Being Denied Medicaid or CHIP
Being denied Medicaid or CHIP may grant you access to a special enrollment period, an exemption, or catastrophic coverage depending upon your situation and your state. Here is what you need to know:
- If you applied for Medicaid or CHIP and got a rejection letter, then you may qualify for a special enrollment period.
- You can’t simply wait until you need coverage outside of open enrollment and then apply knowing you will be rejected.
- A rejection from Medicaid or CHIP may also qualify you for an exemption from the fee for not having coverage.
- A denial from Medicaid or CHIP may also qualify you for catastrophic coverage.
- Rejection can be due to income because the Marketplace sent you to Medicaid and you got rejected, because your state didn’t expand Medicaid and you applied during open enrollment, because Medicaid sent you to the Marketplace, or for other reasons.
- In most cases, your rejection letter is sent to the Marketplace, but you’ll want to make sure you have a copy for proof, in case you need when applying at HealthCare.Gov or if you are filing for an exemption from the IRS.
- There are most certainly situations where applying for Medicaid and CHIP nets you nothing more than a rejection letter. For instance, if your income is too high, your state expanded, and you enroll outside of open enrollment.
Complex Situations Due to Rejection From Medicaid
There are many complex situations regarding Medicaid rejections special Enrollment, exemptions, and catastrophic coverage and they are subject to change. We don’t have a list of every situation, but our basic advice will help point you in the right direction.
- First and foremost, apply to HealthCare.Gov during open enrollment if you can. If HealthCare.Gov sends you to Medicaid and you are rejected you have more flexibility than you do if you are rejected on your own.
- If your state didn’t expand Medicaid, you’ll have fewer Medicaid options, but will be more likely to qualify for an exemption or catastrophic coverage based on rejection.
- Medicaid and CHIP can be enrolled in at any time of the year based on income. If you reasonably think you or a family member would qualify it makes sense to apply (even outside of open enrollment).
If you have further questions, please feel free to ask specific questions in the comments below.
Why Does Being Rejected For Medicaid or CHIP Qualify People for Special Enrollment?
The goal of the Affordable Care Act is to make sure people who want coverage can afford it. Those who tried to get affordable coverage from Medicaid or CHIP, but experienced a denial, get an extra opportunity to get private coverage.
This is in part because many state’s rejected Medicaid expansion so it was easy for people to be confused about their Medicaid options. Also, this is due in part to the fact that Medicaid and CHIP are offered 365 days a year.
In many cases, a person could apply for Medicaid or CHIP before the deadline, but not be officially rejected before open enrollment ended.
These rules help make sure people in these scenarios get a fair shake but also gives some Americans who missed the deadline an additional opportunity to get coverage.
Apply for Medicaid or CHIP today and make sure to see if you can get a special enrollment in the Marketplace if you have been denied.
Author: Thomas DeMichele
Thomas DeMichele is the head writer and founder of ObamaCareFacts.com, FactsOnMedicare.com, and other websites. He has been in the health insurance and healthcare information field since 2012. ObamaCareFacts.com is a...
Thomas DeMichele's Full Bio
Mike
In Dec 2019, I got laid off and I declined Cobra insurance and didn’t do anything during open enrollment periods. Now there is a special enrollment period due to covid19 emergency. and I’m still unemployed, uninsured. I don’t have any qualifying event (marriage or baby etc).
Hypothetically, if there wasn’t the special enrollment in Feb-May 2021, I can go to medicaid (I don’t qualify) and get a rejection letter. Can I then get enrolled into an ACA compliant medical plan by showing the rejection letter? (assuming if there was no special enrollment period due to covid now.)
I’m quite confused whether the medicaid application needs to be during open enrollment in order to trigger an enrollment period for someone.
ObamaCareFacts.comThe Author
In 36 states served by Marketplaces that use the HealthCare.gov special enrollment due to COVID-19 is open to everyone, and most other states adopted this policy. You most likely qualify regardless of your circumstances (although income-based rules and such still apply for cost assistance).
https://obamacarefacts.com/2021-special-enrollment-due-to-covid-19/
Lyn
What does one do when ones Medicaid is terminated because they don’t plan to live in a state forever? I think some things are ridiculous, especially if one is on SSI and has been since childhood, as I don’t really know anyone who plans to live in their current state indefinitely maybe 1-2 people. This person has resided in the state over a year and was a prior resident for a decade. Any advice would be great, it stinks of discrimination but mostly due to the individual and ongoing battle with DHS regarding other benefits as they were not awarding SNAP using proper deductions either… Just seems odd.
ObamaCareFacts.comThe Author
That makes no sense to me, had no idea it was a rule. That said, I feel to see how anyone can for sure know the future? How could you know if you will live in your state in the future or not? You may want to revise your answer to reflect that reality unless you know for absolute certain you will be moving soon.
Myong Guinnip
I’d personally also like to say that most of those that find themselves without the need of health insurance can be students, self-employed and those that are not working. More than half of the uninsured are really under the age of Thirty-five. They do not experience they are needing health insurance as they are young and healthy. Their particular income is frequently spent on homes, food, in addition to entertainment. Some people that do represent the working class either 100 or not professional are not provided insurance by way of their jobs so they get along without due to rising valuation on health insurance in the United States. Thanks for the suggestions you discuss through this website.
Dani
If a man is on Medicare is his unborn child covered thru pregnancy??
ObamaCareFacts.comThe Author
Pregnancy is covered through Medicare, so is postnatal, but once the child is born they will need a different insurance type. At this point you have to figure out if private coverage, Medicaid/CHIP, or another option is the right option for the child.
Learn more here: https://www.aarp.org/health/medicare-insurance/info-05-2009/ask_ms_medicare_question_57_.html#:~:targetText=Does%20Medicare%20cover%20pregnancy%20and,them%20do%20indeed%20become%20pregnant.
kamille Bruns
I was canceled on Medicaid and just found out when I went to pick up prescriptions. I never received a rejection letter in the mail and my children are still on it. I was doing fine up until I started receiving child support which put me over my annual income. But that alone wasn’t the only reason. I live with my boyfriend so we cut expenses down the middle, water power etc. I also pay my personal stuff like my phone, car insurance etc. I am solely responsible for my two children and their expenses as well. My boyfriend does the same and he has children he is responsible for. So neither one of us can afford high medical bills. My issue as of late is that I went into the hospital a week ago and was told I have a gallbladder that needs removed. I have bacteria in my blood some how. Low immune system due to malnutrition. Recently went back to the hospital and learned I have thrush due to the heavy antibiotics I’m on. All of these future medical appointments are going to send me into such a huge financial state that I just don’t know what to do. I’ve never in my life have had any debts. I pay my bills and do what I’m supposed to do. All of this just has been a big shock. I also tried last night to apply for emergency care and was told I qualify for Medicaid but obviously that isn’t true or I wouldn’t be here on this site.
ObamaCareFacts.comThe Author
So there is clearly something complex going on here. It seems to me like you have have wrongly been taken off of Medicaid and your next move should be a call to your state Medicaid department https://www.medicaid.gov/about-us/contact-us/contact-state-page.html
Since this a complex problem there is nothing perfect for me to say and I would urge you to contact the official departments and appeal as needed ASAP. Also don’t put off emergency care simply due to insurance. You can also seek direction from a public hospital.
Aundrea
I recently just lost medical assistance through my state(Pennsylvania) due to getting married and my husband making too much money. The state said they sent my information to the ffm for final determination. How long does it usually take to hear back from them and am I ok right now with not having health insurance till I hear from them?
ObamaCareFacts.comThe Author
This is a somewhat complicated question. You have a timeframe after losing coverage in which you need to apply for special enrollment and get new coverage. Thus it depends on specifics.
You should contact your state Medicaid department and/or healthcare.gov so you can coordinate new coverage. You may need confirmation of losing coverage from Medicaid for marketplace coverage. Also, you and your husband will likely want a family plan, and thus you’ll both need to coordinate as a family with the marketplace.
Stephanie R Lunt
I make less than $10K a year. I suffer from mental illness at times. However, I am not disabled so I do not qualify for Medicaid in my state. Now I am eligible for a marketplace plan, but I’d have to PAY FULL PRICE which isn’t even a consideration given my income.
ObamaCareFacts.comThe Author
In states that didn’t expand Medicaid people can fall into the Medicaid Gap https://obamacarefacts.com/medicaid-gap/
In short it is because Republicans blocked the requirement to expand Medicaid and the law was initially designed for low income to get Medicaid and 100% of the poverty level or higher to have the option of getting tax credits. Without the mandate for expansion you simply have people with no options. This has never gotten fixed due to disagreements over healthcare between the parties and the democrats losing political power around the same time the mandate for expansion was taken away.
nick
I’ve been rejected for both Medicare and chip,checked the market place and there coverage is to expensive,so I get no insurance at all,iam a single father who takes care of my 4 year old son by myself,they don’t care if you have a mortgage or how much you pay for bills food gas exct exct,so now what?I can’t afford health insurance,can’t get help for assistance with getting insurance,it makes me sick.
Marie
My son is my dependent, and a part time student. He has never worked was on my insurance until he turned 26 year old in August. He applied for Medicaid because he has been diagnosed with autism and ADHD that affect him from self support. He was denied in October based on eligibility for SSI according to letter. So, he applied for SSI due to his disability, and still awaiting determination. I want to know if I can file a exemption with the IRS on his behalf from ACA taxes penalty? He is not required to file a tax return, and he does have denied letter from Medicaid. According to turbotax review, I have to pay 133 for reach month that he was not covered. (Sept to Dec)
ObamaCareFacts.comThe Author
Form 8965 offers exemptions, you should be able to get one in the case where he has applied for Medicaid and was denied. You’ll likely need the denial letter to give to Healthcare.gov so they can verify, but in general you should be alright.
Check form 8965 “exemptions” and check with healthcare.gov and you should have everything you need to have him exempt from the fee.
https://www.irs.gov/instructions/i8965
harold lashway
Obama care is killing me slowly. I retired at 62 because of health concerns. I make under 8 thousand a year. I can not qualify for insurance of any kind. florida has no extension of Medicaid coverage. I am going blind and I think I have a cancer tumor on my foot. I cant get health insurance. now what? Move where I can get it cmon florida. I have been very good to florida and florida treats me awful. what do I do? I need care but no money. house payment or dr
ObamaCareFacts.comThe Author
ObamaCare is expanded Medicaid and then states like Flordia used a case ruling from a Supreme Court cases brought forth by a Conservative law firm to justify not expanding Medicaid.
This is to say, it is not ObamaCare that is the root of your problems, it is the conservative leadership in Flordia.
That said, pointing fingers does zero to help you. One option you have is moving to a state that expanded Medicaid, although that is easier said than done. Another option is looking into local charities and other such services.
I wish there was a better answer I could give.
Will
Hello,
I am in Florida (no Medicaid expansion), and called the Marketplace in early December 2017 for a quote on insurance. I was told I qualified for a premium tax credit, but the premium was still higher than I liked so I told her to hold off on that and she sent in an application to Medicaid on my behalf. She said if I got denied I can come back later and get Marketplace insurance.
Come mid January I still have no confirmation or denial of Medicaid, so I call the Marketplace again and spoke to another person to check. She re-entered all my info and resubmitted my Medicaid application. I finally got the Medicaid ineligibility letter (dated 02/09/2018) and immediately call the Marketplace and spoke with another person. We found I am eligible for SEP because of Medicaid denial, and signed up for a plan. My application is “pending” as I needed to upload the Medicaid denial letter which I already have done.
My concern is will my SEP be revoked or rejected because this all happened too late? It is now mid February and well outside open enrollment. I am just worried sick about this. Thanks for your help!
ObamaCareFacts.comThe Author
In a situation where you are supposed to get Medicaid, but then don’t, you would generally qualify for special enrollment. You would need to coordinate this with HealthCare.Gov and they will likely ask for proof of the Medicaid rejection.
Dennis and Judy Leduc
can too many assets or income inhibit you from being on medicaid or chip
ObamaCareFacts.comThe Author
In states that expanded Medicaid, no, in other states they get to use their own sets of rules (so you have to check).
General answer is “no, not unless you are talking about long term care.” Long term care, for example end of life care that gets paired with Medicaid, is a whole other deal. The state can collect those dollars. Its called estate recovery: https://obamacarefacts.com/questions/will-medicaid-take-my-estate/
Mom of disabled 18 year old
I live in Illinois with an income this month of $122.00 + $27.25, and was cancelled for Medicaid because I applied for SNAP. I take care of my disabled son and receive child support (not counted) and will have a part-time job that will not pay enough to afford anything. I looked up community centers and it was blank. So much for being in an expansion state. They cover the disabled child but not his caretaker, and cover the ex-husband but not the ex-wife with custody during the school year. I am 61 and could lose my home if I get sick but am unable to afford anything at this time. I always paid while I could but cannot do so now. Appeals here take months and they sound as if they just decide whether they should even give you a hearing if it is important to them, so who knows. Just the tone of it is horrifying here in Illinois and does not seem to be based upon objective facts at this time in February 2018. One’s current income is irrelevant. Child support ends in May. Several part-time jobs will not provide affordable access to real healthcare at my age. A flurry of salespeople is happy to call with a range of prices, but my income is too low to pay for shelter expenses at this point. They do not answer or provide any information, nor do they respond to appeals, other than to say that the appeals were filed.
Mom of disabled child
Just saying that the expansion states are beginning to dump people where they can get away with it, not based upon objective qualifications, because of the upcoming cutbacks. It is supposed to be based upon income, but is now becoming more about dropping whoever does not go through an intimidating series of “bureau” appeals, no matter who one is taking care of or one’s income. It seems to be more about who gets noticed, so that they can dump them. I hear about single men who are still on Medicaid but have not been noticed. In other words, they did not recently apply for SNAP because they needed it. Something about that triggered the dumping, with very little income.
ObamaCareFacts.comThe Author
Thanks for making su aware. I would call your state congress people and let them know.
Carol Stroud
What is private insurance thru healthcare.gov. denied Medicaid willing to pay and unfortunately I now need serious spine surgery.veen to ER adm mophine sent home. Unable to wait till open enrollment.
ObamaCareFacts.comThe Author
In some instances being denied Medicaid can qualify you for a catastrophic health plan. To get this you need to coordinate it with heatlhcare.gov. Otherwise insurance is only sold during open enrollment.
Marlene
Why did my daughter qualify for free nj family care and upon moving to Florida qualifies for nothing?? She was denied Medicaid. She has a permenant disability since birth. We are struggling for answers reasons and solutions. The fm marketplace appears to be only option, how can that be?? Help please.
ObamaCareFacts.comThe Author
With all due respect… The answer to your question is Republicans, namely Rick Scott: https://en.wikipedia.org/wiki/Rick_Scott
In other words, Medicaid wasn’t expanded in Flordia because Republicans in congress have been trying to “break ObamaCare” and have used a loophole opened up by a conservative back lawsuit to opt-out of expanding Medicaid. The result being that millions of Americans don’t have access to the care they need.
Pretty messed up, right?
That doesn’t mean there is nothing you can do though. You can for example look into local charities, or consider a move to a “blue” state, as almost all “blue” states have expanded Medicaid. Although, none of that will matter if the Republicans get their repeal bill through.
I hope this is clear to people when it comes time to vote. Trump and the Republicans ran on repealing “ObamaCare”… but it was ObamaCare that expanded Medicaid.
Meanwhile, we should also be speaking up, as CHIP wasn’t funded by the deadline. That means that 9 million children who are lucky enough to be covered are gearing up to lose their coverage… again, due to Republicans and the vendetta against public programs like Medicaid/CHIP.
Sorry to get political, but the alternative is sitting idly by while tens of millions of Americans get dropped from their health insurance.
Mary
I am 50 years old and was turned down for Obama care for not making enough $$ . I then applied for CHIP thru NJ and I was rejected for making too much! (They said I made $100 over the limit to qualify). Where do I turn now?
ObamaCareFacts.comThe Author
Essentially and unfortunately you turn back to the Affordable Care Act and the exchanges.
At this point you’ll probably have to prove that they told you to try for CHIP/Medicaid so you can qualify for special enrollment. I don’t know that for sure, but just a heads up.
You can also inquire into the state medicaid department as to why you were denied and seek advice from them.
Larry
My wife and I live in NJ.I am 62 a diabetic, heart condition and copd.I can no longer do the work I did all of my life.I just started receiving SS at $1,291.00(first check was in Feb) per month my 2016 adjusted gross income was $5,023.00.We just sent in our redetermination letter for 2017.My question is does Medicaid include Roth Ira distrabutions as earned income for determing you’re eligibility?I have had to go into(small) s avings in order to live.
Also when we signed up for Medicaid originally they went by previous tax years income so will SS earned in 2017 be included in 2016’s income for our new determination?
Thank you
ObamaCareFacts.comThe Author
Qualified Roth distributions are not counted as taxable income and therefore they don’t count toward Medicaid or ACA cost assistance.
https://obamacarefacts.com/questions/are-roth-distributions-counted-towards-magi/
Katheryn Wendler
I was not given an exemption from Obama care and made $16,540 dollars. I live in Texas where Medicaid was not expanded! No way I can pay obamas charity $413.00 and pay my own health care and meds. I am 61 with no husband or children to help provide. I work . what is the exemption income for me in Texas? I am on hold with the number I was told to call for almost 2 hrs, can you answer even just that one question.? I am sure my income was below the mandatory level for at least 3 months of 2016. If you can not answer this question, who can? I have received a letter of demand for money that does not exists. ..by July 3. I was given a date of October 15th when I filed, so what is the truth?
ObamaCareFacts.comThe Author
You need to take the exemption on the 8965 form that says your state didn’t expand Medicaid to claim that exemption.
With that said, you are almost exactly on the poverty level (but actually a little over). So that could be what is causing an issue. 138% FPL in 2016 was $16,394.
So, you technically made a few hundred too much and thus would incur the flat fee.
This is a good example of someone who would have benefited greatly form Medicaid expansion but who is in a very bad place with no expansion.
Sorry, this is really not a very cool thing.
If I had a time machine I would have suggested figuring out how to claim a few hundred less (by not making the money, or by donating, etc; i.e. by legal means). Not 100% sure how to proceed from here.
Hope that insight helps.
