Child Under 26 but Files Own Taxes?

[TwoLabs]

Mother and daughter on a marketplace plan for 2014. Daughter was claimed as a dependent on 2014. We completed a 2015 application and the daughter was sent to Medicaid, where she was denied. So we then filed an appeal and we are in the middle of that process.

In the meantime, while doing her taxes, H&R Block informed her that for 2015 the daughter won't be able to be claimed as a dependent because over 50% of her support will be paid by herself and not her mother.

I know hc.gov says that she can remain on her mother's plan even if she is financially independent, etc. However, how does this really work? I called HC.gov and spoke to someone who might have 5 brain cells. He couldn't give me a solid answer or anything other than "Well...maybe....".

Right now my best guess is that yes she'll be able to remain on her mother's plan, but her mother won't get credit for her as far as subsidy calculating purposes right? What about the daughter's income?

 

[DS4]

she'll be able to remain on her mother's plan

Yes, to age 26

but her mother won't get credit for her as far as subsidy calculating purposes right? What about the daughter's income?

Daughters income not figured into "household income" any longer because mother is not claiming her as a dep.

 

[Yagents]

Can apply for own plan and tax credits for 2015 (or Medicaid) with s.e.p denial of medicaid

Or

Can stay on mom's plan and pay full price

Or, buy off exch plan with Medicaid denial s.e.p.

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Timely article on the subject:

Complicated young adults: How do you get them covered? | LifeHealthPro

 

[RayNY]

If it's on-exchange, you're not going to be able to get a parent/child plan due to the way eligibility works. Subsidy eligible clients have kids forced to Medicaid, as you've already experienced. You'd have to purchase off-exchange and pay full price, or enroll them on-exchange as two individuals as if two separate households.

Off-exchange, I'm 100% sure they can stay on the parent's plan even if they are independent, filing taxes, or living somewhere else. Personally, that's exactly what I'm doing for my coverage.

 

[TwoLabs]

Okay Ray, so you are saying that if the Mother qualifies for a subsidy by her own income data (based upon a tax HHI of 1), then she won't be able to add her daughter on her On-Exchange plan, right?

So really, the only ways to get both the Mom and the Daughter on the same plan is off-exchange?

I just got back her appeal decision from the Marketplace. We initially filed the appeal because the daughter was denied CHIPS. The appeal was declined, and the reasoning? Essentially, "Your marketplace eligibility determined you may be eligible for Texas Health and Human Services Commission, but only THHSC can make that final decision. They will send you an eligibility notice, which will contain information about what to do if you disagree with the decision. As a result we are dismissing your appeal."

We ALREADY did that! I sent in a copy of the THHSC declination for CHIPs for the daughter WITH the appeal letter. Sheesh....

 

[RayNY]

Dealing with the exchanges is a headache, but if a parent qualifies for subsidized coverage, the children are forced into CHP. It's just a rule.

THHSC will deny the daughter, she's over 18, and thus not eligible by their guidelines. The exchange will insist she's CHIP eligible, because that's what they do. If you give the appeal and denial to the exchange, they might let you add her on to the mothers plan, but I haven't managed to do that successfully yet.

Chances are, the denial letter is an SEP and the daughter is enrolling on her own, unless the mother wants to give up her subsidy and get an off-exchange parent/child plan.

 

[houcoogster]

Yagents answered the question succinctly. Those are your choices.

 

[taterpeeler]

Subsidy eligible clients have kids forced to Medicaid, as you've already experienced.

not always ray and texas medicaid/chip has a mind of their own... i get plenty of kids covered with subsidies

 

[RayNY]

not always ray and texas medicaid/chip has a mind of their own... i get plenty of kids covered with subsidies

Were the kids put to CHIP and you moved them back manually? Or did it let you add them within the portal?

I'm just curious how they're handling it down there. Here in NY, auto denial, and you have to do some leg work with appeals/calls to make it happen and it's darn near impossible. I personally haven't managed to do it, but luckily, all my clients were fine with their kids on CHIP.