ACA/Medicaid nightmare, need help

[fh2000]

This happened to us in California for the year of 2020. Covered California auto renew process (a little different than OP situation), put us in Medi-Cal because we failed to put in estimated income.
Long story short, I had to call the local county office, Medi-Cal staff to deny our Medi-Cal which then kicked back to Covered California. The whole process took more than a month. Right before January. It was stressful for us.

 

[jim584672]

This happened to us in California for the year of 2020. Covered California auto renew process (a little different than OP situation), put us in Medi-Cal because we failed to put in estimated income.
Long story short, I had to call the local county office, Medi-Cal staff to deny our Medi-Cal which then kicked back to Covered California. The whole process took more than a month. Right before January. It was stressful for us.

If you got on it after March 2020 you would have been locked in for 3-4 years due to the public health emergency.

 

[Golden Mean]

I think I'm 80% of the way back. Here's what I think happened.
Sometime in early Nov (I think) NV ACA automatically submitted my 2025 renewal. When I logged in Nov 16 to do the renewal myself, I saw it. It showed I was approved and showed a subsidy, but I noticed the income was showing $0. So I edited and resubmitted the renewal and all was well. I selected my insurance, got my cards and paid for Jan (I pay a month early).

Yesterday I got a notice from ACA and when I logged in I was canceled for everything due to being on or being available for Medicaid.

Called NV Medicaid (almost impossible to find the right number) and after waiting an hour and half, I did get to talk to someone. They said their renewal from me had $0 income and they did not have any renewal with income on it. And they said they just (the day before) sent ACA my Medicaid eligibility (took them a month). I explained the situation and got them to cancel medicaid for me and send me a cancellation document.

I gave the NV ACA that cancellation letter and the page shows I can now pick an insurance policy and it shows the subsidy, but it also still shows an issue with Medicaid eligibility. Hopefully that will clear out soon.

So I think the main issue here is the ACA automatically submitting my renewal with $0. No idea why they'd auto submit or use no income since I've been in their system for 3 years with income.

Fingers crossed.

 

[Golden Mean]

Following up: The pending status on the ACA application was resolved Friday afternoon. I've paid my Jan premium (again) and I think I'm all set for Jan 1. Getting coverage for Jan 1 was my main concern. I originally thought you had to have applied by early Dec to get coverage Jan 1. Guess not. Luckily.

For posterity, in southern NV, for a Medicaid contact that doesn't require you to already have an account number with them, the number is 702 486-1646. Then select anything because none of the choices will be what you want and I was told all the selections go to the same phone bank. Be prepared to be on hold for hours. I had to specifically request the doc I needed to be emailed. They originally were only going to snail mail me the form.

Next year my plan is to do my application as early as possible. I waited until Nov 15 this year to reduce the chances they would screw up this year's coverage, but that didn't work out well...

Mods: Feel free to add resolved to the title if appropriate/possible. Thanks!

 

[Golden Mean]

So you have net worth of $3M and you are worrying whether you get subsidized insurance on the exchange or Medicaid?

Sorry couldn't let this one go by.

It might be a good idea to pause before posting something like the message above.

a) My income (MAGI) is too high to be on Medicaid, so it would be unlawful for me to do so.
b) I could not get 2025 ACA because they thought I was in Medicaid (for 2025).
c) I cannot get health insurance without the ACA (regardless of the subsidy).
d) Lack of health insurance is one of the few things that could bankrupt me in retirement.
e) No idea where you got $3M. I have nothing near that amount of wealth.

 

[TickTock]

Glad it worked out for you, Golden Mean. Tenacity wins a lot of battles.

 

[MC Rider]

I second the idea of walking into an office. Worked for me with minimal wait. But we are not in a big city.

 

[GenXguy]

I ran into an issue last month where despite entering in $30,000 estimated 2025 income for a single person, I got "referred to Medicaid" because my November estimated income was very low with no option for renewing my marketplace plan for 2025. I had to resubmit my application with a higher November income so that it would let me renew my marketplace plan again this year. I did this within 10 minutes or so of my original application.

What's interesting is that the state later still sent some Medicaid paperwork about a week ago to apply for that, which I disregarded. I just now checked the Healthcare provider website for my account (showed renewal for 2025) as well as Healthcare.gov (showed my approval and premium tax credit amount), so looks like everything is going smoothly because I resubmitted right away when it first tried to direct me to Medicaid.

I posted my original eligibility notice in this thread:

ACA and predicting income (plus avoiding DMI)

Interesting. This is one place I don't gamble since I consider the stakes too high. I would worry I'd somehow become ineligible for ACA if I constantly way under-reported my income which would radically change or end my ER. The biggest concern if you under report income is being placed into...

www.early-retirement.org

 

[robnplunder]

So you have net worth of $3M and you are worrying whether you get subsidized insurance on the exchange or Medicaid?

I bet many here are worth more than that but still qualify for ACA because their income level qualifies them for subsidy. I am one myself.

Op's concern is valid but something I believe will resolve itself.

 

[GenXguy]

Op's concern is valid but something I believe will resolve itself.

The OP actually mentioned a few posts back that they were able to resolve it. ACA/Medicaid nightmare, need help

 

[wolf]

True- which makes absolutely no sense. It should have kicked OP into Medicaid at the time of renewal- that’s how it works typically in California anyway.

Maybe. In California, in called, "Covered California". When I talked to Rep. It's possible to be accepted, but later be denied, and put into Medicare, if ones "income" is to low. I manage my daughter's plan.
However in OP's case. Maybe, there was a "clerical" error. ie. income, household income, dependents, etc

 

[Irishgirlyc58]

Maybe. In California, in called, "Covered California". When I talked to Rep. It's possible to be accepted, but later be denied, and put into Medicare, if ones "income" is to low. I manage my daughter's plan.
However in OP's case. Maybe, there was a "clerical" error. ie. income, household income, dependents, etc

I manage my son’s plan through covered California- no subsidy.
I also worked in health and human services in California for 35 years- which included medi-cal.
It’s supposed to look at your income and kick you into the correct program at the time.
Supposed to as in that’s the way it was presented. I was a director so I didn’t do the hands on work. My job was to know who the experts were and ask them.

I have played around with the income levels on covered California just because I was curious how it was from the users perspective. It seemed to work correctly but then I didn’t execute the action because that would have been a nightmare to get fixed! Maybe there would have been issues at the end.