Alyison
My kids were both on CHIP and now have been kicked of because they say my husband makes too much money. I went through the marketplace but we can’t afford any of the health plans on there. We even qualified for a tax credit but our monthly premiums we’re still too much. We live paycheck to paycheck as it is. We can’t even afford cable anymore. My husband got a dollar raise so that’s why they got kicked off. But what CHIP doesn’t understand is that he works in the oilfield. His hours are never guaranteed. So far he’s been getting lower hours but next week they could be normal or they could be worse. I don’t know what to do. My kids need insurance but we can’t afford it. And please don’t tell me to repeal because what good is that going to do. They’ll just say no again…
Joy
I have Medicare part A. Can’t get B until July. Being penalized cuz I was on husbands insurance but now it’s too expensive to get at his job. Signed up for medicaid for myself. Asked me all these questions about my husband I answered them then they wanted to see a marriage license??????? Should I have just signed up and said I was single? I get disability, under $800 a month and I need insurance until part B starts. Are there any other options?
ObamaCareFacts.comThe Author
Once on Medicare you don’t have many options outside of open enrollment periods. As for what to tell the people when you enroll, it is always good to tell the truth.
I am almost positive insurers can’t sell short term policies to people on Medicare, so really not sure your options.
This is probably a question for a qualified broker or Medicare assister. https://www.medicare.gov/Contacts/
Joanne King
Pregnant mother….due July 4. It’s MAY 17. Healthcare.gov said she had to wait to be turned down by Medicaid. Medicaid took forever and she just got the okay for insurance. Then healthcare.gov said she missed the deadline!!! Her baby is due, they are moving to another state in two weeks……..NO COVERAGE AND NO ONE WILL HELP!!! She just found out the she has placenta previa. So please stop writing basic “call healthcare.gov”….because it’s a run around!!! HELP!!! Do something….give answers!!!
ObamaCareFacts.comThe Author
I would actually contact a public hospital and your state medicaid department directly again.
https://www.medicaid.gov/about-us/contact-us/contact-state-page.html
There is no perfect solution to some of these issues (it isn’t us being dismissive, it is us informing you of the options we know).
In an emergency, getting to a public hospital is the best bet, although any hospital has to treat you in an emergency. In a non emergency there are only so many places to go for help, state medicaid, healthcare.gov, public hospitals, and private charities.
You could look into short term coverage, although they may deny based on the stage of pregnancy.
This is one reason why we need a single payer system and why plans that restrict special enrollment and Medicaid (like the new Republican plan) are not ideal.
R. Parker
I think you should over look on people that don’t have a job or any kind of financial coming in. And I think they should change the policy of you have to be 65 and older, 20 years and younger plus got to be pregnant or have AIDS shit. For a person like me that can’t get dissabilty due to people who got it and ain’t got any of those. I have been trying for almost 2 years to get health insurance but can’t get it cause of these policy. Anyway, that is what I think. I think Texas is the worst place to live if you’re looking for help in any other way. Texas is big alright, Their head is bigger than their ass, sorry that’s how I feel. Thank you
Cathi H Lugo
I make less than 8000.00 a year and can’t afford health ins..don’t know what else to do
sherry
My husband made around 100 dollars too much in overtime now kicked off medicade its june . We received medicade checks of 975.00 a month to cover his work health insurance. Im terrified we are stuck now paying this every month atleast till January. Im going to lose everything . Its 40 to 50 percent his income gone plus now huge copays things arent even covered 100 percent. Im searching for a way out so we dont starve or lose my home .
Miranda Welsh
Hello, i have been recieving Medicade for about 3 years. It started out with pregnancy Medicade, then when I had child, it switched to some other kind of Medicade. I recently got married to my husband , before we married he didnt qualify for Medicade. Now that we married, i filed for medicade for the family. My husband is head of household, he works while i stay home with our 3 infants. My husband was finally approved for Medicade, the children still have it.. But I was denied ? is it because i dont have a job? i just dont get it
ObamaCareFacts.comThe Author
I am not sure, that doesn’t seem right that your husband would qualify and not you, however some states have unique rules and miscalculations can be done. You can start by following up with your state Medicaid department, and if need be you can appeal. https://www.medicaid.gov/about-us/contact-us/contact-state-page.html
Bri
Do I need to put my husbands va benefits on our form for Medicaid? It clearly states on healthcare.gov and the Medicaid.gov website that va disability income is not included in the MAGI system? So why when I put it on the form for my Medicaid renewal, I’m now suddenly not qualifying for Medicaid? they’re including it as income.
ObamaCareFacts.comThe Author
You are right, VA benefits are not included for Medicaid, but generally those rules only apply to states that expanded Medicaid. You may live in a state that didn’t expand Medicaid.
You should call the Medicaid office directly if you have questions.
Shelly
I had medi-cal insurance in CA and suddenly I was informed I had insurance through my employer so I was no longer eligible for state assistance. This happened at the exact time my dad broke his hip and my mom was diagnosed with macular degeneration. I cracked a molar clean through and had to pay cash for my ER visit and meds and later an extraction. I never had employment based insurance- not for years. I didnt make any changes or know how they reached that conclusion. I just opted to pay this year out of pocket as Ive always done. I now try to file and im being penalized for no insurance hundreds of dollars I dont have. Its BS. Im trying to support myself and I cant ever win.
Allison Katt
So I had Medicaid for my two children. Their renewal dates were different and my daughter’s case closed in December. ( I had just done a review for Medicaid and didn’t realise that they were separate) After speaking with multiple people at dfacs and making calls the last few weeks, I was told I need to reapply to get coverage for my daughter and to get coverage for myself. I applied on the website. Afterwards they show you a PDF talking about eligibility. My son who already is receiving Medicaid is eligible and I am eligible because of our lack of income. My daughter’s results say Eligible to purchase health coverage through the Marketplace, including catastrophic plans. And open enrollment is closed. So why is she not eligible? She is 1yrs old. I am not employed. She was previously receiving benefits.
jackie pasquale
My daughter is 21 and just started a job that offers health insurance with a cost. She is on medicade/ childhealthplus right now. Will she still qualify for this or does she have to take the health ins offered?
Erin
Whether someone qualifies for Medicaid depends on the state (non-expansion states, states that have work requirements), but the thresholds are income based and are not related to whether an employer has offered health insurance. She will need to see what the income based requirements for Medicaid are in the state she lives. If she qualifies for Medicaid, she is under no obligation to enroll in the insurance her employer offers.
Rolando
It helps to those ho had been denied due to his income but for the fact of a matter if sum up all the monthly expensis it become little. How do some computations. the medicade people.did.
Deb
I’m in this position now, was on marketplace insurance, when annual income went down so had to notify of change. change was low enough for me to be put into medicaid in Wisconsin, but the Medicaid does things by the month so when my monthly wages went up above the “required” amount even though my annual wasn’t going to go up, medicaid denied me and the next month (march 1) I am off medicaid. so now what? this month my medicaid monthly income allotment will be down again and as a monthly amount would qualify me for medicaid, so I guess I play the game and enroll March 1 into the marketplace again…they send me to medicaid because my income is too low for the market place and then medicaid accepts me again. I called medicaid about this denial and they said i need to talk to the marketplace and apply for gap insurance with them..when i called the marketplace they had no idea what the heck gap insurance was. so i figure the only way to get insurance now is to play the back and forth game every time my monthly income goes a tad over the medicaid amount and i have to report it even though annually I would still qualify. it’s a vicious circle that there is no answer for. Stupid is what it is.
I am wondering, if I should get married and end up with out a week or two of insurance before my husbands insurance kicks in am I now with a gap enough to be disqualified for insurance for any preexisting conditions? Or will I have to pay a fee for not having insurance for a few week or month? Can’t find answers on that either. Nobody knows nothing.
Bee
My son was receiving medicaid and was up to date with all his doctors appointments. His last month receiving benefits last year was April. Since he was up to date with his shots I had no reason to take him to the doctors. His next appointment for the following shot was in October, I realized then he had not had insurance the entire time. He was without insurance since May 1st till October 31st. As soon as I realized this I noticed in my account with myaccess they had transferred my sons information to the Marketplace and it says creating another application was not necessary but I never received anything in the mail from them. I called and they had not enrolled him. I ended up reapplying and that’s when I was able to get him coverage with Florida KidCare. Can I get an exemption in this situation where the application was sent to the Marketplace not requiring me to reapply pending approval or notice from them?
Thank you
Erin
That is really unfortunate. You should apply for an exemption and explain your situation. One of the hardships on the list is “You had another hardship. If you experienced another hardship obtaining health insurance, use this form to describe your hardship and apply for an exemption.” I don’t know whether it will be approved, but Trump’s recent executive order instructed HHS to as many exemptions from the Obamacare fees and taxes as possible. So, it’s worth trying.
schrodie
I was denied Medicaid in Texas “just because” they didn’t expand coverage to poor adults. I can’t afford even the least expensive Bronze plan. I have serious chronic health issues that can kill me if not treated. Yet the county hospital won’t even run any tests or anything (they have a ‘charity’ plan for people like me, but it doesn’t really do any good if all they do is send you to Urgent Care when you can’t get an appointment). The care there is atrocious, they are always being cited and threatened with loss of funding, people have died there for neglect and malpractice and if they are negligent and it can be proven, there is no recourse (lawsuit) because they ALWAYS cop “sovereign immunity” since they’re a county hospital. My primary doctor there never has any appointment openings. I’ve been trying for 2 years to get an appointment for a referral to an endocrinologist but there are NEVER any openings, and you can’t just set up with a specialist without a PCP referral… they simply will not allow it. So– recap, no insurance and no Medicaid, and impossible to get in with the county clinics so I guess I will just die.
Good going, Republicans. You get your wish. I’m poor and uninsured and if I’m dead, I’m no longer a problem.
Cassandra gutierrez
My autistic 20 year daughter is attending college in Illinois and we live in California I have been paying cash for some health issues she had, and have a hospital debt in Illinois that we are delinquency now, what can I do to get her indured
Erin
Even though you can insurer her on your coverage because she is under 26, it is not always the best option to do so. If the coverage you have won’t cover the services from the place where your adult child lives, for example, it may be better for non-dependent adults under 26 to get their own coverage. Your daughter should consider enrolling in health insurance in Illinois. If she is low income, she will qualify for Medicaid or for cost assistance to purchase health insurance on the Marketplace. As for the hospital debt, insurers are required to offer some coverage for emergency services out of the network, but sometimes they try to deny those benefits. IF you haven’t already, you will want to try and get the insurer she had to cover more of the bill from the hospital. After that, if you are having difficulty paying what you owe the hospital, contact the hospital and find out how you might be able to get the bill forgiven for financial reasons. This doesn’t work or apply in every case, but can often result in hospital bills being reduced.
Casey Cantrell
I recently got out of the military, I am currently unemployed and have been since November. I applied for Medicaid but my son was the only one who got approved. They stated that I made too much for me and my wife to qualify, but I am unemployed. They are basing my income on my last paycheck. Is this right?
Erin
They should not be basing it on your last paycheck especially if you have your discharge papers. Medicaid expansion to non-disabled adults under 138% of the federal poverty level is administered at the state level and not every state has chosen to expand Medicaid. States have also renamed their Medicaid expansion programs as well and this has at times created confusion. However, if your state expanded Medicaid, you should be able to apply for it based on your families (you and your wife’s) actual income when you apply. If that’s the case you should appeal the decision and/or apply again. This is a side note, but just to throw it out there you are also eligible for unemployment when you leave the service.
Leslie Turner
I am a 61 year old who has heart issues I need meds but had to quit because i have no insurance i wear a difibulater which i have to get checked but no insurance so can not my prescript for the 2 meds i pay for refill is out and needs dr. to approve. Need to see cardio dr.no insuranse so cant.Can not afford obamma care so i guess i am out of luck.it is just sad the way people who worked hard all there life and did the best they can just get covered up in paperwork andpolitics.
Lynn Bogawitch
Maybe you can help my husband and I. We were receiving Medicaid through DSS in NYS and they decided it was more cost effective for us to get insurance through my husbands work and DSS would reimburse us the cost of that insurance. We would also continue to receive Medicaid as a secondary insurance after getting insurance through my husbands employer. We have not received reimbursement since DSS sent our case to NYS of Health. We just got told to renew our insurance back in September and they sat on the paperwork we sent them to recertify. Twice they did this. Then we were told they needed more information about my husbands pay so we sent that too. We were told we met the income requirements of under $51,000 for a family of 6 and we needed to just wait longer so we did that. Two days ago we got a denial letter saying insufficient information was sent to them and when we called to find out what was going on they told us that they had cancelled our medicaid due to making to much money. My husband did not make the $51,000 they said we needed to make to be cancelled. We only made 48,000. They then gave us a number and told us to call and enroll in the Essentials Plan. We tried that and we’re told that we didn’t qualify because we get insurance through my husbands employer and they sent us back to NYS of Health to figure out what was going on. No one we talked to knew. We get BCBS of Texas through my husbands employer and they tried to tell us that insurance ran out on November 18th which is funny because my husband renewed during his jobs open enrollment period and they are continuing to pay whatever medical bills we have. When asked how one place can say we qualify and another says we don’t is we got told that no one knows what’s going on. Now this has been going on for 4 months and I’m a cancer patient and 3 weeks away from scheduling my treatment for the year and I want to know what the hell is going on and what I can do about all this. All I want is my insurance through my hubby and my medicaid as secondary like I had before and if I can’t get my medicaid as secondary what I can do bc I definitely can’t afford $14,000 come January. This system in NYS is so screwed up and confusing maybe you can explain to me what’s going on.
Dorothy Mayo
I dont understand why cant get medicaid. I live on socal security and can barely make it from month to month. They sent me to the Marketplace to apply and the lowest premium they gave me was 997.00 a month. Thats almost my whole social security. I think its horrible the way this government treats its senior citizens.
Erin
This is because you are likely already enrolled in or eligible for Medicare. First, go to Medicare.gov and sign-up for Medicare. That doesn’t mean that you won’t have health costs though, every state administrates Medicaid for it’s dual eligible population a little differently. So you’ll need to contact your state Medicaid office and let them know you are on SSI or SSDI, but you are also low income. Ask them how you sign-up for Medicaid if you are dual eligible?
Working Poor
My family was covered through Medicaid for the first 5 months of 2016 while I was unable to work due to medical issues. The month I went back to work, our Medicaid ended as my income now put us over the guidelines. The monthly premium for family health insurance through the Marketplace is way out of our budget – not even close to be affordable. We are forced to self-pay and not have health insurance in order to keep a roof over our heads and food on the table. On top of that stress, we will have to pay the tax penalty. There is a serious issue in the gap between Medicaid eligibility and the cost of premiums through the Marketplace. Our gross income is not enough for help but is still not enough to pay health insurance premiums yet we still get penalized.
Anon
A social worker changed my eligibility for Medi-Cal at an unknown date (no notice of action was ever sent/received). I found out indirectly, after the change became effective from a scheduling nurse at the hospital. This forced me to cancel numerous specalized tests that took many months just to get approved. This has also resulted in a sudden full stop to my health care (chronic disease involved). I’ve had zero success getting this resolved and have no idea who I need in my corner to get this social worker dealt with as this is not the first time she has failed to send proper documentation/forms. Her voice mail box is almost always full as well. This is in Orange County, California. I think I may need legal support but I obviously don’t have the resources to afford it. Where do I need to be looking to get my health care resumed?
Cheryl
I applied at the marketplace and it says I’m denied for Medicaid, I’m not old enough for Medicare, and the cheapest plan I get offered through the marketplace is over $600.00 a month!!! I might make $12,000 a year and can’t get any kind of help with health insurance! ObamaCare is supposed to help people who want health insurance but can’t afford it. Oh well we gave you a exemption number so you won’t be charged when you file your taxes. Well thank you for not charging me for this insanely priced insurance that nobody can afford!
Jessica
I keep trying to apply for my daughter who has asthma and my state agency never calls me about it
Dawn
My mom was on Medicaid snap so she could live in assisted living. She has dementia and it is getting worse.
She fell again and I put her in a nursing home after a hospital visit. Her renewal has come up and they asked about a trailer she had. I told them I surrendered the title for salvage for lack of money to fix the unlivable trailer and no money to move off of trailer lot. I received denial letter yesterday stating failure to provide all required info and failure to cooperate in verifying the value of resources. And then it stated income and /or expenses of the following individuals were considered in determining your eligibility! ?
What can/ should I do now? I don’t know the value of the trailer. It was unfit to live in!
Antionette Dorthery Coleman
or food and informatio care treatment option . Body in pain badly . Antelope valley hospital 1600 west ave j Lancaster California 93534 . The doctor gave her wrongful medication without testing her health problems. Emergency room doctor told her they don’t do any tests at the hospital. Antelope valley hospital don’t test for the health problems Antionette Dorthery Coleman coming to seek help for . No test at the hospital they can do or be done at the hospital because the hospital don’t do tests vagina testing or they don’t do vagina exam at Antelope valley hospital. Date incident 9/25/2016 . 10/2/2016 visits 5150 72 hour hold reason no one wanted to help Antionette seek help Antionette try harming her self to seek help nobody wanted to help her . Antionette went to the hospital in a police car to the hospital 72 hours hold . After the police left Antelope valley hospital they told her to sign insurance paper saying she have insurance and told her they are discharge her to leave . They aren’t gone treat her or hold her for a 72 hours hold . After the officer left her at the hospital.. Antionette Dorthery Coleman 44756 E 2ndst apt 4 Lancaster California 93535 bod 3-27-1986 phone numbers 323-501-4663 . Antionette reported the health problem she never been treated for or care for . Modify is trying to help her seek no help . Antionette explaining what happen to her that day and how they treated her at the hospital ..
April
Hi! Ok so my family qualified for Medicaid from Jan-July then it was cancelled. Having to reapply. We cannot afford Obama care (either premium is to high or deductible is). My daughter has a deadbeat donor who refuses to acknowledge/claim her has never seen her my husband supports her. He has repeatedly stated that he wouldn’t/couldn’t pay child support. He would sit in jail. He has 2 other kids and a fiancee to support. So I light of that I didn’t apply for child support we want nothing from him. Now I was denied Medicaid because I didn’t apply for child support. Can this be used as an exemption of the fines???
Waqas
My father and mother enrolled through healtcare.gov. in 2014. Both of them due to low income, received health coverage through NJ family care program.
My father has turned 65 in Aug 2016, NJ Family care stopped asking him to get Medicare. But he can not now get Medicare, because he has not been a resident since 5 years. Now he has no coverage. And there appears no way to resolve it.
