Medicaid work requirements easy to get around...

[G-Money]

Interesting thread.

 

[Onda]

I recall some forum members are retired early, have tax deferred retirement assets and opted for Medicaid. This may affect them.

It could conceivably require them to return to the work force.

By that metric, anyone not currently working is “early retired.”

On welfare? Early retired.
Living in a tent under a bridge? Extreme lean-FIRE.
No income, no assets, no housing? Congratulations — you have achieved the lowest possible withdrawal rate.

 

[MichaelB]

By that metric, anyone not currently working is “early retired.”

All I am saying is some forum members chose Medicaid. I’m trying to relate the thread topic and show relevance to our forum.

It’s not an easy topic.

 

[GenXguy]

I was kind of surprised by multiple people not getting the point and not understanding the post. Remember, this was discussed in a thread a while back where people were wondering if simply having the income equivalent to 80 hours of work would be sufficient. I looked into this for a friend of mine that sells on eBay, and at that time, I told him he would probably have to track his time for everything related to his eBay sales. Jim's information would imply that's not necessary if he has enough MAGI income.

I think there are probably a lot of early retirees taking advantage of Medicaid. This will make it easier for those people to continue doing so without actually having to work. Sadly, the poor truly disabled (but not legally disabled) will be the ones that suffer from the work requirements.

...just have $580 of income a month. Any income counts!

One thing I would say is that I think the $580 figure for the month would only be in states that have the federal minimum wage, not states like New York and Illinois, where minimum wage is more than double that.

 

[RetiredHappy]

Is this the official and final position, that income of $580 per month would qualify for Medicaid without work or community hours requirement?

 

[jim584672]

One thing I would say is that I think the $580 figure for the month would only be in states that have the federal minimum wage, not states like New York and Illinois, where minimum wage is more than double that.

States may not use their state minimum wage in place of the Federal one, see page 42.

"We further recognize that individual States may have a generally applicable State minimum wage that is higher than the Federal minimum wage (or in limited circumstances lower or no minimum wage). Because section 1902(xx)(2)(F) of the Act references only section 6 of the FLSA (that is, the Federal minimum wage) and does not provide for the use of alternative 42 29 U.S.C. 203(m)State minimum wages, States may not use such State-specific minimum wages in place of the applicable Federal minimum wage to calculate the monthly income threshold for individuals to demonstrate compliance with community engagement under § 435.552(f)(1)."

 

[MichaelB]

Is this the official and final position, that income of $580 per month would qualify for Medicaid without work or community hours requirement?

Medicaid is a federal program implemented by each state, so states can impose the work requirements they feel appropriate, as long as CMS gives a nod of approval.

 

[GenXguy]

States may not use their state minimum wage in place of the Federal one, see page 42.

"We further recognize that individual States may have a generally applicable State minimum wage that is higher than the Federal minimum wage (or in limited circumstances lower or no minimum wage). Because section 1902(xx)(2)(F) of the Act references only section 6 of the FLSA (that is, the Federal minimum wage) and does not provide for the use of alternative 42 29 U.S.C. 203(m)State minimum wages, States may not use such State-specific minimum wages in place of the applicable Federal minimum wage to calculate the monthly income threshold for individuals to demonstrate compliance with community engagement under § 435.552(f)(1)."

Cool. AI mislead me when I fed it the document.

 

[RetiredHappy]

Medicaid is a federal program implemented by each state, so states can impose the work requirements they feel appropriate, as long as CMS gives a nod of approval.

I am interested in California's Medi-Cal rules, and so far they have indicated that they will go to 6-month renewal instead of the current 12-month re-qualification. Don't know anything about whether they will have work/community hours requirement or will go with MAGI as the only income qualifier.

 

[jim584672]

Medicaid is a federal program implemented by each state, so states can impose the work requirements they feel appropriate, as long as CMS gives a nod of approval.

They needed a 1115 waiver before this law was passed. The 1115 waiver is for a demonstration project to improve the program. The law had no work requirement so these waivers were getting struck down in court because these requirements are not designed to improve the program and the courts voided the waivers as arbitrary and capricious.

The OBBBA requires all states to impose "community engagement" by 2027.

 

[jim584672]

I am interested in California's Medi-Cal rules, and so far they have indicated that they will go to 6-month renewal instead of the current 12-month re-qualification. Don't know anything about whether they will have work/community hours requirement or will go with MAGI as the only income qualifier.

Yes, certifications will be for 6 months in all states starting in 2027.

 

[Just_Steve]

Medicaid is bette coverage. Total protection from Provider billing, $0 cost, $1 or $3 Rx, vision and dental, $200 max OOP a year.

You also get perks, like half price Amazon Prime, Walmart Plus, discounts on phone, electric, and Internet.

I think you need to do more research on medicaid adult dental benefits
My quick search:

21 and older

Varies by state

Often limited to emergency services; comprehensive care less common

Medicaid vision is not very good for adults either.

