medicaid work requirement rules for ACA applicants

[tenant13]

Current monthly.

It really depends on the state. Once the pandemic ended and recertifications started, I couldn't stay on it because the state asked for the prior year's1040. And even though my monthly income was tiny - I do once a year CG harvesting - they kicked me out. NJ uses either monthly or yearly income - whichever they consider more appropriate. It's a case by case situation.

Tbh - it's their loss. They would have gotten every penny back after my death since we have estate recovery laws.

 

[EastWest Gal]

The other issue with the Medicaid work requirement-I've read that the thing that trips people up is that you have to file paperwork (I'm guessing online) proving you worked those 80 hours every month. You get kicked off if you miss a filing. I'd just try to find some volunteer work-help at a food bank or something.

DS is taking a break from trying to find a full time position and working seasonal for a couple of years, maybe turning it into a year round position at one of the local ski resorts or entertainment venues. He has enough invested that he can claim capital gains by selling assets in his brokerage account and then buying similar assets (capital gains harvesting for income reporting) to stay above the 138% FPL. It's seems stupid to do this for health insurance. Many people are applying for hundreds of jobs online and getting nothing. Many of the openings are fake and are designed to give the impression that a business is growing when it is not.

Someone I know moved to Australia and is working there and studying German. His ultimate goal is to move to Germany where he can go to college without going broke.

 

[ivinsfan]

It will be quite the task to track who is working the 80 hours and who is not...even volunteering involves extra paperwork. As for your boy if he wants options and flexibility and HI provided by the government these are the hoops he has to go thru. I'm not sure I understand your point about the guy wandering to Australia and studying German, you can do college in the US without going broke....but good luck to him... its sounds like a great adventure.

 

[Teacher Terry]

If anyone has done volunteer work it’s next to impossible to get 80 hours of work in a month. You would need to volunteer at numerous places and it would be quite the juggling act.

 

[EastWest Gal]

It will be quite the task to track who is working the 80 hours and who is not...even volunteering involves extra paperwork. As for your boy if he wants options and flexibility and HI provided by the government these are the hoops he has to go thru. I'm not sure I understand your point about the guy wandering to Australia and studying German, you can do college in the US without going broke....but good luck to him... its sounds like a great adventure.

He's gay. And he's afraid.

 

[jim584672]

Jim, as you may recall from our discussion in other threads, I joined the NY Essential Plan in April, 2024, when the state expanded its income cutoff from 200% of FPL to 250% of FPL. I was in a ACA Silver plan before

From what I have heard and read here, with my MAGI in the $36k range, it looks like I won't be subject to the Medicaid work requirement. Do you agree?

Yes, Essential Plan is not Medicaid so no work requirement. It is a BHP plan under the ACA.

 

[jim584672]

It really depends on the state. Once the pandemic ended and recertifications started, I couldn't stay on it because the state asked for the prior year's1040. And even though my monthly income was tiny - I do once a year CG harvesting - they kicked me out. NJ uses either monthly or yearly income - whichever they consider more appropriate. It's a case by case situation.

Tbh - it's their loss. They would have gotten every penny back after my death since we have estate recovery laws.

The law states current monthly with a state option, if chosen, to "budget" reasonably forecast-able income, for example a weekly paycheck can multiplied by 4.3 to smooth lumpy monthly income, (some months have 4 or 5 weeks).

 

[perinova]

Tbh - it's their loss. They would have gotten every penny back after my death since we have estate recovery laws.

Unless NJ is very different; estate recovery is usually on costs related to LTC and nursing home.

 

[jim584672]

Unless NJ is very different; estate recovery is usually on costs related to LTC and nursing home.

NJ is very different, they do it for anything over age 55.

 

[bobandsherry]

If anyone has done volunteer work it’s next to impossible to get 80 hours of work in a month. You would need to volunteer at numerous places and it would be quite the juggling act.

Nah, there are many animal rescues / shelters that are looking for all the volunteer hours that they can find. And if they can't find the hours to volunteer, then there are jobs to be found.

 

[perinova]

NJ is very different; they do it for anything over age 55.

I didn't know that, and by the way it looks like the norm. The list below coms from justiceinaging.org

36 states recover Medicaid costs beyond the federal minimum, meaning they may also recover for additional services or from a broader set of assets:

• Alabama, Alaska, Arizona, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Missouri, Michigan, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Utah, Washington, West Virginia, Wisconsin, Wyoming.

These states limit estate recovery to the federally required minimum:

• Arkansas, California, Colorado, Connecticut, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Montana, South Dakota, Texas, Vermont.

 

[jim584672]

I didn't know that, and by the way it looks like the norm. The list below coms from justiceinaging.org

36 states recover Medicaid costs beyond the federal minimum, meaning they may also recover for additional services or from a broader set of assets:

• Alabama, Alaska, Arizona, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Missouri, Michigan, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Utah, Washington, West Virginia, Wisconsin, Wyoming.

These states limit estate recovery to the federally required minimum:

• Arkansas, California, Colorado, Connecticut, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Montana, South Dakota, Texas, Vermont.