Now we are freaking out because next year my mother turns 65 and she is heart patient, has rheumatoid, and has a pace maker. Can any one offer any advise.
It does not make sense to have full coverage till he was 64 and now he is 65, he has lost any coverage altoghether.
Macy
I am pregnant right now. If I apply for Medicaid and get denied because of income, will I be able to reapply when the baby is born and I am no longer working?
Erin
Yes. If your income changes substantially and would qualify for Medicaid coverage (eligibility varies by state) then you can apply for coverage. You will want to call your states Medicaid office to get more specific and up-to-date details on your state’s eligibility criteria and coverage options. They can also tell you exactly how and when to apply and what dpcuments you may need.
Erin
Yes. If your income changes substantially and would qualify for Medicaid coverage (eligibility varies by state) then you can apply for coverage. You will want to call your states Medicaid office to get more specific and up-to-date details on your state’s eligibility criteria and coverage options. They can also tell you exactly how and when to apply and what documents you may need.
Catrina
What does it mean if you were denied Colorado Medicaid ,for tax credit sharing?
Cat
What does it mean if you were denied Colorado Medicaid ,for tax credit sharing?
Martha Johnson
I have several medical conditions that are live long and will not go away without medical attention Medicaid denies me because I’m not 65 or older or should I say black either but I agree with some of the other comments on this page I will die of a horrible death because of the sorry ass Medicaid in Florida unless you’re an illegal black or over 65 you don’t stand a chance they will sit back and let people die before they do a damn thing about it is a shame . You have so many black people running around Jacksonville Florida with Medicaid food stamps and cash assistance and there’s not a damn thing wrong with these people people who need it can’t get it my medical conditions are life-threatening and they still won’t help me that is a damn fucking Shame. Same with Obama care fuck Obama care I have neuropathy I cannot drive I cannot work I can’t even dress myself but yet I’m supposed to afford Obamacare Obama can stick it where the sun don’t shine . Thank God his term is almost up hopefully not Clinton but whoever makes it in office will do something about Florida’s Medicaid .
salina
I was told by the market place that I qualified for Medicaid. Applied and got denied. Then they gave me blue cross blue shield which only covers medical expenses. I am completely healthy medically. I need all my teeth pulled out there riddled with infection and my eyesight is getting bad so I need new glasses. I have no income what so ever and I’m being told I have to pay a fee every month to get dental an vision added. Well hello I have no income. The affordable care act to me has turned out to be a load of crap. I think its ridiculous that we can get the medical help we need without being rich. I go to the dentist the 25th to get three of my worst teeth pulled and have to pay almost five hundred out of my own pocket. My grandma saved up to help me get the worst ones out. The world is crap now a days.
Sarah
Hello,
I’m in need of some advice! Before one of my appointments (this was a few months ago) I was called by the office informing me my insurance was inactive. I called my insurance and ended up receiving MD Medicaid for a short while (before this I had MD Physicians Care), and then it was inactive. I called the help desk number and was told that it was all online and to visit the MD Health Connections website in order to re-enroll my coverage. I went online and sent in all the documents and received no letter or email stating my application status. I finally got a hold of someone from the Health Connections website and they said I “did not meet the coverage requirements for Medicaid due to my income”. I work full time hours, but am not a full time employee at my work, so I’m guessing I make too much money to qualify. I was told I had to buy my own plan from the Health Connections website, but I cannot afford that. I’m 20, and live on my own and pay all my own bills. I simply cannot afford to pay for health insurance. My employer offers insurance, but I am not a full time employee as of right now and that process will take a few months. I am confused as to what to do next. I can’t wait months for insurance through my work and I cannot afford to buy my own plan.
Mary
Was approved for Medicaid in August went back to work last week of September, healthcare.gov notified me I’m not longer eligible for fidelies Medicaid that was effective nov 1. Do they notify Medicaid that my income changed or can I continue with straight Medicaid?
Amanda
My daughter was denied Medicaid because my husband (her stepdad) makes too much. Tell me how it is fair to expect a step parent to supply insurance for a step child. I am a full time student and can’t afford insurance, so the responsibility falls to my husband. Her dead-beat dad hasn’t seen her in 3 years or paid child support for a year, yet my husband is responsible.
Andrew Juinio
My mom was denied her health care benefits card/ health insurance from medical because she was told she has an “open case”. However, it is paramount that my mom gets her insurance as soon as possible. I want to know what are the possible reasons she was denied regarding this open case.
Robert Tarter
I got a letter from the Ohio Department job Family Services in Clermont County Ohio staying at my service will end at the end of September because I make too much money and I tried telling them that I work at fast food and 6 people got fired and I picked up some extra hours but my hours have went back to normal so should I be able to reapply or should my case be reviewable please let me know I need my health insurance I am on a lot of medication and I don’t know how I will make it without help she told me I was $300 over the limit but can I request oh State Hearing or what should I do
ObamaCareFacts.comThe Author
You can appeal this. I would call the state Medicaid department and start there for info. Always start and the top and work your way down. And ALWAYS APPEAL.
If you need to, ok have options like going down to good will and donating $300 worth of stuff. I.e. lose $300 in MAGI income if needed.
Sharon Benson
Oh my goodness. This is the most confusing mess I’ve ever had to deal with especially when suffering from chronic conditions & pain which came about while protecting & serving as a police officer. I’ve lost everything, but now with no income and getting turned down in Florida for the little bit that I was able to secure in another state is devastating. I am unable to get medications that gave me some life at least. I’ve gone off meds abruptly and I don’t wish that experience on the devil! I’m beside myself & in tears. And angry…
Joseph
My Medicaid was cancelled without notice and for no explained reason in 2015. I went and reapplied for Medicaid in Jan. 2016 and I was denied in Mar. 2016. Now I’m being told that sence my disability was denied my Medicaid was also canceled. Is that fair after my case is still pending and the decision has been appealed?
A ingram
I am pregnant and applied for medicaid and was denied because my husband and mine’s combined income was a little bit over. I already spoke to Medicaid office and they said there was no way for me to get approval. I have an individual BCBS plan but it does not cover anything related to pregnancy. Is there any kind of program that will cover me for pregnancy since I dont qualify for medicaid?
Mel
I have been on Medicaid because of my heart problem. I received a letter today saying I no longer will have it come September (two weeks!!!!!!!!!) because I make to much money. But I make NO money and haven’t for three years. I live with my parents because of my situation and they asked for their income. But they do not pay for me and cannot pay for insurance for me. I don’t even know why I am being dropped if I have NO income?!
Carl
i applied for Medicaid and was denied. They said I make too much on unemployment which is about 600 every two weeks but I can barely afford rent and the rest of my bills. I already have a daughter and her mother demands I get her insurance. I live with my gf who is pregnant but she has Medicaid and I take care of her as well. I need health insurance so I can get treated for my depression and I feel so out of options. What can I do?
SM
I have been receiving CHIPS (medicaid) for years and this year I applied and I am being denied, I make to much to receive chips for my son.. I am barely making it here in Austin TX. What options do I have for insuring my son, he has ADHD and he needs his medication monthly..
Andrew
I’m a convicted felon in Missouri and got referred from obamacare to Medicaid, what do I do?
ObamaCareFacts.comThe Author
You can contact healthcare.gov to ask for further advice, but the answer is Missouri Medicaid http://dss.mo.gov/fsd/msmed.htm
Robin
We live in Texas. My brother is SEVERELY handicapped with cerebral palsy along with other complications like being legally blind. He can’t even wipe his own nose for himself. He requires 24 hour care. Just so we are clear as we move on, he is the only one in our family who is on medicaid, my mother has her own private health insurance, she is NOT trying to apply for medicaid.
My father just died which qualified him for some death benefits. Upon receiving those, he now makes too much for Medicaid by 22 dollars. He is also a part of the CLASS program which lets my mother receive payment for being his care giver, which is great because she’s retired at this point. This is her only source of income. In order to be in CLASS, you have to be enrolled in medicaid, as of 7/31/16 he isn’t, therefor my mother/his main caretaker just lost her job.
I fail to see how the extra 22$ a month is going to help pay for wheelchairs, all of his medicines, lifts, slings, catheters, along with the enormous amount of other supplies needed to keep him functioning and comfortable. We have tried to re-apply online and been declined, we have visited several offices today to try and straighten this out and NO ONE KNOWS how to fix this, they just send us in circles.
Anyone have any ideas?
Tasha Coonce
I missed open enrollment and just found out I’m pregnant so I applied for medicaid was denied due to income… is there anything else I can do to get insurance coverage? I cannot afford $1000/ per doctors visit they are requesting for me to private pay.
Scott Chenow
I’m a diabetic, with kidney issues, I have moved to Florida and lost Medicaid because this backwoods state refuses the Medicaid expansion…. Please help!
ObamaCareFacts.comThe Author
There is no specific simple help to suggest from a Federal standpoint (unless you qualify for Medicare due to specific issues related to a disability). With that said, you may find local community based options including charitable ones. I would call around to the state Medicaid department and local assistance programs to see what can be done. In an emergency you should go directly to a public hospital.
Jeff
I decided to do some long term travel and during that time, my Obamacare plan expired and when I signed up for new coverage for 2016 it said I did have enough income to qualify and kicked me over to Michigan Medicaid. When I applied to Michigan medicaid, they said my assets were too high from my savings and a mutual fund. So I was denied. I decided to go without, but I am about to return from my traveling soon and still don’t understand my options. It doesn’t seem fair. Without being insured my “assets” would disappear in an instant without coverage! I am basically just living off my small life savings at this point.
Aliesa
Our daughter was accepted for CHIP but we didn’t have enough time to get the paper work filled out. There was a slight miscommunication when we called to tell them we would be late with the paperwork and we were under the impression that we didn’t need to fill it out and because of this we were denied. I don’t believe we would win a hearing over a miscommunication. How long would we have to wait before trying to apply again?
ObamaCareFacts.comThe Author
You can appeal immediately. I think you direct that to the Medicaid office as a first step. I would call them.
Dorothy
I was denied for medicaid and my children have copays they said I make to much money. If they counted my 1,000 daycare per month I would qualify but they said because its not coming out of my paycheck they cannot accept it…that doesnt make any sense to me…
Karen Marcellis
How do I know if my state Illinois expanded Medicaid?
Is there an example or list of reasons to loose Medicaid?
Income increase
Married and income increased
Moved from one state to another
Allen Bates
I recently lost coverage through my job and my wife is sole income and only make 700$ we are a family of 6 and desperately need affordable coverage for health and drug coverage
Jen
My husband and I want to start trying for a baby this summer. We haven’t signed up for insurance yet because it was actually cheaper for us not to have insurance. Now we want to try for a baby, and make too much to qualify for Medicaid. We were told that even if we found an affordable insurance plan, we wouldn’t even be able to sign up until November. We really didn’t want to wait until November to start trying. Needless to say I am so upset about this. What options would I have?
ObamaCareFacts.comThe Author
Having a child is a qualifying life event and CHIP has higher eligibility than Medicaid in many states, so there are healthcare options outside of open enrollment. Beyond this, getting a plan next open enrollment in November is a solid bet.
June
In 2015 my daughter (who always had insurance until 2015 when she was no longer able to be covered under my plan) applied on the marketplace and was referred to NJ Medicaid. She received confirmation of her application and called and called and kept being told she would eventually hear something. Which she did not for the whole year. (Not to mention the Government wants to charge her a penalty on her taxes for 2015, even when she did what she was supposed to do) 2016 applied again, same thing, referred to Medicaid. This time she took it upon herself to also complete a Medicaid application and send in not wanting to go through the same thing as 2015. She received confirmation of receipt. Just today, 5/31/2016 months later she received the denial after waiting and sending in requested information 3 times and placing numerous phone calls. This has been the most frustrating experience for all of us. Is she now able to go on the Market place to choose a plan? I believe should would be able to get a subsidy.
[email protected] Erin
If she was denied Medicaid and had a wait, she can apply for an exemption from owing the fee and from having insurance on the Healthcare.gov website.
worrymom
Hello I apply for Medical for my 3 children (18,17,13) in the state of California and they got denied because of income as you can see me and my husband we can’t not apply for insurance due to legal status so how can apply for my kids insurance over Obama Care?
Marianne Morrison
My son lost Florida kidcare because he is 19. I can’t afford the silver plan..is there any kind of health insurance he can get? He is a full time college student
ObamaCareFacts.comThe Author
He can shoot for a university health plan, sometimes they will offer assistance on those based on income. If he files his own taxes, this may help, if that is an option. No simple answer, but university health plan is probably the best shot. Other options include short term (but it won’t protect you from the fee).
lindsey
My father has around 4000$ in savings in which he’s currently living off off. I believe that this makes him ineligible for medicaid. Currently, he has 0$ income. So, the marketplace says he makes too little and needs to apply for medicaid. He will begin collecting retirement soon. Does the retirement count as income for Obamacare? If he’s denied medicaid, can he definitely get Obamacare?
Tanya
Me and my husband currently receive Medicaid and now I’m currently pregnant we both work but soon I won’t be able to work much hours and I just found out out Medicaid renewal will be due soon will they cut me and my husband off Medicaid if we don’t meet the income requirement or will we be able to at least keep it until the baby is born or is there a special type of Medicaid program that will at least cover t pregnancy expenses ?
ObamaCareFacts.comThe Author
CHIP typically covers pregnant mothers (based on income, with higher thresholds than just regular Medicaid). Google “CHIP + your state” and you should find your state’s CHIP program (part of Medicaid).
john
My wife was dropped from my insurance yesterday without notice because I failed to send a copy of her social security card. She went to have her wisdom teeth removed and found out on arrival that her insurance was cancelled and it is now costing us $6000. Does anyone know if there is any way I can fight this or be reimbursed for the money? I’ve paid on time every month and my insurance is still active, only she was dropped.
ObamaCareFacts.comThe Author
You can appeal this in a number of ways. Start by calling them and explaining you attempted to send the card and see what they can do. If you need to appeal, read this: https://www.healthcare.gov/appeal-insurance-company-decision/appeals/
Lori
I was just dropped from Medicaid help paying for my Medicare premiums, CO pays and deductibles. I’m fully disabled and have been receiving social security disability checks to the tune of $849 per month for two years. Medicaid denied my request because I cannot provide legal proof that I junked a totalled vehicle 8yrs ago so it still shows registered in my name. I can only talk to A call center rep. Medicare is now taking $124 per month off the top of my disability check to cover Medicare premiums. Now I have less than $700 a month income. Well needless to say, I cannot afford media gap coverage, Medicare Co pays or deductibles. I’m a stage 4a, 56 yr old head and neck cancer survivor. This is a broken system to say the least. Wth. Am I to do now. Sad I survived…
Lori
My Mother doesn’t qualify for medicaid due to her monthly income, can she apply for Obamacare ? she needs assistance with Adult day care etc…
Velinda Woodard
Obamacare rep said I was denied medicaid, never received denial letter and I need a copy for my records and to get assistance in another program.
Worried mother
If my employer offers insurance could me and my husband apply without our children getting kicked out of the medicaid program?
[email protected] Erin
Yes. CHIP eligibility is based on your families income and if your child/children are eligible, they are eligible regardless of what insurance you and your spouse choose for yourselves. Their eligibility and the amount you pay for that coverage (low or no cost) is based on your families income, so if that increased dramatically, that could affect their eligibility for CHIP.
Courtney
Afordable Care Act my a$%s. This is all BS. I have to pay 63.90 just to enroll. I’m pissed. I really can’t afford this. This country has gone to shit. Only cares about money. When Healthcare should be provided.
Adrian
I received a notice saying that you or someone with Medicaid or CHIP is no longer eligible. It also said for me to log on to the Healthcareusa.org to finish my application – presumably from information they sent to the marketplace. However, my current insurance is through my workplace and it does not include dependents. My husband is VA and my son is MoHealthnet. We already pay a premium through MoHealthnet and they would send a Missouri Department notice if anything with my sons premium changes. So, what gives? Is this something I should take seriously? Also, we are at the bottom of the premium bracket.
Jian Wang
My parents applied for health insurance in coveredCA in California. Because my mother lost job in last November and my father earned only about 1400 per month, coveredCA suggested my parents to apply for medical. We started application to medical in January, but the application process has never finished until this April and they denied the application because my mother started receiving Unemployment benefit ($244 per week) at the end of January, which made their income slightly over the limit. As a result, we go back to coveredCA and start another plan in May. However, I am concerning about the period from January to April. Because we believe we can get medical at that time and wait for the application process, we don’t have any health insurance in this four months. Will my parents get tax penalty for that ? Can we get exemption ?
ObamaCareFacts.comThe Author
So the short answer is ‘likely’. When the marketplace gives you “bad advice”, specifically when that results in you taking action (like applying for Medicaid) then the paper trail should be enough to get you an exemption. Everyone gets a free “less than 3 months without coverage” by taking CODE B on form 8965 – exemptions, aside this, an exemption that would extend a full four months would likely require proof of Medicaid denial and a call to the marketplace. If it is in the process, then you can put PENDING on form 8965 to ensure you can file on time.
Sherri White
I had Medicaid in Michigan. I got a new job and had to do my 6 month review. I then received a letter stating too much which according to their brackets I’m under by almost $2,000 and that I don’t take care of a child under the age of 21. Last I checked I’m pretty sure I know when I had my child and he’s 7. I then called to see if I could find cheap insurance and a gentleman told me you qualify for Medicaid. I asked him if he would like to call and let DHS know that because I’m a single mom who gets no help from the state whatsoever. He even said it makes no sense because I don’t make enough to even afford the cheapest insurance he could find.
