Ohio Family Coverage Coalition

 

HOW TO SURVIVE THE CUTBACK

IN PARENTS’ MEDICAID COVERAGE

 

Things Parents on Medicaid and Advocates  Should Know About Keeping Coverage

 

1. What Change is happening to Parents’ Eligibility?

The legislature lowered the income eligibility limit for parents and guardians under the Healthy Families Medicaid Program (“Parents’ Coverage”). Starting in January, parents or guardians with incomes over 90% of the federal poverty level will no longer be eligible (see chart).  You can keep your Medicaid if you have earned income, or are pregnant or disabled.  See below!

 

2. When will the change happen?

The change goes into effect on January 1, 2006.  Current recipients will not be affected until their six-month re-determinations take place after January 1, 2006.  People with re-determinations in December 2005 will not be affected by the change until June 2006.

 

3. Can parents with income between 90-100% of poverty still get onto Healthy Families Medicaid?

 

Yes!  People with incomes up to 100% remain eligible until December 31, 2005. Such eligible persons should apply before that date!

 

4. What can I do to keep my Medicaid if I am a covered parent with income higher than 90% poverty?

 

(1) Pay attention to your re-determination date!  If your re-determination date is in December 2005, DO NOT RESCHEDULE OR MISS IT!  (Many people put it off until after the holidays.)   If you normally do it by mail, bring the paperwork to the county office.  If you have an appointment (such as for food stamps), keep it!   This will preserve your Medicaid for another 6 months.  If you miss your re-determination deadline, make sure you reapply for Medicaid before Dec.31.

 

→Hint:  If your re-determination date is in January or February, ask your caseworker if you could do it in December instead, to give you the extra months of coverage.

 

(2) Before the state can end your Medicaid coverage, it must do several things:

 

A. Give you notice and right to appeal the termination.  If you think the agency has incorrect information about your current income or has made a mistake, you should file an appeal. If you file the appeal within FIFTEEN DAYS, you will keep your Medicaid coverage until the appeal is decided. However, you could be made to pay back the value of your Medicaid.

 

B. Determine if you are eligible for Medicaid under another category.  There are several different categories of Medicaid, with different eligibility requirements. If you are no longer eligible for Healthy Families Medicaid, you may be eligible for a different category of Medicaid.

 

  • If you are unable to work, you may be eligible for Disability Medicaid. Your caseworker will need medical records from your treating doctors about your disabling conditions.
  • If you are pregnant, your caseworker will need a confirming letter from your doctor.
  • If you have had any earned income, you could be eligible for Transitional Medicaid (see below)

 

(3) If you are losing parents’ coverage because your income is too high and you have any income from working, you are probably eligible for Transitional Medicaid!

 

A. How much earned income do I need to get Transitional Medicaid?  If you have any work (earned) income and your income is too high to keep parents’ coverage, you should be eligible for Transitional Medicaid. $1.00 of earned income is enough!  You must also have been on Healthy Families Medicaid for three of the previous six months.  To get Transitional Medicaid, make sure your caseworker knows you have earned income.  You should then be enrolled.

 

B. How long can I stay on Transitional Medicaid?  You can stay on Transitional Medicaid for six (6) months, no matter how high your income is. You can stay on Transitional Medicaid for another six months if your income is no higher than 185% of the federal poverty level.

 

C. What do I have to do to keep Transitional Medicaid for one year?  You will receive a form for reporting your income every 3 months. Make sure you submit those reports!  Many people lose their Transitional Medicaid because they fail to comply with the reporting requirement. Once you lose it, you cannot get back on until after you’ve returned to regular Medicaid with earnings.

 

D. Once Transitional Medicaid runs out, can I get Medicaid again?  After you exhaust Transitional Medicaid, you can become eligible again for parents' coverage if your income goes below 90% FPL. You will remain eligible as long as your income is below 90% FPL (see the chart).  The cycle can repeat itself – if you are on parents' coverage for at least 3 out of 6 months, you can be eligible for Transitional Medicaid again, if you have earned income and your income goes above 90% FPL.

 

(5) Are other changes happening to Medicaid?

 

Yes. Medicaid will cover fewer dental services after January 1. So, if you need dental work – especially root canal, dentures, or other treatment – make sure you get it as soon as possible.

 

Remember: Use your coverage while you have it!

 

 Income: 90% Federal Poverty Level:

Fam. Size

per  mo.

per year

per hour*

2

$ 962

$11,547

$ 5.55

3

$1,207

$14,481

$ 6.97

4

$1,452

$17,415

$ 8.37

5

$1,697

$20,347

$9.78

                               

 
 
 


For more information, contact

Ohio State Legal Services Assn:

1-800- 589-5888