New York doesn't recover for the expansion group. Only in a LTC situation. I don't think your list is accurate just off the top of my head from what I know.

 

[GenXguy]

It’s easy to bypass by simply declaring your estimated monthly income as slightly higher than the 138% FPL and that’s what I would do now - there’s no way I’m wasting 80hrs a month for something I don’t want to do.

Under the new law, you will need to provide verification, and you're less likely to get away with providing fraudulent information.

 

[RetiredHappy]

My son who has a learning disability/high functioning autism/ASD, has difficulty holding down a job and has periods of unemployment mixed in with working in minimum wage jobs. It has been such a pain that he gets health insurance through work, then loses it and goes on Medicaid that has a long approval process, then back to another job and 90 days later, gets on employer insurance plan again or sometimes not if he cannot get full time work, rinse and repeat.

With this change, I am thinking that the next time he loses employment, he needs to apply to ACA and declare income above 138% of FPL. His tax return has been above 138% for the past few years, so it should not be an issue. He has a ton of capital gains in his brokerage account - money that I have been gifting each year that is invested, so in the event that he does not make 138% of FPL, we can easily sell some positions to make up the difference. In a way, it's also tax harvesting without the need to pay capital gains tax, something that we have not done for him. He has enough capital gains that he can do it for many years.

Does anyone see an issue with this approach?

 

[perinova]

New York doesn't recover for the expansion group. Only in a LTC situation. I don't think your list is accurate just off the top of my head from what I know.

Apparently, the reason they mention this is because NY recovers 'Medicaid covered services'.
Advocate says NY is one of the most aggressive states for Medicaid estate recovery - Justice in Aging
I am reading different things though and I don't know about expansion group or not. So be careful about my link, you may very well be correct.
Out of the states that recover more than the Federal Minimum only 30 recover Managed Care premium. So maybe this where the difference comes from?

 

[jim584672]

Apparently, the reason they mention this is because NY recovers 'Medicaid covered services'.
Advocate says NY is one of the most aggressive states for Medicaid estate recovery - Justice in Aging
I am reading different things though and I don't know about expansion group or not. So be careful about my link, you may very well be correct.
Out of the states that recover more than the Federal Minimum only 30 recover Managed Care premium. So maybe this where the difference comes from?

I would not agree NY is aggressive on Estate Recovery. It is one of the easier states, no recovery for the expansion group. Only Probate is subject to recovery. Nursing home and having at home nursing is recoverable.

 

[Teacher Terry]

Nah, there are many animal rescues / shelters that are looking for all the volunteer hours that they can find. And if they can't find the hours to volunteer, then there are jobs to be found.

Actually, that’s not true where I live or the other 4 states that I worked in. I spent my career as both a social worker and then in vocational rehabilitation, helping people with disabilities find employment and I can tell you that there are many people that cannot hold even minimum wage jobs and yet cannot qualify for disability because the requirements are so stringent. These people also find it difficult to maintain some volunteer positions.

Agencies that use volunteers can only find so many unpaid low skill things for them to do. They often don’t have staff to train and supervise volunteers either.We would often place people in volunteer positions, trying to help them build work skills and we would actually pay the employer to assist our clients and learning how to become workers. Even with them getting paid it wasn’t always easy to find placements.

If you’re unfamiliar with all the programs, requirements and difficulties many people face It’s easy to make unrealistic judgments. My career was not teaching. It was something I did for fun for a while after retirement. I have 3 graduate degrees in my field.

The paperwork is another hoop that people have to jump through and there will be people that will have difficulty keeping track of what they need to do, filling out the forms or having to use the computer to do so. All they have to do is miss one deadline and then they will be thrown off Medicaid. Some people will have someone in their life to assist them to stay on track but many won’t.

This is being done so they can save money because they estimate that 8 million people will not be able to meet the requirements. Peoples whose hours on the jobs fluctuate according to the season such as casino workers, people employed in tourism, jobs, where people that are caregivers will have some months where they will not have enough hours that they have worked and they may not know in advance that this is going to happen.

 

[Teacher Terry]

My son who has a learning disability/high functioning autism/ASD, has difficulty holding down a job and has periods of unemployment mixed in with working in minimum wage jobs. It has been such a pain that he gets health insurance through work, then loses it and goes on Medicaid that has a long approval process, then back to another job and 90 days later, gets on employer insurance plan again or sometimes not if he cannot get full time work, rinse and repeat.

With this change, I am thinking that the next time he loses employment, he needs to apply to ACA and declare income above 138% of FPL. His tax return has been above 138% for the past few years, so it should not be an issue. He has a ton of capital gains in his brokerage account - money that I have been gifting each year that is invested, so in the event that he does not make 138% of FPL, we can easily sell some positions to make up the difference. In a way, it's also tax harvesting without the need to pay capital gains tax, something that we have not done for him. He has enough capital gains that he can do it for many years.

Does anyone see an issue with this approach?

I’m glad your son has you to help him. After spending 30 years helping people with disabilities obtain employment I can tell you more often than not that people do not have the support that they need.