Tracy
My name is Tracy and i am a 37 yr old wife and mother of four , I have been denied Medicaid in the state of MS because we have an income of 1468.00 a month. I was told because MS didn’t expand the Medicaid program that i will also be denied any assistance with copayments for healthcare.gov. I’m very ill with many things but most important cervical cancer. I was also denied by disability. What am i supposed to do? I obviously can’t. Work to afford to buy my insurance and i can’t afford the Dr co-pays. Please enlightenment me what would be helpful. I’m i just supposed to suffer with miserable pain and die because you people think Obama’s care is a good idea. Well it’s not and millions of people like me are suffering for it So thank you,
ObamaCareFacts.comThe Author
This is very sad. I don’t do victim shaming, but I will take a moment to shame Mississippi who has chosen to deny you care under NFIB V Burwell (the supreme court case which allowed states to opt out of expanding Medicaid). In short, it isn’t Obama, he expanded coverage under the ACA for free to all low-income adults and children, it is the Republicans in MS who rejected medicaid on a state level due to cost despite 90% funding from the Federal Government.
http://ideaexchange.uakron.edu/conlawakronpubs/5/?utm_source=ideaexchange.uakron.edu%2Fconlawakronpubs%2F5&utm_medium=PDF&utm_campaign=PDFCoverPages
https://obamacarefacts.com/obamacares-medicaid-expansion/
Jay Fouke
My girlfriend and her daughter have been denied for Obama care and Medicaid. She has been tirelessly trying to obtain coverage for her daughter for the last twelve weeks to no avail. Two days ago she took her daughter to the er for an injury that now requires the care of an orthopedic surgeon. No doctor will see her without coverage. What is her next course of action?
David G
I had medicaid last year. I was kicked off last year when i received a 50cent raise in pay. Later when i looked into the numbers i found i more then qualify. in Ohio adults limits are at the 133% mark and in a family of 4 my limit should be about 32k i only make 28.5 even after my raise. I then reapplied. Now it has been almost 6 months and i have not gotten approved or denied, nor will anyone answer or return my calls… I don’t know what to do… I have had medical bills in the gap that I cant afford, and I am now again in a situation where I need medical attention. please help me.
Dena Crump
I moved from Az to TX. I cancelled my AHCCCS insurance and have now been denied medicaid in TX due to not having a child under age 19. I will not know till July if I will get SS Disability. I have medical conditions that I need insurance for. what do I do now?
Michelle Pietroburgo
I am 25, a single parent, with a 15 month old son. Back in December 2015 when I called to bring him back in to see his pediatrician for his flu booster shot, they told me his insurance had lapsed on November 30th, 2015. I have TennCare and mine had not lapsed. I went to the healthcare.gov website to reapply for insurance for him, and I went ahead with filling out the application for both of us. (As I said, I already have TennCare coverage, he WAS also covered under the CHIP CoverKids Tennessee children’s insurance program.) I have no source of income, and listed as such on my application. When I got my eligibility results letter, it said I qualified for TennCare again, but told me I ha to go to the Marketplace and choose a plan to PAY to get coverage for my child. I thought children under 19 were covered automatically, when you fall under the poverty line?! I have not been able to get help from anyone, it is now MARCH and I have been trying to figure out why he was denied since December 18th, when I applied and got the eligibility notice.
Jennifer Toth
I applied for my newborn daughter in Portland, Oregon and was denied. I work and receive health care benefits through my employer, but they do not offer it to dependents. I was denied Medicaid. What can I do? She’s now without health care and I’m scared to death. I was told by the rep on the phone I would qualify based on my income, and that the system would back-date her enrollment so current bills with her pediatrician would be covered. Now I’m screwed. What do I do? 🙁
Jennifer Toth
By the way, before you respond…….I can’t afford to pay out of pocket for her policy, I know I can enroll in the Marketplace. What is the process to appeal? What are the guidelines? Am I wasting my time trying? How long will I get a response?
Thanks
ObamaCareFacts.comThe Author
Your child should be covered under CHIP. You can appeal directly to the state Medicaid office. I would do this immediately and try to get some solid answers. Oregon is pretty good about Medicaid so you shouldn’t have too much issue. Make sure it is clear she isn’t covered by your employer.
Patricia Murphy
I am hoping that someone can help me. My 28 year old daughter just graduated from Wake Tech Community College, in NC, in May of 2015. She is a Radiology Technologist, and it took her until December of 2015 as a PRN technologist. She went onto the healthcare.gov site in fall of 2015, and it directed her to medicaid. She was denied this and she gave up. She just found out she is pregnant, and so re-applied for medicaid, and now they are telling her she makes too much money. We turned to private insurance and thought she could get a catastrophic plan that covered maternity, which we were told would be possible due to her life event of the pregnancy and then being turned down for Medicaid. The insurance company then told her that this is not a qualifying event and that she simply would be denied any health care until open enrollment, which is after she will deliver. How is this legal? Can you help us
Mary Jane Grover
Hello, I applied for MI HEALTH on December 29th, 2015. I also applied to Healthcare. Gov. I was rejected by Healthcare.gov.and referred back to Medicaid. I bring in 1497$ a month and not eligible for medicaid. I’m pretty upset that DHHS worker doesn’t return my calls. I have a 1086$ spend down.
Tonda
I enrolled my husband and I during open enrollment but was directed to CHIP/Medicaid for my daughter. It wasn’t until after open enrollment was closed that I got the denial letter from Medicaid. What is the next step I need to take for my daughter? Will I be penalized for her not having coverage?
ObamaCareFacts.comThe Author
You can use the denial to enroll in special enrollment in the Marketplace. So that is a good next step. Do it quick so you don’t miss the window of opportunity.
Caitlin Mckay
I will be 19 in a week. I have been hospitalized 3 times since the beginning of the year. A sta-home nurse comes out every Monday to draw blood. I have medication delivered by ups in a weekly basis. I am currently on metformin and other medication. I received a letter stating that my insurance will end on my birthday this month. How can I her coverage for myself
ObamaCareFacts.comThe Author
What you need to do is contact healthare.gov today and enroll in special enrollment. If you are under 100% of the poverty level you may not be eligible for tax credits, but you’ll still be eligible for coverage.
Beth
I wasn’t able to pay the 1st premium for my Obamacare ($101.00+). I was just dropped from the medically needy program (florida) for not enforcing “child support”, we’re separated…but not divorced and equally share our kids. My employer is looking to give us money towards insurance now…would I qualify for a special enrollment based on being dropped by the medically needy program?
Lisa in Denver
My husband and I were just terminated from Medicaid! I went to fill our Rx’s at Walgreens and Safeway and they told me were ‘terminated’. Why? Husband is unemployed and I make $1500 a month. Live in Colorado. Please help
ObamaCareFacts.comThe Author
That doesn’t make any sense. Appeal the decision to your state Medicaid office. https://www.colorado.gov/pacific/hcpf/colorado-medicaid
LN
Hi Fact,
I lost my job in Jan-2016 and so my family insurance through my employment.
My family (4) only income source is now the unemployment benefit (Texas)
I’ve applied the state’s medicaid/CHIPS for whole family, and just received a letter from Health Insurance Marketplace saying that “Your or someone on your application doesn’t qualify for Medicaid and CHIP” … And direct me to “complete and submit this application… to see if qualify to get Marketplace coverage . . .
My question about my 2 kids, aren’t my children eligible for CHIP ? Even our income is now just barely $13,000 for this fiscal year 2016 ?
.
ObamaCareFacts.comThe Author
So by their income guidelines you qualify, but Texas can choose to account for more than just income. You can always contact them to get clarification on exactly why you aren’t qualifying and appeal their decision. http://www.texaschildrenshealthplan.org/apply/do-i-qualify
Cab47
My husband and I were forced on PA Medicaid in 2015 and I knew I had until January 31st, 2016 to sign up for healthcare through healthcare.gov as my income level changed for 2016 and I was happier because I could use my doctors. I had an ER visit and then my husband had an ER visit and was admitted to the hospital the end of February 2016 and my Healthcare.gov policy did not start until March 1, 2016. How convenient timing to let me know that oh by the way you are no longer covered under Medicaid as of Feb. 18th few days short of my healthcare.gov and they received claims. It is stated that open enrollment is until January 31st and so I signed up by that time and now there is a gap of about 8 days of coverage and that is when these claims came in. They had my updated information from the begging of the year now I have to appeal. Has anyone had this issue?
Chad
I qualified for a special enrollment period but my wife’s results says that she may be eligible for medicaid. If we find out she was denied medicaid does she get added to the plan I chose for myself or are we able to choose a different plan together? Would our tax credit go up as well? And does her coverage go retroactive to when I signed up?
ObamaCareFacts.comThe Author
If you guys file together then something is wrong. Either the family should qualify for Medicaid or tax credits, not both. Double check exactly what is up if you file together, otherwise her coverage won’t be retroactive and you’ll likely have to switch to a family plan using Medicaid denial (or another marketplace mistake) to initiate special enrollment.
MB
I’m a college graduate. For years insurance was affordable up until this year. My job offers 3 Tiers for insurance: Tier 1 you pay $300 a month with no co-pays because you have 5,000 deductible, Tier 2 $500 a month but HMO, Tier 3 $700 a month PPO. No, I don’t qualify for Medicaid or Chips, Foodstamps, or Vouchers for living expenses. ALL expenses come out of my pocket yet. I cant afford to pay 300 a month for nothing, because I have never met a 5,000 deductible. I thought I was being smart and enrolled in the marketplace for short tem ins. I was mislead the agent ( because short term doesn’t even qualify for the healthcare law) stated there was a 45 copay that was a lie and my daughter got sick and I spent $ 414 for the doctor ($145) and medicine ($ 269) in addition to the 264.00 a month I paid United healthcare for absolutely nothing. What I’m confused about is why is it that people that don’t work can take their kids to the doctor for free and have to pay for nothing. We work hard everyday for the things that we need, yet they are giving to people who don’t care or try to take of their responsibilities.
Ginny
Can you be denied medicaid because you’ve had a tubal litigation? If so, why?
ObamaCareFacts.comThe Author
I don’t think so in any case, but certainly you can’t in states that expanded Medicaid.
Frank Lee Annoid
It is cheaper to pay the Dr. or Emergency room than to get insurance.YET we are FORCED to have insurance, even if we rarely ever use it.
I am 66, and my daughter and I and my grandchild all live together. She is a Postal employee- a Post Master Relief(PMR);she started working for them 8/9/14. According to the P.O., she was eligible for insurance in January 2015, at $320 per mo. In Aug.,2015 she was eligible under a different scenario, which offered more than one carrier, and a variety of different plans with varying costs. The 1095C However shows her Not eligible in Jan.2015, and they claim they offered her insurance every other month of 2015, and claim she waived it. The truth is, she was NEVER offered insurance for ANY month in 2015. In fact, her hrs. got cut from 36 a wk. to 4-4.5 a wk, AND she ended up training a Clerk, who then entirely took her job!. She has not had ANY hrs. since last July. She is still ‘on the books’ because if they fire her, they’d have to pay unemployment, which they don’t want to do, so they just keep all the PMR’s on the books, as if they are working. Then, in Sept., they said she could- if she ‘applied for permission’ – get assigned ‘occasionally’ to work in a 2 hour office. The nearest 2 hour office is over 2 hrs. away- so she’d be driving 2+ hrs. to work 2 hrs., and then drive another 2+ hrs. to get home (not financially viable, as any wage would be eaten up in gas and maintenance immediately).
So she got CHIP for her daughter, and the Social Service Office told her as long as her child was covered, she was covered. Yet, the 1095B Form claims she was not covered Jan, Nov & Dec. As far as I go, they claim I am not covered, yet Medicaid paid any DR. bill I had after they submitted it twice. They did not send ANY 1095 regarding me whatsoever, even though I am part of the household, and do NOT get Social Security, Disability, nor do I have a retirement benefit coming in at all. I am, in fact, eligible for Medicaid (I have 0 income). I cannot be on Medicare without filing for Social Security, which I am not going to do yet. There’s no reason for me to be on it yet. i exchange work for my daughter for food and housing;I take care of EVERYTHING, cooking, cleaning, laundry, errands, childcare, homeschooling her daughter, and take care of all the finances, pay the bills, which are all(except the phone)in MY name- my name is even on the lease. Yet, because she gets up and goes to work, I am somehow HER ‘dependent’. If she actually had to exchange money TO A STRANGER for all I do, then she’d get a credit, but because I’m her mother- well, that doesn’t count. Something WRONG with that picture!
ANYWAY…How do we resolve the fact that both the Post Office, and Social Services have given false information on the 1095’s? AND THEY WILL NOT CORRECT IT (too much trouble, I guess; either that, or reporting correctly would work against them getting even more money out of us).
WHY do I have to have insurance when I have been to the Dr. maybe 4 times in the past 40+ yrs.? They should think about paying people who DON’T use the Dr., instead of fining them for not having insurance they would never use. Then, I find out that once I do decide to get Social Security, I will have to pay well over $100. a MONTH for Medicare- (something I’ve already been paying for my entire working life, since age 15), and it’s something I probably will never use, given my health, and the fact that I have rarely been to the Dr. in my life. So I’ll get a pittance for Social Security, because they have mismanaged it all these years and are reducing it, and then have to give back even MORE $ for something I may never use. How lame is that? I might as well have taken all that $ I earned all those years and thrown it down the toilet. I used to pay health insurance at some companies I worked for over the years, but never once ever used it. Never once.
So, what do we do to get it all corrected? WHY do we have to go through this just to file our taxes? So far, the IRS is planning on taking these incorrect forms as gospel, and figuring it all out with incorrect information- which means, we’ll be, no doubt, paying- for what, pray tell? I am spitting mad about all this, as it is totally an unfair system for the worker, and for those who have worked for many years. All this nightmare, so some couch potato can have ‘free’ insurance? Get off your duff and work, like the rest of us(2 to 5 jobs to keep bread on the table and pay for housing and utilities, car insurance, etc.)- maybe you’d be healthy then, because when you work that much, you don’t have TIME to get sick!
Clearly, the people who really need it are getting denied it, and those of us who don’t need it, are getting penalized.
It needs to go back to a system of whoever wants insurance needs to find a way to pay for it, and those who don’t want it, are free to not have to have it! If those who want to milk the system were FINED instead of rewarded, then we wouldn’t have this huge mess.And while we’re cleaning up the system, make sure to take the Usurper to Gitmo until tried for Treason, along with all the other treasonous political office holders.
Now, back to the insurance scam…HOW do we get this straightened out in a TIMELY manner, so as to be able to file our taxes? HOW does one know IF any exemptions apply? I’ve been 3+ weeks figuring this stuff out, and have yet to get any straight answers. CAN the P.O. and Social Services be held accountable for submitting false information to the IRS? WHO will correct it? WHY is it acceptable for them to blatantly lie? WE surely would not get away with it. All I want to do is file the tax return- something that could easily be done in a day prior to Obamacare. Like OUR time is worth NOTHING. Pay someone? NO WAY. Had enough taken already. Please tell me how to fix the issues.
Deanna
I recently started a new job who offers employer based insurance. I am paid $17 per hour which means I bring home roughly 1,000 biweekly without insurance deductions. The cheapest plan offered for insurance will cost me $800 per month, this is including my 3 dependants. The cost of insurance literally takes half my paycheck leaving me with about $400 biweekly. I cannot afford this. I know I or my children wouldn’t qualify for Medicaid or CHIPS because my income is too high. What other options do we have?
Jennifer Toth
I make the same and am in exactly the same boat. Was it your job that offered the policy at that extreme rate or the state? Now I’m really getting scared……
samuel lea
my grandma lives here in Washington and hospital said her medi-care has ran out and her pension from McDonald douglas where she built planes in world war 2 is to much and she has to live even though she has heart failure and pneumonia she is 90 years old live with my mom you is 73 years old need help they live in electric city Washington
Virginia
I applied with the marketplace to get coverage for my newborn son less than 30 days after his birth in September of 2014. The market place referred my application to South Carolina Healthy Choices. South Carolina never got back to me with a denial or acceptance of coverage even after my application was resubmitted late 2014 for coverage in 2015. This has caused us to incur over $15000.00 in hospital bills due to a hospitalization shortly after his birth. In November of 2015 my employer offered health insurance coverage and now my son is covered under my work plan. My question is can I get a tax exemption for the time my son was not covered in 2015?
ObamaCareFacts.comThe Author
An uncovered Child would likely be covered under CHIP in retrospect. I would defer this back to the state Medicaid office. Or appeal the denial. That is not a simple situation though.
Jackie
I applied through the market place, and it said I may be qualified for Medicaid back in Feb-March 2015, never got a response past that. I tried again 2 more times for coverage, each time it said “i may be qualified for Medicaid, you will hear from your state”(IL) and didn’t get a reply until the end of December! I sent in the proof of salary, and didn’t hear from them: not until January of 2016, when they DENIED me. I’m right at the poverty level, maybe a tad over. After all of that, NOW I’ll be penalized for not having health insurance?! This system does not work! I shouldn’t have to wait for 10 months to find out if that I “may qualify for Medicaid” and then get penalized for lack of coverage.
ObamaCareFacts.comThe Author
Your denial triggers a special enrollment period. My advice would be (since you are over 100% FPL according to the state) to claim tax credits and use special enrollment. If you estimate over 100% of the poverty level then you can get tax credits legally. If you don’t end up with 100% in real household income at the end of the year, then you simply file form 8962 accordingly and repay up to the limit (for income below 100% the limit is little to nothing depending on the exact situation.)
https://obamacarefacts.com/advanced-tax-credit-repayment-limits/
chuck
they applied my income frome 2013 when i was making much more than i am now. is there a way to dispute that?
ObamaCareFacts.comThe Author
Yeah 100% you can appeal all decisions. I don’t want to be conspiratorial but the people who process applications are people. People make mistakes and have biases. You can and should appeal any decision you don’t like in healthcare. Google “appeal medicaid decisions” and add your state name in there.
Maria D
I don’t know if I’m in the right place with this letter… To it may concern: I applied in Nov.2015 and I was given the option with Fidelis Care and my part of the payments from me was $183.18 (that was a little higher than before but I have no option) I agree with that. Then I receive a letter from Fidelis Care saying that I owed $420.27 !!!!!I So I called them and ask for the reason… – they toll me that NYSOH didn’t sent the PREMIUM and I have to call NYSOH and only they can cancellated (I asked for it,I can’t afford $420.27 monthly). So when I called A lady who help me toll me that I was in 2 applications and me and my kids was receiving Medicaid,my answer was that “no we are not receiving Medicaid” because for my knowledge I wasn’t,I explained to her that my kids have Hudson Health Plan because that’s the name that in the cards,she insisted yes I say no, but the true I got so confuse,because at the beginning of the phone call they ask for phone # just in case the call is hung up; it happen! (I don’t want to say that she hung me up because she was “so aggravating as she murmured) then I called back, then it was to late and the other person couldn’t help me out , I had to call another day….. just for not to make this long and I lost count the times I called, they told me that the system don’t let them go in my application, and I have to wait until they can go in and fixed…..and I just received another letters From Fidelis Care now I owed $1,260.81. Please check my application, I’m not pretending to get free med Insurance but my child of 5 yrs old needs Med insurance.
