Household Eligibility Determination Group Individual Spouse if living together Children – natural, adopted, step children If under 19- their parents and any siblings under the age of 19 living together Exceptions Child living with relatives who are not parents Children claimed as dependents by non-custodial parents, although both parents file separate returns
Income MAGI Modified Adjusted Gross Income Not equal to the net income on a tax return MAGI rules –Medicaid Enter all income accurately Certain income is not countable, but you still need to enter it
APTC Eligibility Must file taxes File jointly if married No one claims them as dependent Not eligible for Medicaid or don’t have affordable employer sponsored insurance If employer insurance is affordable the family is ineligible for tax credits If the annual family premium is more than 8% of the household income, they could apply for an exemption from the “shared responsibility” / individual mandate from the IRS due to lack of affordable coverage. Remain uninsured for the year Apply for a catastrophic plan APTC can be $0
CSR Eligibility CSR only for silver plan Other plans have out of pocket maximums, but not as low as CSR Not eligible: Undocumented individuals Taxpayers filing separately Non tax filers Anyone who is eligible for Medicaid, Medicare, or any other government insurance Anyone with income below 100% and denied Medicaid for a reason other than immigration status Anyone who has affordable health insurance offered by an employer
General Tips For child support, if an applicant says they do not want to located the missing parent, it does not hold up the application. It will be reported to the agency and they will decide if they need to contact the applicant. Immigrants and refugees: Receipt number Not verified by the HUB Put in Alien Number Medicaid Fix
Dental Insurance Kentucky requires that individuals under 21 have dental coverage QHP with dental MCO with dental Stand alone dental plan If the plan selected does not have dental, the system will prompt you to select a dental plan.
Penalty Exemptions Individuals who are uninsured for less than 3 months of the year Individuals with very low income and healthcare coverage is considered unaffordable (more than 8% income) Individuals who are not required to file a tax return because their income is too low Individuals who are Alaska natives or members of a federally recognized Indian tribe Individuals who are not lawfully present Individuals who are incarcerated Members of a healthcare sharing ministry Members of a recognized religious sect with religious objections to health insurance Individuals who can claim a hardship
Hardship Exemption Homeless Evicted in the past 6 months or were facing eviction or foreclosure. Shut-off notice from a utility company. Domestic violence Death of a close family member. Fire, flood, or other natural or human-caused disaster that caused substantial damage to your property Bankruptcy in the last 6 months. Medical expenses you couldn’t pay in the last 24 months. Unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member. You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you do not have the pay the penalty for the child. As a result of an eligibility appeals decision, you’re eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace. You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.
Myth Buster The Affordable Care Act specifically prohibits any liens or levies for this particular tax.
Q&A How long should it take to get documents approved? I have some that have been approved in 2 hours, some from October 2nd are still waiting approval? What's the best way to handle follow up when things are pending approval?
Q&A How is everyone keeping up with appointments- both scheduling them, following up with them, keeping track of assists/applications submitted/enrolled numbers?
Q&A Are you scheduling yourself a certain amount of time for outreach activities, or just filling in when you are not in an appointment for enrollment?
Q&A What's the typical amount of time to complete an application? How long do you schedule your appointments for?
Q&A Who as done over the phone appointments? What is the process? How has it gone?
Q&A How are you tracking problem applications?
Next Webinar: December 5, 2013 Sharing Best Practices and Lessons Learned 11 AM – 12 PM Lindsay Nelson firstname.lastname@example.org 502-227-4379