 

[COcheesehead]

Apparently this provision was around back in the Clinton days too.

 

[RetiredHappy]

I’m glad your son has you to help him. After spending 30 years helping people with disabilities obtain employment I can tell you more often than not that people do not have the support that they need.

I am also thinking that when he applies for ACA, I will sell some of his positions to make sure that he incurs capital gains for that month to avoid being bounced to Medicaid since Medicaid uses monthly income.

 

[Teacher Terry]

Apparently this provision was around back in the Clinton days too.

If true it was a bad decision that hurt people just like it will now.

 

[Irishgirlyc58]

Apparently this provision was around back in the Clinton days too.

I worked in health and human services for over 35 years including Medi-Cal, California’s Medicaid programs. Before the implementation of ACA people between the ages of 22-64 without minor children or disabled were not eligible to federal Medicaid.
In California counties were responsible for providing medical coverage- which was below bare minimum.

There was a requirement for food stamps that able bodied adults meet a certain number of hours of work. I thought that was implemented by GW Bush but it could have been Clinton.
Is that maybe what you are thinking of?

 

[Irishgirlyc58]

Actually, that’s not true where I live or the other 4 states that I worked in. I spent my career as both a social worker and then in vocational rehabilitation, helping people with disabilities find employment and I can tell you that there are many people that cannot hold even minimum wage jobs and yet cannot qualify for disability because the requirements are so stringent. These people also find it difficult to maintain some volunteer positions.

Agencies that use volunteers can only find so many unpaid low skill things for them to do. They often don’t have staff to train and supervise volunteers either.We would often place people in volunteer positions, trying to help them build work skills and we would actually pay the employer to assist our clients and learning how to become workers. Even with them getting paid it wasn’t always easy to find placements.

If you’re unfamiliar with all the programs, requirements and difficulties many people face It’s easy to make unrealistic judgments. My career was not teaching. It was something I did for fun for a while after retirement. I have 3 graduate degrees in my field.

The paperwork is another hoop that people have to jump through and there will be people that will have difficulty keeping track of what they need to do, filling out the forms or having to use the computer to do so. All they have to do is miss one deadline and then they will be thrown off Medicaid. Some people will have someone in their life to assist them to stay on track but many won’t.

This is being done so they can save money because they estimate that 8 million people will not be able to meet the requirements. Peoples whose hours on the jobs fluctuate according to the season such as casino workers, people employed in tourism, jobs, where people that are caregivers will have some months where they will not have enough hours that they have worked and they may not know in advance that this is going to happen.

This is spot on.
I worked in health and human services- social services and employment programs including the Workforce Innovation and Opportunities Act program.
Volunteering sounds great as a sound bite- but the likelihood of it being a viable solution is slim to none.

 

[COcheesehead]

I worked in health and human services for over 35 years including Medi-Cal, California’s Medicaid programs. Before the implementation of ACA people between the ages of 22-64 without minor children or disabled were not eligible to federal Medicaid.
In California counties were responsible for providing medical coverage- which was below bare minimum.

There was a requirement for food stamps that able bodied adults meet a certain number of hours of work. I thought that was implemented by GW Bush but it could have been Clinton.
Is that maybe what you are thinking of?

No, the article I read today said the work requirement was part of Clinton’s administration.
I’ll find the story and post it.

Edit:


The Clinton Administration and Work Requirements:

• The Clinton Administration played a key role in welfare reform, with the passage of the Personal Responsibility and Work Opportunity Act of 1996.
  
  
• This legislation included work requirements for recipients of the Temporary Assistance for Needy Families (TANF) program, which replaced the Aid to Families with Dependent Children (AFDC) program.
  
  
• The Clinton Administration also granted waivers to states to implement work requirements in other programs, including some Medicaid provisions.
  
  
• The Clinton Administration's welfare reform efforts emphasized a "reciprocal obligation" where recipients were expected to work or participate in work-related activities in exchange for assistance.

 

[Irishgirlyc58]

No, the article I read today said the work requirement was part of Clinton’s administration.
I’ll find the story and post it.

Edit:


The Clinton Administration and Work Requirements:

• The Clinton Administration played a key role in welfare reform, with the passage of the Personal Responsibility and Work Opportunity Act of 1996.
  
  
• This legislation included work requirements for recipients of the Temporary Assistance for Needy Families (TANF) program, which replaced the Aid to Families with Dependent Children (AFDC) program.
  
  
• The Clinton Administration also granted waivers to states to implement work requirements in other programs, including some Medicaid provisions.
  
  
• The Clinton Administration's welfare reform efforts emphasized a "reciprocal obligation" where recipients were expected to work or participate in work-related activities in exchange for assistance.

Oh yes- Clinton definitely did that. I remember it well. Still in effect as far as I know.
They are saying that there was a provision for states to request a waiver for certain Medicaid provisions. It was not a nationwide requirement for all Medicaid recipients 22-64 able bodied without dependents.

The TANF work requirements are nationwide.
It created a lot of positions for government workers.
I used to have a book on the success/ failures of the PROWA at the 10 year mark but I tossed it when I retired.