James Slezak
My 52 year old stepson had Medicaid coverage but has been told his coverage has been dropped. He has pancreas/liver problems and needs surgery on a torn Meniscus. He says he did everything he was asked to do to ensure his coverage would continue. Who can he contact to get help in resolving this matter?
ObamaCareFacts.comThe Author
You need to appeal directly to the state medicaid office.
Jan
Hello!
I have a quick question. If you apply for Medicaid and are denied, does the Medicaid agency have to provide you with your other eligibility options (per the “no wrong door” policy of the ACA)? I have a friend who applied for Medicaid in Indiana and was denied, and I’m wondering if the agency should have provided her with info about her eligibility for the Healthy Indiana Plan.
Thanks!
ObamaCareFacts.comThe Author
I would assume this is policy, but i’m not sure it is a rule. I don’t think Medicaid directly would help you enroll in a marketplace plan, but they should have at least provided the information and suggestion.
Robert Schlatter
Here is the situation. We are eligible for Medicaid because of income in Pennsylvania. However we are resident aliens for less than 5 years; as a result we are not eligible for either Medicaid or Obamacare.
Do we still have to pay a penalty for not having minimum essential coverage?
We did an estimate and found that the penalty would be about $400.00.
ObamaCareFacts.comThe Author
All the fees and credits are based on taxable income. So if your income qualified you, then yes you have to get coverage or pay the fee. The five year rule applies to Medicaid and Medicare, not the marketplace (due to the type of subsidization). That said, if you can prove you were rejected from the Medicaid and Marketplace, yes, this likely would help you qualify for the exemptions. Learn more here: https://obamacarefacts.com/obamacare-exemptions-list/
Brittany
I filled out an application on Healthcare.gov on December 17, 2015. My results stated that I should be eligible for Medicaid, so Healthcare.gov did not give me the option to buy any type of insurance. Late January of this year I received my denial letter from Georgia Medicaid, stating that my income was too high. I am an unmarried stay at home mother with no income whatsoever. I do live with my child’s father who supports our child and me financially. What is my next move? Should I appeal Medicaid’s decision? I am so lost!
ObamaCareFacts.comThe Author
You can use your denial, most likely, to get marketplace coverage via special enrollment. You can also appeal. So both are options, and actually you can do both at the same time.
Marianne
My son was denied Medicaid but approved for Florida kidcare until his 19th birthday this May, can he get his his own healthcare thru the marketplace in May?
ObamaCareFacts.comThe Author
Yes he can. He can enroll starting 30 days before his new plan will end so he doesn’t have a coverage gap. Don’t wait too long, the special enrollment window is only 60 days from the end date of the previous coverage.
Learn more about special enrollment here: https://obamacarefacts.com/special-enrollment-period/
Michele
I was denied Medicaid but, I have bipolar disorder, borderline personality disorder, and depression. Also I was told that i have arthritis in my neck that causes migraines, numbness of face and somtimes spells of trying to focas. I was told that within 10 years I will more than likely be in a wheel chair do to the issues with my neck. How can I get help to were I am able to see a doctor and get the help I need. With the black out spells and feeling weak it is hard to hold a job down with that alone also it is hard to deal with people with my mental disorders. Please help me figure out a way to were I can afford the help I need.
Amanda
So I am a single, working mother, who is also a full time student, and I fall in the gap, but medicaid in Oklahoma covered my daughter. Can’t get insurance anywhere, I’ve gone through every route and either it’s over half of what I make a month or I don’t qualify for the program. Work doesn’t have insurance for me. Obamacare wants to charge me full price at over $400 a month. Soonercare says I make too much when I only make around $600 to $800 a month. No insurance through my school either. I don’t want an exemption for a fine that no one should be charged with in the first place, I want to go to the doctor, get my prescriptions, and to get some glasses so I can see. What do I do? If people are falling in the gap, doesn’t it make this ACA kind of useless? Seems to me that the only option I have to be able to get health insurance is to quit my job and live off the state, and that is not an option in my opinion. Tell me how to get insurance please.
Karlett Jackson
If my son qualify for Medicare in one state because he’s a quadriplegic why can’t he get it in another state his condition has not change we are not poor but we are no way rich and i can’t find anyone to help us
Jessica Noll
I make 16,300 a year, I have 3 children the agent on the phone said I don’t make enough money to have ObamaCare. I work 38 hours a week what do people like me do for Ins. I thought ObamaCare was to help the poor. Apparently not
ObamaCareFacts.comThe Author
You don’t make enough for tax credits, you likely live a state that rejected Medicaid. The ACA was supposed to help you, but your state republicans blocked the program to hundreds of thousands in your state (true in almost every state that didn’t expand Medicaid statistically).
https://obamacarefacts.com/obamacares-medicaid-expansion/
Banti
we are enrolled for health insurance through marketplace. However the youngest member of the family was referred to NC CHIP, and informed me to wait for a month until they contact me by mail. It has been about 43 days and I did NOT receive any letter of accepting or denying the CHIP for my 17-year old. I went to the county social services department office to inquire. They did not even mention the marketplace, but instead gave me a form of many pages to fill out for all family members. My question is:
a) should I wait until they inform me in writing about the outcome of ACA marketplace request (granting CHIP for my son, or denying)? OR
b) fill out the form and wait for their reply which, they said, would take at least 45 days?
Thank you. BKWA
ObamaCareFacts.comThe Author
Really good question. Technically the Medicaid process (including CHIP) should end in an acceptance or denial letter. You can use a denial letter to enroll your son in special enrollment, but you can also choose to enroll your son and then un-enroll him if you get an acceptance letter. Both should work, but given the importance of the situation we would suggest double checking with the Marketplace. Each solution has pros and cons. Ultimately CHIP is a darn good deal if you can get it, but a family plan has it’s perks too (namely sharing cost sharing).
LeeAnne
I am beyond frustrated with this new healthcare situation. I applied for health insurance through the marketplace and was told that one (only one, not the rest) of my children qualified for Medicaid. However, I had a rejection letter from Medicaid from the month before. I told the marketplace we did not qualify for Medicaid and sent them a coy of the rejection letter. Thus, we were able to enroll in a healthcare plan through the marketplace. However, ten months later, I received a letter from the marketplace stating that the children had Medicaid and we needed to cancel our marketplace insurance immediately. So, I did. It turns out that the kids, unbeknownst to me, did have Medicaid for the previous ten months – even though I never received anything from Medicaid. Now its time to file taxes and I am being told that I will have to pay back the premium tax credit that was paid for our marketplace health insurance because my kids had Medicaid. I wouldn’t have even had the marketplace coverage if I didn’t have to legally and now it looks like I’m going to have to pay the whole premium because the agencies in charge can’t seem to figure out what they are supposed to do either! I don’t know what to do at this point.
Kyle
I have had Obama care for two years. My MAGI this year went below the 100% poverty level. It says “congrats” you qualify for medicare! No, We don’t because Idaho does not give medicare to healthy working adults. So now what do I do? I could cheat and add some fake business income as a DBA to get my MAGI up!
ObamaCareFacts.comThe Author
I wouldn’t cheat and drum up MAGI, I would use one of the many vehicles in modern life (tax or work related) to create more MAGI. Not claiming this is easy, just saying it’s the best solution. Also, to clarify it’s “Medicaid” not Medicare which is the low income insurance.
Carol Coyle
I have been on Medicaid for my self and my daughter, I am a widow and she receives survivor benefits from her fathers death. She just had her 19th birthday and Social security benefits end and I received a letter today that Medicaid coverage will end as of Feb 1st I have been unemployed for two years now and having health issues so I have not filed income taxes in two years as I had no income. how does one get obamacare if you have no income and state medicaid will no longer cover you? If you have no income how does one pay for health insurance?????
emma
i am no longer eligible for medicaid, i was recently married. The marketplace is saying i cannot get subsidy because my husband has insurance through his work. How does that affect my insurance? We cannot afford insurance through his work, he gets employer help but my portion will not be paid by his employer. This is so wrong. I read that it has to be more than 9% of my husbands income and insurance and it is not for just him, so I cannot get a subsidy yet if i am added to the lowest plan at his work it will be over 11% of our gross income.
ObamaCareFacts.comThe Author
Make sure to check out this page for more clarification: https://obamacarefacts.com/affordable-employer-sponsored-coverage/
Tammy jackson
I have not been employed for over 7 yrs. I have 7 felonies on my criminal history I am unemployable. I am 46 years old, live with my mother my daughter is 20 years old. I do not qualify for Medicaid and my mother can’t not afford my insurance through Obama care what or anything can I do
Niraj S
My mother just moved to North Carolina from California where she was receiving
Medi-Cal. In North Carolina they rejected her Medicaid application and she cannot afford health insurance and has a lot of medical problems. What can she do to get coverage as soon as possible?
I was told to apply for disability for her but that could take up to 2 years before it is approved and she needs medical attention right away.
ObamaCareFacts.comThe Author
I really don’t know what to say in these situations. Don’t move to red states and seek local assistance?
Aleksandra
Can you keep medicaid if you not working and have a child of 3 months
ObamaCareFacts.comThe Author
Medicaid rules differ by state. In all states it’s based on income, but in about 20 there are other things factored in. So ultimately it is state dependent. You should call your state Medicaid office.
https://obamacarefacts.com/obamacares-medicaid-expansion/
Rebecca
I applied for Obama care and they denied me coverage for my kids from the market place and chip/Medicaid! So will I be able to get an exemption! Also of I pay all of my health care cost out of pocket why would I have to pay a penalty at the end of the year if I am covering my expenses on my own!
ObamaCareFacts.comThe Author
Double check the 8965 form to ensure you understand what exemptions you will claim: https://obamacarefacts.com/form-8965-health-coverage-exemptions/
You won’t owe the fee if you have an exemption. With the mandate you need at least essential and catastrophic coverage (aka minimum essential coverage). This provides an insurance against catastrophic events in regards to cost and coverage. The reason there is a fee is because the fee is a tax that helps fund the cost of making sure people are using coverage and not relying on the system without coverage in an emergency (which essentially costs tax dollars indirectly). That is one explainer, it’s a bit more complicated.
Ranisha
I have a close friend who had United Health care for the year of 2015, and when she applied for 2016 she was pregnant and told that she would be eligible for Medicaid, and was therefore not given any other options as to continue her United Healthcare coverage. In Jan. 2016 she delivered her baby. She later contacted medicaid only to be told that they had not received her application, although the market placed confirmed it was sent. The market place then resubmitted her application. Today, she contacted Medicaid to confirm receipt of the application from the market place. However, was told that she was not eligible for medicaid. The problem is she has delivered a baby with no health coverage un be knoweth to her, and she will now owe a huge bill. Is there anything she can do?
Jennifer Drain
I have Medicaid and food stamps for my two younger children, but my 19 year old does not qualify for Medicaid only share of cost which I don’t understand that whole process, because they want him to pay $2066.00 of his own care for the month and if he goes over that they will cover the rest. He has no income and does not use that much medical care anyways. I have medical insurance through my employer but can not afford to add him on my policy, can he qualify for Obama care even though he is not working. I receive food stamps for him because of my income so I don’t understand why they won’t give him Medicaid.
Nikema
I applied for Medicaid but haven’t heard back yet. I didn’t qualify for the Obamacare I guess cause I went thru them first. What should I do if I don’t hear back by the time I’m ready to file?
ObamaCareFacts.comThe Author
It’s important to know what your health options are. There is a big difference between the marketplace and Medicaid. You can always call healthcare.gov for help, but Medicaid followup questions should be directed to your state Medicaid department.
Michelle Desrosiers
I am on SSDI, 64 yrs old, I have been on Medicaid thru health source RI from Jan. 01,2015 to 12/2015 when I realized in Dec. they terminated me because I went on medicare part A only in Aug 2015. I cannot afford medicare part B /D. What do I do now?
ObamaCareFacts.comThe Author
If you have access to Medicare you have to choose Medicare plans. There is cost assistance offered, so you should look into Medicare options. You can only keep Medicaid until you are Medicare eligible.
Keith A Lang
I applied for Medicaid on the Marketplace, and was told I was not eligible. I am unemployed, and receive SSI benefits. I receive $532.92 each month, and am my own Payee. I cannot afford my Bi-Polar medication, as the SSI is my only income. I just moved to Georgia two months ago from New Jersey. I am moving again, in March, to another county in Georgia. I realize that my Medicaid from New Jersey, is no good, because of moving to another state. I live with my father, my girlfriend, and older brother, in my father & brother’s home. I have to use my SSI to pay for mine & my girlfriend’s food, so I don’t have any money left after that. I don’t know what else to say, except for that I need some kind of help. I want to enroll in an acute partial care program, like I did in New Jersey.
Jessica
I had an active Medicaid application for several months in 2015 before I was denied. I spent many hours on the phone and faxed my income papers in several times and my application was continuously pending. Do I have to play the penalty for those months that I was waiting on approval?
Mike Johnson
My Fiancee is disabled and has been wrongfullly denied her Long Term Disability Insurance (That she paid for, we have a lawyer working on her case) In the meantime she has applied for SSI (6 Months ago ) and Medicade but we live in Florida where they don’t care.. So she has no income and has no health insurance and she is Disabled (Verified by 3 Doctors) With all of that how can she qualify for the subsidy having no income? Also, if she doesn’t qualify how is she supposed to pay the Insurance that she desperately needs because she is disabled?
Darby
I applied for healthcare November 17th, 2015. At the time, I could apply for Medicaid. A month goes by, no notifications or mail from Medicaid. I call them, they don’t even have my name in the system. I call healthcare.gov, and we do my application over, and doing that caused me to not apply for Medicaid anymore because my parents label me as a dependent on their taxes. I can’t afford the “catastrophic” insurance. But, I still tried to apply early. Do I still have to pay the fine, even though I tried but healthcare.gov screwed me over?
ObamaCareFacts.comThe Author
So you still have time to correct this. If your parents will claim you as a dependent then they are responsible for your coverage. This is good to reinforce, if you claim someone you also take responsibility for getting them coverage (which typically means on your family plan).
If your family decides not to claim you, then you can most likely just reapply for Medicaid. As long as you have coverage in place before January 31st, 2016 you are safe. Everyone gets “less than three full months in a row” without coverage each year.
Alexandra
I’m a single mom with 2 kids living in Williamson county Texas. I carry marketplace insurance for all of us because my work insurance for us would be 31% of my income. When I reapplied for 2016 insurance through the marketplace they tried to kick my 3 year old off the policy saying he’d qualify for CHIP, I had tried applying for both kids the previous year & they’d been denied but because it wasn’t within 90 days they asked for me to apply again. In the meantime I asked them to please keep my kids on insurance so there’d be no lapse of coverage. I got the CHIP letter saying my 3 year old was denied but my 7 year old qualified. It’s all based off my income neither child has a disability so how is my income too high for my 3 year old but ok for my 7 year old??
ObamaCareFacts.comThe Author
That makes no sense. The younger the child the higher the eligibly level. So if anything it would be the opposite. I’d just appeal this starting with a phone call for clarification.
Alyson
Please HELP!!! My disabled husband has been denied Medicare part B until July in spite of requesting activation last September.Consequently the state of NY will not allow him to purchase health insurance through the marketplace! We just moved from TX to NY to be near family. He was allowed to purchase insurance through the TX marketplace while he waited on his Medicare but this is not allowed in NY! He has part A but since he requires monthly visits to a specialist as well as vital procedures and medications which part A doesn’t cover, his life will be put in jeopardy from these rules!!! He has just applied for Medicaid but the jury is still out on what that will do and when. HE CANNOT HAVE A LAPSE OF COVERAGE!!! IS THERE ANYONE HUMAN OUT THERE WHO CAN HELP HIM??? Can anyone tell me anything other than the rules???? My husband is a very sick man whose right to buy health insurance has been taken from him!!!!
Cynthia Monaco
Medicaid and CHIP terminated my grandsons because of the household income.
ObamaCareFacts.comThe Author
You can appeal this, or you can use this fact to enroll in the Marketplace via special enrollment (or open enrollment during the open enrollment period). You can also just reapply for Medicaid.
johnny
Hello my name is J and I live in south carolina and I was wondering if I have medicaid, and got my renewable notice,I was working but then started recieving my disabilities check of 1630.I had to quit my job because i couldn’t so it any longer.
#1 question: Will medicaid give you a certain time ( notice ) before they drop you.#2 i was told if i was working they (medicaid) would have to cover mr for at least 93 months. I was also wondering if I could apply for health care before deadline and just drop the coverage if they renew my medicaid? I have a ton of health issues and just want to make sure i get some kind of coverage! thanks
johnny
Does medicaid consider your medical conditions when your up for renewal as well? If they approved you the first time and you still have the same conditions will that help in determining as well?
ObamaCareFacts.comThe Author
So for Medicare there are a few conditions that can qualify you early, for Medicaid in states that expanded it’s only income that is counted, for non-expansion states I know there are other factors (but I think they are all age, family size, income based). So my educated guess would be that you should be approved or disapproved based on income. You can always get more direction from them, appeal, reapply, and find ways to reduce income.
ObamaCareFacts.comThe Author
Medicaid should let you know before you are dropped. You can always call your state Medicaid office and follow up, you can also appeal and reapply as necessary. Generally Medicaid is based on income, so unless your income changes you shouldn’t have much to worry about.
Elizabeth
My son is schizophrenic and has other mental health care issues. We have always had Medicaid for him but now that I’m married we make too much and it will be canceled soon. What other coverage can I get for him? Will he still be covered even with the pre existing mental health problems? He takes three medications a day and has to go for therapy weekly.
ObamaCareFacts.comThe Author
You should call healthcare.gov and see what type of subsidy options you have. At the right income level you can get a plan with relatively low premiums and out-of-pocket costs that covers your doctors. You’ll have to do some shopping and likely have to be prepared to spend a little more in premiums to get the right network and cost sharing amounts. Try to consider your spending over the whole year.
Karen R
My husband & I were covered on his health insurance through his job til he became unemployed this past June. At the current time, we have NO income and NO health insurance. We have been selling assets (none are worth very much, cars with blown up motors, etc) to keep the lights on and water, etc.. but have no extra money at all- I am 48 & he is 46, our children are grown up and out of state, and we live in Alabama so Medicaid is NOT an option for us at all, what do we do??