• Routine eye exams: Some states cover annual or biennial exams for adults; many donot.
• Corrective lenses (glasses/contacts): Covered in some states, often with limits (onepair every 1–2 years) or only after medical necessity is shown.
• Medical/diagnostic eye care: Vision services needed to treat an eye-related medicalcondition (e.g., cataracts, glaucoma, diabetic retinopathy) are commonly covered.
• Emergency/acute care: Most programs cover urgent eye care when medicallynecessary.
• Coverage limits and prior authorization: Many states impose limit

 

[jim584672]

I think you need to do more research on medicaid adult dental benefits
My quick search:

21 and older

Varies by state

Often limited to emergency services; comprehensive care less common

Medicaid vision is not very good for adults either.

• Routine eye exams: Some states cover annual or biennial exams for adults; many donot.
• Corrective lenses (glasses/contacts): Covered in some states, often with limits (onepair every 1–2 years) or only after medical necessity is shown.
• Medical/diagnostic eye care: Vision services needed to treat an eye-related medicalcondition (e.g., cataracts, glaucoma, diabetic retinopathy) are commonly covered.
• Emergency/acute care: Most programs cover urgent eye care when medicallynecessary.
• Coverage limits and prior authorization: Many states impose limit

Depends on the state a lot. I had 2 crowns, fillings, X-Rays, cleanings when I had it. Eye exam is not just for a medical condition.

 

[GenXguy]

I wonder if this would work for BadgerCare. @aaronc879 had mentioned work requirements, but maybe showing the $580 MAGI would suffice.

It would be narrow window to have $580 to $1,255 MAGI every single month and risk getting your benefits frozen since investment income is usually lumpy.

 

[jim584672]

I wonder if this would work for BadgerCare. @aaronc879 had mentioned work requirements, but maybe showing the $580 MAGI would suffice.

It would be narrow window to have $580 to $1,255 MAGI every single month and risk getting your benefits frozen since investment income is usually lumpy.

WI has no Medicaid expansion so the income limit is 100% FPL instead of 138% FPL, which is currently $15,960 / 12 = $1,308 a month. They do cover the 0 - 100 range with their own version of "expansion". I guess they didn't want the 90% Federal match.

 

[aaronc879]

WI has no Medicaid expansion so the income limit is 100% FPL instead of 138% FPL, which is currently $15,960 / 12 = $1,308 a month. They do cover the 0 - 100 range with their own version of "expansion". I guess they didn't want the 90% Federal match.

This is an interesting thread. I hope you are right about IRA withdrawals counting as I was under the impression the income had to be earned starting in 2027. I will definitely look closer into this as it gets closer to open enrollment for ACA so I know if I need to use ACA or not. Badgercare in Wisconsin has a premium if you have income between 50-100% of FPL. So I guess I need income between $580/mo and $654/mo to keep Badgercare with no premium. I have enough cash savings that I could withdraw $600/mo for 2027 and 2028 and be good. After that I would likely have to go on ACA. Thanks for this thread. It could be useful for people like me. Most stuff on here is only for multi-millionaires and/or 6 figure earners.

 

[jim584672]

This is an interesting thread. I hope you are right about IRA withdrawals counting as I was under the impression the income had to be earned starting in 2027. I will definitely look closer into this as it gets closer to open enrollment for ACA so I know if I need to use ACA or not. Badgercare in Wisconsin has a premium if you have income between 50-100% of FPL. So I guess I need income between $580/mo and $654/mo to keep Badgercare with no premium. I have enough cash savings that I could withdraw $600/mo for 2027 and 2028 and be good. After that I would likely have to go on ACA. Thanks for this thread. It could be useful for people like me. Most stuff on here is only for multi-millionaires and/or 6 figure earners.

The law doesn't qualify the type of income or limit it to "earned" income. When this was passed last July many people noticed the wording and it was discussed at length on the FIRE related Reddit forums. The recent document guidance merely follows the wording in the law.

 

[zinger1457]

How would one go about showing/proving what their MAGI is? The new rules state that you have to periodically show that you are working and meet the income requirements. It doesn't seem like showing what your MAGI was on last years tax returns or what you estimate your MAGI will be on your tax returns this year will be enough. This is going to be a nightmare for the states to manage.

 

[jim584672]

How would one go about showing/proving what their MAGI is? The new rules state that you have to periodically show that you are working and meet the income requirements. It doesn't seem like showing what your MAGI was on last years tax returns or what you estimate your MAGI will be on your tax returns this year will be enough. This is going to be a nightmare for the states to manage.

Medicaid is monthly based so they would want the last few months of income, so I guess your financial statements showing your income.

 

[zinger1457]

Medicaid is monthly based so they would want the last few months of income, so I guess your financial statements showing your income.

So you tell them you aren't working and your income is interest/dividend only? Wonder what the response to that will be?

 

[jim584672]

So you tell them you aren't working and your income is interest/dividend only? Wonder what the response to that will be?

When I was on it and sent the statements with high balances, response was approved. If the income meets the requirements they really can't say anything about.

 

[Just_Steve]

I thought medicaid was asset based, is it not?

 

[jim584672]

I thought medicaid was asset based, is it not?

The Medicaid expansion group created in 2014 has no asset test.

 

[Just_Steve]

The Medicaid expansion group created in 2014 has no asset test.

So not the non expansion states?

 

[jim584672]

So not the non expansion states?

Yes, it only applies to the expansion group, those states have no such group.