone who would otherwise qualify for medicaid, so, for example, you make 1100 a month in disability(SSI), but medicaid has an absolute income limit of 800 dollars, well, you have to pay them 300 dollars, every month, before it kicks in for that month.

Response to Indykatie (Original post)

 

bunnies

(15,859 posts)
23. No.
Sat Oct 5, 2013, 03:22 PM
Oct 2013

In many states Medicaid is only for the blind, pregnant, or permanently disabled. Poor, childless adults dont get anything.

Welcome to DU.

 

duffyduff

(3,251 posts)
24. Correct. If you're 55 and over and are eligible, your estate can be recovered for repayment.
Sat Oct 5, 2013, 03:32 PM
Oct 2013

Not really a good deal.

I am weighing options here because I think my income could change from being Medicaid-eligible to not being.

I don't want to sign over whatever estate I may have to pay the government.

 

bunnies

(15,859 posts)
25. Yeah. I just found out about that little tidbit the other day.
Sat Oct 5, 2013, 03:39 PM
Oct 2013

It completely blew me away. Why cant states just HELP people who need it without all these damn strings attached?

 

bunnies

(15,859 posts)
22. This is pure bullshit.
Sat Oct 5, 2013, 03:21 PM
Oct 2013

If the state does not expand Medicaid, none of the rules change. Believe me, Im in one of them. I know first hand.

Warpy

(111,352 posts)
26. Medicaid was always supposed to cover marginal workers
Sat Oct 5, 2013, 03:45 PM
Oct 2013

Mean and stingy Republicans blocked any change in the eligibility requirements that remained the same dollar amount set in the 1960s and was never indexed to inflation.

The only people who qualified were people already on AFDC/TANF and destitute elderly people in nursing homes.

 

quinnox

(20,600 posts)
27. I think this is incorrect and misleading information
Sat Oct 5, 2013, 03:50 PM
Oct 2013

I did a search when you first posted this in a different thread, and found the facts don't back the OP up.



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