ObamaCareFacts.comThe Author
You might be able to apply for exemptions. https://obamacarefacts.com/obamacare-exemptions-list/
You may also be able to use your medicaid rejection letter to get catastrophic coverage as well as an exemption. Make sure to apply to Medicaid.
Daisy
I was recently changed my job after my Medicaid renewal. Although I changed my job, I am still under the income limit. Then I got another renewal package which I need to submit by 2/10/16, otherwise my coverage will be ended. I went to the local office and just being told that I might be denied this time because my current employer is offering health insurance. (If I knew I would not change my job.) But I have declined my current employer’s medical insurance because I have to pay all the premium while I am on leave. My due date is just two weeks before 2/10/16.
My questions are: would I end up with no insurance when I deliver? Would the medicaid still pay for my labor bills before the termination date? What should I do now? I hope you could help me out with this….
ObamaCareFacts.comThe Author
If you don’t have coverage through work and are eligible for Medicaid then Medicaid can cover you (even retroactively). This can’t be a guessing game though. You have to sort this out with your state Medicaid department ASAP.
Socorro M Concepcion
I have been trying since Dec. 15, 2015 to obtain information about this insurance to see if it could help me since I cannot afford the amount of money they are charging for health insurance. I live of disability and am very sick and cannot even purchase my medications any move. What can I do? Where can I go? Who can help me? I’ve had to stop seeing my doctors for 3 months already.
ObamaCareFacts.comThe Author
The best course of action is first checking with HealthCare.Gov and your state Medicaid office (and potentially Medicare since you have a disability), then if that doesn’t work try asking local assistance programs.
frustrated georgia mom
I had private marketplace coverage for 2015 for my daughter and I. When I went to re-enroll (with no income or other life changes) on the 15th of December and see my new coverage options on healthcare.gov, my 2 year old child “might be eligible” for medicaid in my state. Medicaid has up to 45 days to make a determination, leaving her uncovered for over a month as of January 1.
My daughter is having recurring illnesses requiring antibiotics for the last 4 months, and is still sick. What should we do? Georgia’s medicaid number keeps you on hold for hours and/or automatically disconnects. If you go in person to the offices, there are just rows of telephones to call the same number that no one picks up.
I am seeing that other parents are finding this issue of months of gaps in insurance coverage, which is incredibly frustrating as a caregiver who just wants her child to be able to see a doctor when she is sick. How was there no warning of this?
ObamaCareFacts.comThe Author
That is awful. You can appeal any Medicaid decision. It’s a join state / federal program, I doubt the federal side would have much tolerance for the state side’s shenanigans.
John C
I am in wisconsin. I applied during open enrollment (Nov 2015) and was told I did not make enough money for help through the market place and was referred to the state to apply for Badgercare. I was denied badger care and the good folks sent my case to the state for Gap coverage. I found out recently I was denied Gap coverage and my info was sent to the Market place and told to resend my app with updated info the state gave them. I called the market place to have my app resubmitted (I got the impression the lady was a bit clueless) but she told me I did not qualify for help through the market place and needed to pay full price for health coverage. Is there no options for me?
ObamaCareFacts.comThe Author
Look at this page. It shows what income will qualify for what things. https://obamacarefacts.com/federal-poverty-level/
Project income based off this knowledge, look into earning a bit extra and deductions as needed. Appeal Medicaid’s decision if you think it doesn’t make sense.
Also make sure you understand Medicaid eligibility in your state https://www.medicaid.gov/medicaid-chip-program-information/by-state/wisconsin.html
julie
We live in a state that didn’t expand Medicaid. I am disabled and receive 925.00 per month income and I am on Medicare. My husband is a full time nursing student. He MUST have insurance to stay in the program. We had catastrophic coverage these past six months that cost 100.00 per month and basically covered nothing. I see all these ads on tv about cheap health insurance through the marketplace. I go through the enrollment for him and the cheapest insurance available is catastrophic for 400.00 a month, they wonderful silver plan is 700.00 a month. Are you kidding me? Who is behind the ads on tv showing 50.00 to 80.00 a month coverage? Is that real? We live on NOTHING, and the “cheap” insurance is almost half our income?
Dulcia
They cut me off Medicaid this month bc 7.50 a hour is too much money. How am I supposed to pay for my bills, and other stuff especially me being a single parent of 1? I just was told that the Medicaid limit is 300 dollars a month. OK, how is someone going to survive on that? 300 a month? That’s my months rent. My light bill is 200 bucks and I don’t even have a car so I pay expensive cab fees so I can go grocery shopping and take my daughter to her doctors appointments. How could anyone live on 300 bucks? When I get sick, how am I supposed to be able to get better and take care of my child? So do they not want single moms to get jobs? Working single moms pay the taxes for moms to sit on their asses and just collect free benefits while not only paying taxes but we have to pay for healthcare? How is this fair? All I have is foodstamps and they know how much I make and I still get the same amount as I was getting before I found my new job. They told me that my benefits aren’t even close to the max limit on foodstamps so how am I cut off Medicaid?
ObamaCareFacts.comThe Author
You can contact your state Medicaid office and appeal any decision.
MaryTolbert
i AM ON DISABILITY i APPLIED FOR MEDICAID i WAS DENIED. i WENT THREW THE MARKET PLACE THEY WANT ME TO PAY 700.00 A MONTH I CAN NOT AFFORD THAT I ONLY RECEIVE 1,207.000. 4 OF US IS LIVING OFF MY INCOME WHAT CAN I DO? WILL YOU HELP ME?
ObamaCareFacts.comThe Author
This is because your state rejected Medicaid. 20 states did this leaving millions of working Americans and their families without coverage options. You should try CHIP for the kids and you can call your states Medicaid office to apply there. You can also get help through HealthCare.Gov. It’s always advised to apply for Medicaid and be rejected as this may grant you exemptions and catastrophic insurance options through healthcare.gov.
Liz
Hello,
I am a recent college grad, age 23. I am still in the process of looking for a job and therefore have no income. Though I am claimed by my parents on their taxes this year, I will not be claimed for next year, 2016. From my understanding, I will qualify for Medicaid in January. If I wait until January to apply for Medicaid, will I be fined for not signing up for Obama Care on December 17th?
ObamaCareFacts.comThe Author
So every year you get two full months without coverage. So you can enroll anywhere before January 31st, 2016. The caveat is that you won’t have coverage until then and if you miss more months in the year you may owe the fee for each month. So you are safe, just make sure you understand the rules.
Dave
the marketplace stated that my kids qualify for Chip. So we are waiting to hear. Now I’m picking a plan for my wife and I. If I pick a plan with no vision or dental for kids, then the kids get denied by Chip, do they go on my healthplan that doesn’t fit our needs or does the whole family get to pick a new plan? Of course we won’t hear from Chip until after the deadline.
ObamaCareFacts.comThe Author
That is a great question. Probably would make sense to get on a family plan with a dental and vision option to make your life easy. Dental and vision must be offered to kids, but this can be done through a stand-alone or as part of the family plan. If it’s part of the family plan then it’s subsidy eligible, if not, then not. So getting a plan that has it included will give you more options, but you should be able to choose either.
Jayce Simmons
I have applied for Medicaid due to inability to work. I have a congenital spinal defect that prevents me from working. My physician refuses to release me to work. I also have degenerative disk disease. My birth defect allows me to leak spinal fluid that puts me to bed with excruciating migraine headaches 4 to 5 days every week. I have no income. I am 37 years old, and my mother, who is retired, supports me. I have no way to pay for insurance or medicine. I desperately need help. The state of Louisiana has not approved me for Medicaid although I have applied. They require paperwork from years past that I do not have and can not get. What should I do?
Rin
Hi there.
I am 19 and I go to therapy for PTSD. I have chronic migraines. I was on medicaid and now I am not. I got kicked off it because I didn’t qualify for it anymore. None of the reasons I have read make sense. I was apparently kicked off it because we make too much money, but when I got through healthcare.gov and it asks me what the house hold size is, I should put 1 because my sibling, nor my parent, are my dependents or a spouse. At that point I put in my income (only my income because it asks for household income and according to what this is saying it would only be mine) (which is less than 10,000 for this year) Then, it says I qualify for medicaid. I’m confused, I want to cry, and to be frank I am scared of calling medicaid about it because I don’t want to be fined 10,000+ dollars for not having health insurance for the past 4+ months. If I need to go on a catastrophic plan or something, it will be costing me 270+ a month (which is half my paycheck essentially) for health insurance anyway because I pay for my therapy myself, which is 200, so adding 70 or more dollars to that (that basically don’t help me with any immediate thing) won’t help me anyway.
What should I do?
ObamaCareFacts.comThe Author
If you live in a state that expanded Medicaid you 100% do qualify for Medicaid. Go back and get a better explanation from them. For both we are talking projected MAGI income. If you are off by just a little bit you can do a number of things to reduce your income or increase it. The line is very thin so if you are on it there isn’t much you need to do to balance out either direction. Don’t give up. Just get on the phone with Medicaid and healthcare.gov until you get the answer you are looking for!
Ursula
I live in La Crosse Wisconsin. I got free health denied supposedly because Im not a citizen or an immigrant. But I am a permanent resident with a green card. I had my daughter in California and I got free health. Didnt pay any bills for labor or anything. Why did they denied me? I definitely dont make enough either.
Alexandra
I used to live in WI & am a permanent resident, as a permanent resident I did not qualify for state health insurance or subsidies no matter how low my income was because I was not a U.S. Citizen however when pregnant & low income I did because I was carrying a U.S. Citizen in my belly. Your kids should qualify for badger care but you won’t. I had to get insurance through the marketplace.
John
Last year I qualified, this year I made about the same amount of money, but got a cancelation as of 12/31/15. Totally blind sided. What can a person like me do? I am single, a food server, and have health issues. Feel like an invisible man
Isabel hayes
Hi,
Currently my husband I have insurance through the marketplace. We have 3 children who used to be on Medicaid, were kicked off, but 2 have since been reinstated on medicaid (ages 3 and 4). My 10 year old was denied medicaid coverage at the end of November and that makes her 3 months without coverage. Last week they sent us a letter saying she now qualifys for the states kid coverage at $300 a month. I don’t even pay that much for my husband and I combined and absolutely no way to pay an extra $300. I’m not even sure how to fix this. Why would they accept 2 kids on state insurance and not all 3? Our state opted to not expand Medicaid (good ole Florida)
ObamaCareFacts.comThe Author
All states do CHIP, they just didn’t expand Medicaid equally to single adults, teens, and parents. So what is likely happening is your children are phasing off of CHIP. As they phase off of CHIP they will have no coverage options unless you guys can qualify for Marketplace cost assistance. It doesn’t sound like you would be too far off the 100% poverty level given the information about your kids. So do look into options at HealthCare.Gov for those who aren’t qualifying for CHIP.
Beckia
I have a disability and got fired because of it and now my Medicad/Fedelis was canceled … What can I do to get this back on track … I mean are they even allowed to do this?
New legal Green card holder
Hi,
I am 61 years old and just received my permanent residency “green card” in October 2015 (sponsored by my son who is a citizen). I receive rental income from the home I rented out in my country of origin that translates to about $703/annually in US dollars
I am being told I will not qualify for both regular Medicaid or expanded Medicaid till I have 5 years residency in the US.
Will I qualify for Obamacare low cost coverage or lower premiums?, My son supports me with all my needs till I can get a job.
.
ObamaCareFacts.comThe Author
If you pay taxes in the US you can qualify for tax subsidies through a healthcare.gov or state marketplace plan, but you can’t get Medicaid (in most cases) or Medicare.
Eileen
My husband died suddenly in 2013. I have been paying for COBRA since then. My 17 year old daughter also receives Medicaid because of mental health issues. I live in PA and my estimated income for 2015 is $18,746. Because I have a dependent under 19 years old the website stated that I may be eligible for medicaid. I really don’t want medicaid for myself. I don’t understand….my daughter has health insurance. When I restart the process and only apply for myself , I can get a silver plan with subsidies. HELP
Thank you
Patricia Couch
Medicaid sent me forms to fill out, I sent it back filled out with proof of mailing. They claim they never got it, but the post office tracked it and showed they delivered it.
Medicaid still claims they didn’t get it, I’ve been cut off Medicaid. I can’t fill my prescriptions.,
My doctor won’t see me, What am I going to do? I have a home attendant
, I’m about to loose her too.
In NYC
ObamaCareFacts.comThe Author
You have to get back in touch with the state Medicaid department. This likely means getting on the phone and potentially going down there or overnighting the forms again. You need to coordinate things with them ASAP.
Ashley
I recently reapplied for Medicaid for my 2 children. My youngest was approved while my oldest (6yrs) was placed on medically needy. I got a letter from Florida Kid Care saying congratulations child 2 is qualified for Florida Kid Care with a monthly premium I just can’t afford. I don’t understand how 2 kids in the same house with the same income can get two different eligibility decisions.
ObamaCareFacts.comThe Author
CHIP is based on age. So the younger they are, the higher the eligibility level.
Chris Swain
Hello I got an email saying I needed to apply at the marketplace I’m currently insured by blue cross blue shield north carolina and my 3 children one being my step child all currently have medicaid. During the enrollment process I was told myself and my stepsonweren’t eligible for medicaid which of course I knew I wasn’t but how can it possibly be that my income didn’t change my wife doesn’t get child support my 2 other children living in the same household were told they may be eligible for medicaid and he is not? Then I get a letter saying Denial of help for the 3 of them reason listed that they’re all already being helped, well of course they are so why in the world did i get an email saying to re do the whole marketplace annoying process if i didn’t have to reapply for their medicaid? Are you supposed to re apply for medicaid for your children at the end of the year in NC or are you not? Obamacare has done NOTHING but make this into a bigger mess and hurt middle class hard working Americans income too high for free healthcare yeah right all you look at is gross income what about all the money on bills and rent and on top of that a fine if you can’t afford health insurance what a joke…….
ObamaCareFacts.comThe Author
You would keep updating Medicaid and the Marketplace as income changes and as the children get older. This way they can direct you between Medicaid and a Marketplace plan. It can certainly get a little messy with young kids at certain incomes because who qualifies for what keeps changing. It’s not perfect and can be frustrating, but it’s good to remember that the core program here is one that is offering free coverage to those who cannot afford it. When things get confusing call both your Medicaid state office and HealthCare.Gov to get it back under control.
Craig
I am self employed. I have a family of 7. Children ages 0-11. I know I can buy private insurance, but thanks to Obamacare, my 2014 plan that I paid $575 / mo is now $1,100 which I can’t afford. I don’t want Medicaid or Chip. We were enrolled for 2015 and everything was fine. The entire family was on a Silver plan. Now, when I re-enrolled for 2016, I was told that 1 kid was eligible for Medicaid, another kid for Chip and the rest on my plan. What a joke. I removed the application. I reapplied and made an adjustment (increase) in my income and now it shows all kids eligible for Chip. My question is, how do I get my whole family on 1 plan that I pay for?
ObamaCareFacts.comThe Author
Yeah, this is a weird side-effect of how things work. Essentially your tax family can include children on CHIP and Medicaid. So you’ll get subsidized based off household income and family size. Your kids will get Medicaid / CHIP. The overall value should be in your favor, but you can’t choose to have everyone on a simple subsidized plan due to the way cost assistance and Medicaid / CHIP pair together. Make sense?
Craig
Thanks for your comments. I hope you don’t mind a few questions.
1. So if my results say my kids “May be eligible for Medicaid”, what happens if they get denied by Medicaid? Do they then get pushed to CHIP?
2. I hear that it can take up to 30 days and sometimes longer to get results from the State. If that is the case and my wife and I already bought marketplace insurance, do they qualify for “special enrollment” so they can get added to my insurance? What if it takes until Feb?
3. If they get denied and put back onto my insurance, would they increase my tax credit?
I just want to add that I have called the Marketplace # and spoken with different people and have gotten different answers. I also want to make a comment about a previous post about having a baby during the year and losing your insurance. This happened to us as well. We were told in Aug that we needed a new application and that we would lose our insurance and deductable since we would be on a new plan. I demanded a Supv. and she confirmed that info. We ended up hanging up the phone and not signing up the baby until 2016.
Thanks again, so much.
Scott
My father, a 60 year old man living in the state of New York, who is disabled with Multiple Sclerosis as well as Bipolar Disorder is unable to work or care for himself with declining mental capacity has recently been declined medicaid. He has exhausted his funds on a nursing home and at the end of the month will be evicted. He has no other resources or family who will help him and needs several prescription medications as well as full time care. What are his options?
ObamaCareFacts.comThe Author
New York expanded Medicaid so he should call the New York state department of Medicaid. https://www.health.ny.gov/health_care/medicaid/
Mike Glaske
My son was receiving medicaid coverage, but received a letter informing him that he was no longer eligible, due to an increase in income, effective 12/1. He has signed up for Affordable Heath Care, through the open enrollment process. However, the new heath care won’t take effect for another month. What is he suppose to do for health care coverage for that time period?
ObamaCareFacts.comThe Author
When you are in between coverage there isn’t really any options outside of short term (this is where short term actually shines). Since there isn’t a solid answer this is perhaps a question to pose to the state medicaid department. They may have a solution as i’m sure you wouldn’t be the first one to ask.
With Medicaid, if something bad happens and it costs too much he can re-retroactively qualify for Medicaid. So depending on the assets he has, he could essentially have a sort of catastrophic buffer due to the way Medicaid works. Again, if you want to ensure his coverage short term will work.
Joseph
I am one of thousands in new york state which has an opportunity to get health care coverage but when we apply for it we have no way to find out the exact details. Aetna is our provider but they can give us the plain ‘jane’ description of what is covered.
joseph
I had meant the The Aetna can’t give us the details of our coverage.
ObamaCareFacts.comThe Author
Well just knowing how the ACA works the new coverage will likely start Jan 1st, 2016 (and Aetna should be able to give you any details you need, HIPPA protects you… not their ability to talk about the contract you signed with them). Aetna can also sell you a short term plan for the month. And DO at least call Medicaid to get their advice.
ObamaCareFacts.comThe Author
That sounds like a red flag. Under law you are entitled to a summary of benefits. And then there is typically a more detailed write-up that goes with that. You can get their drug list and their network list.
Some details change, but this sounds fishy. Maybe they can explain exactly what they won’t give you.
If they can’t provide this: https://obamacarefacts.com/summary-benefits-coverage/
I’d double check you really did sign up with Aetna by calling the official number. Unless their answer is that the marketplace hasn’t confirmed coverage, or something of that nature, it just raises a red flag.
Linda Kline
I was on Medicaid and after the last review they sent me a letter that I was no longer eligible as I made $399 too much. My children are still covered, so I am happy with that but what am I supposed to do now?? I can’t afford any out of pocket for medical care or prescriptions so I will have to stop taking ALL medications,
ObamaCareFacts.comThe Author
The simplest answer is to make $400 less, or to take a $400 deduction (it’s hard to make a specific suggestion without knowing details). Telling people to make less, or more, or to find tax deductions isn’t always the most popular advice. But it’s almost always the best advice.
Cheryl Cook
We were just denied for recertication of Medicaid. My boyfriend is type 2 diabetic and our daughter is in need of braces badly on top. Her consultation is the end of next month and benefits expire on the 1st. We can not afford medical coverage much less out of pocket medical expenses such as the ones previously mentioned. What are our options if any?
ObamaCareFacts.comThe Author
It depends upon what state you live and and what the denial is for. If your state didn’t expand Medicaid you can use the denial to get catastrophic coverage (which may not be the right thing for you here). If you make over 100% FPL you can look into Marketplace cost assistance options through HealthCare.Gov. Also, your child may continue to qualify for CHIP even if the rest of the family doesn’t. Check the guidelines for your state by googling “YOUR STATE” and “medicaid”, that will take you to the right medicaid.gov page. For instance here is the page for Washington: http://www.medicaid.gov/medicaid-chip-program-information/by-state/washington.html
Patricia Brill
I live below the poverty line, was denied food stamps. Yet went to the grocery store, when acouple used food stamps purchasing a 40.00 ham and thick steaks, and went out to get into a brand new truck.
fromTEXAS
in 2015 we were a family glitch and only my husband had insurance not me but we had all our 3 children on CHIP, and considered only my penalty. Then in August my husband lost his job (and insurance) and my oldest child aged out of CHIP in September and she got herself a job and goes to college part time. Between my husband and I we are now averaging lower than his previous income with all sorts of part-time gigs. Our CHIP was up for renewal in October and got cancelled based on too much money now that my daughter started working in September and is still part of the household at the age of 19, and my other 2 teens too, with tiny incomes from part-time jobs. They won’t make more than 2000 a year combined. And the 19 year old won’t make more than 6000 a year so they tell me dependents don’t have to claim if they make less than 6000. But even if they did, it still too low to get kicked out of CHIPS. Well the denial landed us a placement in the marketplace, before it would not allow us to enroll the kids. We projected for 2016 (without kids income) and everyone is enrolled now but it says that if we end up qualifying for CHIPS we will owe their premium assistance. WHAT? how do we even verify or do that? Re-apply or what? I don’t even understand how we were denied to begin with, because the CHIP’s website says to calculate either monthly or yearly income. Even with all the new incomes we still don’t equal to what my husband made before and we had been using CHIP for 3 years. Maybe they were making the decision based on a yearly income and up to August he had a good paying job , plus the kids, plus my income. What if 2016’s calculation WOULD qualify us but we are already enrolled in the marketplace. `
ObamaCareFacts.comThe Author
People shouldn’t’ be in a confusing situation like this over healthcare. But we have to deal with reality. If your income is above 100% FPL with the full family included then you have the right to marketplace cost assistance and don’t have to get CHIP. If the kids are going to be on CHIP, then you can not file for them (if you truly don’t have to claim them) and base cost assistance on your tax family (cost assistance is always based on tax family).
If someone phases off of marketplace cost assistance for Medicaid because their income is too low they don’t owe money back (only owe money back if it is too high).
The key here is projecting your household income and understanding where it lays on the federal poverty level. You should review these pages:
https://obamacarefacts.com/federal-poverty-level/
https://obamacarefacts.com/modified-adjusted-gross-income-magi/
https://obamacarefacts.com/advanced-tax-credit-repayment-limits/
fromTEXAS
yes,yes,yes in the previous 2015 open enrollment we were not allowed to include them in the marketplace because they had an “insurance offer” through their dad’s job, but we were referred to CHIPS and we qualified. Then during re-enrollment CHIPS cancelled us, who knows why, maybe because the kids got jobs (but still not averaged a family income of when we were CHIP qualified). Then for 2016 MP open enrollment, we were able to sign the whole family (no more family glitch, no more CHIP) but we were told that if we qualify for CHIP now or later then we would be responsible for paying back the cost assistance, because the kids would have been ineligible for those subsidies. Our projected 2016 income will be over 100% FPL but it WILL also be very low enough to qualify us for CHIP again. It is the same income as of October, which is when we were cancelled by CHIP for making too much money. We are filing jointly, with 3 dependents who we were told are not supposed to file because they earn less than $6,200 a year, but even if they count their money it is still low enough as per CHIP website guidelines but we don’t understand what happened. I don’t know how does one know. Do I keep applying and applying for CHIP, maybe in January it will be a whole new year therefore a whole new income for them to consider. Do I leave it alone since the marketplace asked if I had been recently denied CHIP and therefore made them eligible, but maybe it matters because we were denied in Oct 2015 and the MP coverage is for 2016 when we will possibly be in CHIP-qualifying-mode. None of us have any insurance offer from any other source and I don’t want to owe the unknowingly undeserving cost assistance.
Kimberly
Hello! I applied for medicaid in New Mexico and they rejected me because I’m a permanent resident and I haven’t been a resident for 5 years. The problem is that I’m a college student and I cannot afford to pay for insurance, so I cannot have medicaid and I cannot pay for insurance. I don’t want to be penalized for something that is not my fault, What should I do?
Thank you!
ObamaCareFacts.comThe Author
You won’t qualify for Medicaid unless you have been in the country for 5 years (in almost all states). If your income is low enough you qualify for an exemption from the fee, in some states getting rejected from medicaid (and having the letter of rejection) will also qualify you for an exemption. Learn more here: https://obamacarefacts.com/obamacare-exemptions-list/
Sarah
I was accepted for Medicaid in our state. My children were denied. Their father and I live together, but we are not married. I claim both kids on my taxes. The state considers me as a family of 3 and my children as a family of 4. Since I qualify for Medicaid, when I apply to get them insurance through the ACA they don’t qualify for any subsidies. Making their premiums not affordable. Since I claim them I am federally responsible to make sure they have insurance. How is someone who qualifies for Medicaid going to afford purchasing full premium plans for 2 children?
ObamaCareFacts.comThe Author
What you qualify for is all based on tax filing. So if you are going to file taxes on behalf of the kids they will qualify for CHIP and you will qualify for Medicaid (assuming since you already qualify). Increasing your family size is only going to qualify you for more assistance, not less, in regards to Medicaid in a state that expanded or CHIP. So they won’t qualify for marketplace subsidies, but should by all means qualify for free or low cost coverage through CHIP. Talk to your state Medicaid office to get them enrolled.
Brian Cox
Colorado State sent a letter stating we we are on medicaid after we had already been denied 2 previous times we applied we were paying for insurance and are now double covered? We never received a letter stating that we had been approved we only applied the 2 times and received denial letters both times because we made too much money. The State said that we needed to come to their office and complete the medicaid paperwork? How could we have been on Medicaid without the paperwork being completed? So my wife went to the office showed them the 2 denial letters they refused to hear it and told my wife that she had to cancel our private insurance. Private insurance that was paid for by my wife’s employer an option which us no longer available. So now the state 7 months later drops us off of medicaid 3 of those months we were supposedly on Medicaid we were on private insurance no reimbursement of course for the double coverage. Now we have been informed that my 10 year old son is covered on Medicaid after we received a notice we have been dropped off of Medicaid c’mon Colorado State get it together already. We are now shopping for insurance we can’t afford and we will cover all 3 of us regardless of what the State say’s if they contact us to tell us he is double covered we will refuse to remove him from private insurance and have them take us to court and let a judge sort out the ineptness of this entire incompetent Quagmire.
Sara
I don’t make enough for ACA yet I make too much for Medicaid. I live in Texas and they don’t offer expansion. Yes I know I won’t get penalized at the end of the year however in order to work full time at work the law required me to be covered. My work doesn’t offer insurance so they are telling me after five calendar months my hours will be cut. How does this help? How do I get covered if I don’t qualify for either program?
ObamaCareFacts.comThe Author
If you make less than 100% of the poverty level you are also below the tax filing threshold and thus exempt from the mandate to get coverage. If you make over 100% and your employer doesn’t offer coverage than you can get marketplace insurance with cost assistance during open enrollment.
Tiffany Kreider
The welfare office is not aware of being able to apply after rejection of Medicare . If they were my husband would have been on your website and would have applied to obamacare for insurance outside of open enrollment and then had insurance. We talked to 4 different people during the process. And not one mentioned the possibility of taking the rejection letter and applying. In fact the opposite is true. They told we would have to wait for an open enrollment. We are very disappointed with their knowledge and training.
ObamaCareFacts.comThe Author
Being rejected for Medicaid (not Medicare) in some instances will get you a special enrollment opportunity, but not in all cases. In some cases it will get you catastrophic coverage, but not in all cases. In some cases it will get you an exemption, but not in all cases. Most of this is explained on the. When in doubt call HealthCare.gov directly. If you feel like you aren’t being helped properly try again or try getting live help or chatting online with healthcare.gov. Not every navigator is going to be a rockstar, but in our experince they are pretty well versed in the ACA.
Rhonda Hayes
They just threw me off medicade ,I have had it since I was disabled now they said I’m not eligible any more,I have a knee surgery coming up in like 15 days just had surgery on my right ankle and am in pyhsical therapy, I’m not a well person now I have to quit p.t. I can’t afford any kind of a co-payment I live on 730.00 dollars a month why do they say Im not eligible I’m in and out of the hospital all the time I’m terminally I’ll with hep-c I also have copd this
Pat
I received a letter from NJ Medicaid saying that my coverage was being terminated because I did’t respond on time to a request for information to renew my coverage (and the letter saying I wasn’t on time was dated 3 days before the due date for the form). It said I would have to request a hearing and go before a judge to have my coverage continue. Can’t I just reapply? It seems like a waste of everyone’s time and unfair punishment to go to court?
ObamaCareFacts.comThe Author
You are right, that does sound like an unfair punishment and a waste of tax payer money. It almost seems purposely designed to disincentive low-income individuals in New Jersey from actually benefiting from Medicaid.
You should call your state Medicaid department and try to appeal to them or sort it out first.
Brandi
I applied for obamacare last year during open enrollment and recieved notice saying I didn’t make enough money for obamacare and that I qualified for medicade in Arkansas and that I would hear from the state medicade office.. I waited 2 months to hear from them and never got a letter or anything.. called the number that was given to me in the notice from healthcare.gov and medicade says I make to much money so I’ve been stuck all year no insurance and gonna have to pay a fine when I tried to get the insurance that is being required and wasn’t able to. Why is that ??
ObamaCareFacts.comThe Author
If you have the notice from the Marketplace and the denial from Medicaid you can most likely get exemptions for these. Gather the documents and then apply for an exemption based on this through HealthCare.Gov. We can say that you will get one, or that it will cover the whole year without knowing all the details. But this would be the smart move for you.
Adriane Hoyt
I was cancelled from Medicaid but my 2 children were not, and have to pay a high premium for them that I can barely afford. My husbands work only offers insurance to him. The marketplace is offering $300/month or more plans… I don’t see how this is affordable.
ObamaCareFacts.comThe Author
Medicaid and CHIP have unique eligibility levels in many states. If your state did not expand Medicaid you may find a scenario where your children can stay on CHIP but you can’t stay on CHIP or Medicaid. If your household income is between 100% of the poverty level and 400% you can get cost assistance on the Marketplace as an individual or you can switch you and your kids over to a family plan on the Marketplace. If it is not and your state rejected Medicaid you may have no options outside of a full priced plan inside or outside the Marketplace.
Carlos
My wife received an enrollment packet from illinicare in April 2015. She tried using the card at the doctor August 2015 and got denied. We called illinicare and they said they made a mistake by sending her the enrollment packet. That she didnt qualify because i made too much. So because of their mistake, my wife has not had insurance since April 2015. What can I do to not get penalized and enroll her in obamacare.
ObamaCareFacts.comThe Author
You should be able to apply for special enrollment. Make sure to have the documentation that shows the denial. There is a window of opportunity for special enrollment of 60 days. You should contact the Health Insurance Marketplace immediately to get new coverage.
Andrea Bowers
My husband and I just moved from NYC to Nevada and lost our precious insurance as a result of the move. It’s September I am just over 4 months pregnant and his job won’t enroll us in insurance until January. I am not working. We applied for obamacare. Only to be told to apply for Medicaid. We did that only for them to basically laugh in our face and tell us we make 1500 + over the salary maximum for Medicaid. Well we sure can’t afford a $700 per month insurance payment with a 10,000 deductible. Nor do we qualify for any obamacare program nor Medicaid. So… Why will we get fined for having no insurance and get billed over 30,000 at the end of all of this for prenatal and delivery expenses. This country’s medical system is a joke. Only help the people who work off the books and work the system or the immigrants who live off welfare for generations!! Never help the hard working middle class who just need a helping hand for a short amount of time and only with insurance expenses. Joke!!
Ed
“Being denied Medicaid or CHIP will likely grant you access to a special enrollment period.”
The operative word here is “likely”. In what situation will being denied Medicaid NOT qualify you for an SEP? Obamacare Facts doesn’t give us any clue. Would be nice if they gave us the entire story.
ObamaCareFacts.comThe Author
Thanks for the comment, we updated the page to try to make it clearer.
The answer is that there are many complex situations (that we have seen mentioned in a number of HealthCare.Gov documents). We don’t have an exact list of all complex situations and if they qualify for SEP, exemptions, and/or catastrophic coverage. Instead of providing the wrong advice, we wanted people to be aware of the situation and give helpful tips.
Zach
I have a client (I’m a producer out of Oregon) who I placed with Medicaid, then was cancelled after being found ineligible upon renewal, June of this year. This was for her and her family (husband and two children). She spoke with a local intake coordinator at our local clinic that also handles Medicaid enrollments and was encouraged to reapply in August. She did, then received a rejection notice dated 9/3.
She’s at about 145% of FPL so her children still receive CHIP. Would her and her spouse be eligible for an SEP with a 60 day window from 9/3? Oregon is an expansion state and this family above 138% FPL so I’m guessing no but I’m seeing too much conflicting information on this and would like to be sure. I tried the FFM call center. The representative I spoke with didn’t know either. Thanks.
ObamaCareFacts.comThe Author
When she was canceled in June it triggered a 60 day special enrollment window. If the marketplace had told her to reapply this may have extended the window until the next rejection letter, since it was an outside source we aren’t as sure. It seems like a grey area, but I don’t see a specific reason why she would have zero coverage options through the marketplace within 60 days of the 9/3 rejection. She should for sure call the Marketplace and attempt to enroll in special enrollment using the 9/3 rejection letter. They may say no, she may find out about an exemption, she may get offered catastrophic coverage. There are a few good things that could happen.
Not saying
I use to live in carthage then i moved to tyler around january And I was on Medicaid untill march. I didn’t receive the notice to re apply. Later I found out that for some reason the mail people where I live won’t put my mail in the box because it doesn’t have my name on it. I tried to reapply twice but for some reason it’s a lot harder here in Tyler versus in carthage. The lady who interviewed me got a huge attitude with me and well it was a lost cause. For a week straight I called to have a differentially interview me and no answer. My child’s went out on july. And I decided to try and reapply for both us. We have been denied twice. And have been denied chip also. I don’t work.(it would cost more money for me to work then stay home) I live with the child’s father and they won’t stop putting him on my case. We live pay check to paycheck. We aren’t married either. I have no idea what to do. He would put us on his insurance but my child alone cost more a month than what he makes so what do I do now. I’m in need of birth control. I’m also only 19. Any suggestions
ObamaCareFacts.comThe Author
Tyler and Carthage Texas? I will assume yes, and give you feedback accordingly. Texas didn’t expand Medicaid and thus has some fairly stingy Medicaid eligibility rules. The ACA was meant to expand Medicaid to all adults below the 138% poverty level ensuring that everyone had access to affordable coverage.
That being said as a single mother with no income you should qualify for CHIP in Texas. You really do have to be claiming just about 0 income to meet this requirement, but you should meet it and should not be being denied CHIP. You should appeal the decision and get a written letter explaining why you have been denied despite being a single mother with no income.
One could argue that what you are facing is discrimination based on your income and family situation. But, for you your best bet will be to get that denial letter, appeal it, and make sure that you and your child get the CHIP coverage that you are due.
http://www.medicaid.gov/medicaid-chip-program-information/by-state/texas.html
Pam
I make 16.00 too much per month on Social Security early retirement to be att 138% poverty level. Anything I can do? Thank you for any responses.
ObamaCareFacts.comThe Author
Yeah 100%, you simply need to take an average of over $16 a month in tax deductions. Remember the 138% is based on MAGI and increases every year around January 20th.
Turbo tax loves to write articles on different tax deductions you can take. Medicaid and Social Security may affect some of the deductions you can take, but considering we only need to offset $16.00 a month it should be doable. Please post your solution to share with others if you find one.
Ideas off the top of the head include starting your own small business and attempting to earn money, this will allow you to set up an IRA and deduct business related expenses and losses. You may even find yourself having fun and making that bit of extra money that makes a Marketplace plan more attractive than Medicaid over time.
Amanda
My husband purchased a platinum policy for our family of 3 during open enrollment. We had a baby in July and are now being told that we have to be denied by medicaid in order to add my daughter and that we will need to purchase an entirely new silver policy for our family (which would make all of our deductibles start over).I really hope this is not the case and would really appreciate some guidance. I live in Texas and have no idea who else to contact.
ObamaCareFacts.comThe Author
When you have a child that is a “qualifying life event”, that means that you qualify to add your baby to your silver policy via special enrollment. Also since your family size would have just got larger you most likely also qualify for cost assistance.
Not sure where you got the bad advice, but you’ll want to call HealthCare.Gov ASAP to get your new family member added.
ps. Being denied Medicaid is a “qualifying life experince” if your state didn’t expand Medicaid (Texas didn’t), but in this case it isn’t required.
Amanda
I appreciate the quick response but the “bad information” we received was given by a HealthCare.Gov representative when we called to report the birth of our child and add her to our policy. Can you provide a telephone # to call and speak to someone that is aware of the correct way to handle the situation. I’d like to get this resolved as quickly as possible. Thank you!
ObamaCareFacts.comThe Author
That is unfortunate, at the end of the day navigators working at the Marketplaces are still human. I would assume they just got confused. Just call the number below again and give it another try.
Qualifying life event = Having a baby, adopting a child, or placing a child for adoption. Enrollment window is up to 60 days after the event.
1-800-318-2596 (TTY: 1-855-889-4325)
Available 24 hours a day, 7 days a week.
Closed Memorial Day, July 4th, and Labor Day
https://www.healthcare.gov/contact-us/
James
People are getting bad advice from the representatives at Healthcare.gov. Also known as the Marketplace. General Dynamics Information Technology has a contract with the government for the Healthcare.gov call center. General Dynamics hires felons on a regular basis during Open Enrollemrn. I’m all for second chances, but they hire anyone. This includes felons that have been convicted of identity theft, stealing Social Security numbers, and writing bad checks. My best advice for the ACA is to NEVER call the Marketplace if you don’t have to. It’s unfortunate but true.
ObamaCareFacts.comThe Author
Just Googled this, you aren’t wrong. I do think that discriminating against people for having a criminal background is unfair, I actually have no problem with tax dollars indirectly going to people who are trying to get their lives together. However, helping people with detailed ACA related stuff can be a tall order for anyone and I can see how things could go wrong. Also… seems like the wrong job for someone who had been convicted of identify theft despite my stance. I wonder how true that is, do you know this stuff directly or is this from a media outlet?
I will tell you, there is nothing easy about giving ACA advice, so power to anyone who is willing to do the job. Hopefully the parent company is doing theirs and keeping some quality control.
Virgil Bromaghin
I was denied because I was told I didn’t prove I was poor.
So I looked up my social security number at social security and found out I was poorer than I ever thought.
Tell me how in 5 years, making only approx. $500 I can be denied coverage, but you still want to fine me for not having insurance which you refuse to give me?
ObamaCareFacts.comThe Author
If that is your income then you would only be denied coverage if your income was too low and your state didn’t expand Medicaid. Also you won’t owe the fee if your income is low enough.
Sounds like you should get on the phone with HealthCare.Gov and get this sorted out.
https://obamacarefacts.com/federal-poverty-level/
Heather
Hello. I had medicaid coverage through New Hampshire but I no longer qualify going forward. Open enrollment for Marketplace is of course closed. What can I do to get health coverage until open enrollment starts again?
ObamaCareFacts.comThe Author
The only way to get coverage outside of open enrollment is Medicaid/CHIP, employer coverage, and special enrollment. https://obamacarefacts.com/special-enrollment-period/
Losing Medicaid gives you a 60 day window to enroll in a plan via special enrollment.
Anna
My mother was denied medicaid coverage in Maryland because she has medicare part a and d. However, she doesn’t have part b, medical insurance. She cannot go to the doctor. She is disabled and meets the income requirements for Medicaid. She doesn’t qualify for the exchanges, I know dual eligibles exist and are covered by both Medicare and Medicaid. Is this not the case in Maryland?
ObamaCareFacts.comThe Author
Glad you asked. Medicare Part A and Part C are “minimum essential coverage”. Those are the types of coverage you need to count as “having coverage”. These are also the types of coverage that prevent you from getting cost assistance on a Marketplace plan. It’s illegal to sell non-Medicare plans to Medicare recipients with these Medicare types. I think Medicaid works the same way. You are most likely being denied for having part A, but are getting a standard denial that says part A & part B.
You can also call your state Medicaid office and ask them directly. She may be able to get Part B, but simply owe a larger amount due to Part B premiums increasing over time if one doesn’t get it. She can call Medicare to inquire about that one.
shannon martin
We have been denied Medicare and can’t get anyone that can help me!!!! We need insurance as my husband’s work does not offer insurance, what do we do
ObamaCareFacts.comThe Author
For Medicare you can appeal a denial: http://www.medicare.gov/claims-and-appeals/file-an-appeal/appeals.html … However no citizen over 65 should be denied Medicare without a complex situation. If you were denied for a disability you can appeal the decision if you think it is wrong.
For Medicaid you can also appeal a denial: http://www.nolo.com/legal-encyclopedia/how-appeal-denial-medicaid-non-eligibility.html … If your state didn’t expand Medicaid, then you have to meet eligibility guidelines, but a denial will allow you to get an exemption and shop for catastrophic coverage through healthcare.gov. If your state did expand Medicaid, then to be denied you need to make more than 138% of the Federal Poverty Level and should be shopping on HealthCare.Gov.
Lacy
My husband and I, along with our 3 children were denied Medicaid because of income. My husband is a type 1 diabetic and my daughter has hydrocephalus which has required 2 brain surgeries in her short 7 years. We were referred to the marketplace where I applied and was told we didn’t qualify for a special enrollment period because they don’t accept Medicaid denial as a valid exemption. I was informed that my family of 5 would have no insurance until Nov 1 when I can apply within open enrollment. Correct me if I’m wrong but isn’t being denied for Medicaid the same as losing insurance? Why can Joe next door lose his BCBS and qualify for special enrollment but we lose Medicaid and don’t qualify?
ObamaCareFacts.comThe Author
You may have explained it to the Marketplace in the wrong way, losing Medicaid should count as losing coverage. It would be simply being denied that wouldn’t count. Maybe the explanation below will help.
If you are denied Medicaid in a state that didn’t expand then: Being denied Medicaid qualifies you for an exemption from having to obtain coverage (you can take this on form 8965). It should also qualify you to buy catastrophic health coverage outside of the Marketplace (although the Marketplace has to sign off on it first).
If you are denied Medicaid in state that did expand, and didn’t perviously have Medicaid, then it does not trigger any event (special enrollment or exemption). If you are dropped from Medicaid, after having it, then it counts as losing coverage and should trigger a special enrollment period.
The idea here, we believe, is to avoid the loophole of someone simply waiting until they need coverage, getting denied from Medicaid, and at that point picking up a health plan.
Kimberly
I had a gentleman who lost his job in May, and so his medical coverage ended then as well. He was sent to the local public aid office to apply for Medicaid, but he was approved for unemployment, so Medicaid sent him a denial letter June 26. He contacted our office for an appointment to sign up in July, but wasn’t able to come in until August 3. We understood that the couple had 60 days from the time of the Medicaid denial letter to apply via an SEP, but we were just told that he actually had to sign up for the Marketplace within 60 days of the end of coverage to qualify for the SEP. Does the fact that he applied for Medicaid and had to wait for a notice from them first not count as a denial of coverage and add 60 days? That’s how I was trained, and that’s the way previous assisters I’ve dealt with on the telephone have understood it to be. Today, I was told that’s not the case. You have 60 days from the time you receive your termination notice to get coverage thru the Marketplace. If you apply for Medicaid first, receive a denial outside that time frame, and do not have time to process the next application and coverage, it’s your loss-basically. You have lost your SEP on the Marketplace and will not be eligible again until the next OEP. Is this true?
ObamaCareFacts.comThe Author
So from what we understand it is 60 days from the time of rejection notice, even if you appeal the Medicaid decision, or don’t receive the letter on time, or whatever. Of course this doesn’t make much sense in cases like this and the way you were trained is probably a more elegant system. But, don’t think this is the way it works with the current rules.
So probably two options here. 1) Apply for Medicaid again and get denied again. Then use that denial letter to enroll in special enrollment. 2) the marketplace has flexibility for “complex qualifying life events”. This sort of confusion and misinformation may be just enough to qualify as “complex”.
You can find all the information we have complied over the years on this page: https://obamacarefacts.com/special-enrollment-period/
Drew
Hello,
Related to SEPs resulting from employer coverage being too expensive –
If I am currently paying more than 9.5% of my annual income for my employer insurance, am I granted an SEP to enroll in new coverage? Can I enroll at any time throughout the year, so long as my employer coverage is more than 9.5% of my income? If my family is on my employer insurance, are they eligible for new coverage as well?
Thanks for your insight,
Drew
Tina
I am disabled i have rheumatoid arthritis Im in bad shape..my husband had open heart surgery. And other bad health issues i am on Medicaid. My dollars was on medicaid they took his away i can no longer afford his medical attion. Or his Medication. He is on 10 prescription. He has cpap i can no longer afford nothing for him i can just pay my rent and behind on that and a 200.00 dollar light bill my husband is just left to die im trying to raise my son 14 no more heart pills blood pressure no nothing i am left with nothing ..our country has went to hell when let your own people die..my husband has a pig valve that has to be replaced but cant because i cant afford insurance and they took away his medicaid im so overwhelmed
ObamaCareFacts.comThe Author
If your husband had Medicaid taken away he has at least 60 days from the time it ended to enroll in a Marketplace plan. If you guys can claim at least 100% of the Federal Poverty Level in income (or you can project that you will) you can get a very inexpensive health plan. Money seems tight, but the savings from a SILVER plan (get a silver plan) at 100% of the Federal Poverty Level will go a long way to helping financially. https://obamacarefacts.com/federal-poverty-level/
Rebecca white
The PROBLEM in Louisiana….expansion cut off at age 64. my aunt is $20 over the state income limits for “dual eligibility” under regular state medicaid. Well under the expansion income guidelines…..BUT turned 65 in March 2016. She was denied. There is NO ACA policy for medicare ppl that she is eligible for… a travesty for the elderly…WHY CUT THE AGE AT 65??? This expansion would have paid her co payments…very expensive and goes up every year. specialists….$45 per visit…sometimes 3 a month…and she has to delay appointments for issues due to the high cots….age discrimination for sure!
Drew
Hello,
What if an individual (who did NOT apply for coverage during open enrollment and would clearly NOT qualify for Medicaid because their income is too high) applies for Medicaid outside of open enrollment and is denied. Does being denied Medicaid, regardless of whether or not you applied during open enrollment, grant an individual an SEP?
Thanks much,
Drew
ObamaCareFacts.comThe Author
You need to a) live in a state that didn’t expand Medicaid and b) make less than 138% of the Federal Poverty Level.
Other factors don’t matter as far as we know. You can check out other exemptions here: https://obamacarefacts.com/obamacare-exemptions-list/
patrick stanish
I applied for Medicaid through Obama care and I had medicaid for a year then it was canceled
ObamaCareFacts.comThe Author
If Medicaid was canceled you can reapply, appeal, and/or you can use the Marketplace to apply for low cost insurance. You only have 60 days from the point of losing Medicaid to make the switch.
Kristen Gurski
I was denied medicaid after not hearing a peep from them for three months. Im pregnant and approaching 5 months or so. I guess everything is ok. At this point i either have to divorce my husband or have my baby in our bathtub. I also find it odd that our family meets the income guidelines.
ObamaCareFacts.comThe Author
You can appeal and reapply to Medicaid. You should call your state Medicaid office directly. https://www.healthcare.gov/medicaid-chip/denied-medicaid-coverage/ (contact number differs between states, so make sure to find your state’s Medicaid office).
Jen
Hi
I’m a British national married to an American. My husband is on dialysis & waiting for transplant. He was refused Medicaid because of me & now he wants to divorce as he needs secondary insurance to cover his transplant, he’s hoping he will get Medicaid once we’re divorced. What a sad situation! Breaking of a marriage so he can get his transplant sorted out! What a heartless cruel system!What options do we have?Please help.
Rose
I am white, I was a single parent of one child for 20 years, no child support, no food stamps and no medicaid, I worked and got no free stuff ever!
michelle mulcahy
I was denied New Jersey Medicaid care. They said I made too much money For me and my son
ObamaCareFacts.comThe Author
New Jersey expanded Medicaid, therefore if you make too much for Medicaid in New Jersey you should look into getting covered through HealthCare.Gov (the Marketplace). You can use the Marketplace to get cost assistance during open enrollment. Since it is outside of open enrollment you’ll need to look into special enrollment periods to get covered. Exemptions from getting denied Medicaid apply to states that didn’t expand.
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/new-jersey.html
https://obamacarefacts.com/special-enrollment-period/
Julia
What about for North Carolina?
ObamaCareFacts.comThe Author
They are still refusing to expand Medicaid.
SingleMomKris
I was just told I don’t qualify for Medicaid because I am receiving unemployment of $350 a week for the first time in 19.5 years. I’ve ALWAYS worked. Now I am a single mom, injured, 3 kids, no job, and they said I have to meet $6800 in unpaid medical bills to qualify. Ok. I’m responsible. I’ve always paid my bills. So now what? I want to cry. I can’t get my surgery without insurance and my unemployment barely pays our rent. We’ll be homeless in 45 days if nothing happens. All I want to do is get better and go back to work!!!!!
CHRISTY
My family and i applied for medicaid and chip in our state ( supposedly they expanded medicaid here) we were denied both options due to income restrictions I go to healthcare.gov they say “I’m sorry you qualify for medicaid in your state” well WTF! I can’t get healthcare anywhere that’s cheap I guess we’re just screwed all the way around! Thanks for everything government!
ObamaCareFacts.comThe Author
Print out that screen, bring it to your state Medicaid office and say “sign me up for Medicaid or the Marketplace”. There are other ways to get in-person help and local assisters too. https://localhelp.healthcare.gov/
You are probably right around the 138% FPL line with household income so perhaps this is confusing healthcare.gov’s screening system. You can 100% get coverage, so just hang in there, get in person help and get coverage. If you do get Marketplace coverage, go with a Silver plan. You’ll get savings on out-of-pocket costs and it will be well worth the slightly higher premium.
kerry
hello; i was receiving medicaid and then it was canceled , we can’t afford obamacare or any other . i had an amputation and they want to take more off . i guess since i’m not an illegal i’m pretty much out of luck and myself and family will die horrible deaths .
ObamaCareFacts.comThe Author
The gap between Medicaid and the Marketplace is a very real and serious issue. Especially true for single adults. Illegal immigrants can’t get Medicaid, Medicare, or cost assistance. Even DACA recipients and new citizens can have a hard time getting assistance for coverage. So to be clear the severity of the issue is very serious.
Chenz
RIP
Bob
We definitely need a better, more affordable healthcare system for everyone.
Someone
As the supply of physicians increases, the cost for their services will decrease.
‘medical insurance’ is not a solution to economic reality.
Step 1. Build more medical schools and/or increase the number of medical school admission seats
Step 2. Increase the # of seats in residency programs
Result 1. increased number of physicians practicing in the US market
Result 2. increased the number of specialists in the US market
The U.S has many medical school candidates who are well qualified to be physicians and are turned away because the number of seats in medical school & in residency has not expanded to meet demand.
https://www.aamc.org/newsroom/newsreleases/358410/20131024.html
An
What does you not being an illegal have to do with anything? Stop bring ignorant! They don’t get help neither. White people get all the help
Mark
Whoever wrote white people get all the help should go down to welfare and check out all the people who are black who receive free health care, free rent, plus an allowance in food stamps on top of it all. I’m white, have been almost homeless with no job and still gotten denied and black people in the same situation as me have gotten everything. So don’t go telling me that white people get it all you’ve got it all wrong and you’re ignorant.
Ignorance hater
Check your facts Sir, Caucasians are the number one race for government aid recipients. Lol. Afterall, whites are the majority. Know your facts.
Becca
Actually, according to my white ex con friend, it was all the white parolees with STDs and/or drug addiction histories who got Medicaid, while most of the black parolees at the same halfway house were ineligible because they did not have a “pressing” health issue like a drug addiction. According to him, more of them had been incarcerated for thug type crimes, whereas more of the whites had been in for drug related crimes…at least at his particular halfway house. As a result of qualifying for Medicaid (due to his heroin addiction history and subsequent Hep C virus), he also qualified for a free “Obama phone”. So he would sign up for a free phone at every one of 20 or so Obama phone kiosks in the city. Then he’d sell the extra phones to the guys in his halfway house who needed a cell phone but didn’t qualify for a free one like he did…and yes, most of them were black not white.
Although my friend’s telling of his story emphasized the racial differences in Meficaid/phone approval, I think it had less to do with race and more to do with the govt coddling addicts. It just so happened that in this particular case, most of the addicts were white and the non-addict ex-cons were non-white.
ObamaCareFacts.comThe Author
Crazy story. Technically you aren’t supposed to just be able to get infinite phones under the program and in most state Medicaid eligibility is based on income only.
This must be a story about a red state, as they are the states that rejected Medicaid expansion. If we assume what you say is true, then we can see that this is one effect of letting the state pick and choose who gets access to healthcare via the Medicaid program.
Melissa
Oh, white people get the help? Hmm, funny. Since I’m a single WHITE mother who has been denied coverage for myself and 2 children. You know what they say when you ASSume… get educated and drop that racist sh*t
Dale Tanner
No they don’t.
Quig
Yes they do get free everything.and all these Indian stores.have you ever wondered why most change management so often? I had someone tell me every 6 months or so they move to another store between family then that other member goes to previous store.they get free interest loans
Angela
Really? I’m white and I got denied. Stop with that crap….it doesn’t matter the color of your skin.
Lisa
White people don,t get all the help I,m white can,t find a job been out of work for nine years were my help . I think if I was darker I would get more help. So start looking around it also white people to that are effective.
ObamaCareFacts.comThe Author
Healthcare assistance literally has nothing to do with skin color, its based on income and family size.
Jules
Kerry, I know exactly,what you mean. I have my mom and dad who’s insurance ( health) is going to cancel out in November 2016. Nothing,like
discrimination against people who have a chronic illness or someone has a disability.In addition their. is an awful,, awful, amount of age discrimination going on here. What needs to be done is a CLASS ACTION,LAWSUIT filed. This is disgraceful. President elect–Hillary Rohdam Clinton recently
stated ” What we need in this country is more kindness and love,” I send you,good thoughts.
Jules
ANGELY
Same here, my husband & I had Medicaid and then cut off because they said “HE” made too much, yeah right !! I can’t tell we are struggling to make it just like everybody else, and they say this is suppose to be a “FREE” country but yet we get penalized for NOT having insurance that should be our decision Obamacare does not make any sense where does this idiot come up with this.. NOT a supporter of neither of them, they do not care about us why should we vote for them for them to screw us over more
Kool Youth
Wait. I thought Obamacare was free! Use the insurance you had before.