Client Loses Aca Coverage Payback Subsidy?

Mar 30, 2016

  1. saintstigers
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    Have a client that signed up on their own thru a link on my site.

    She made a mistake on her application and will be losing her subsidy starting in April. She actually qualifies for Medicaid.

    She was told she would have to repay the aptc for Jan - Mar. I thought I read somewhere that if you are actually Medicaid eligible that you don't have to pay back APTCs that were mistakenly advanced to you?
     
  2. Tkruger
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    She was provided misinformation.

    If the client qualifies for Medicaid then they fall near or below the 100% FPL. That is if the residential state didn't expand Medicaid.

    Below 100% FPL there is no clawback
    Above 100% FPL it is incremental based on the exact amount.

    Regardless even at 130% FPL the clawback wouldn't be much and will not be 100%.
     
    Tkruger, Mar 30, 2016
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  3. saintstigers
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    Sounds good. You sure on this?
     
  4. Tkruger
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    State:
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    Under the health reform law, states have the option to expand Medicaid coverage to everyone under 138% of the poverty level.

    At this time, your state has not decided to expand Medicaid. This means that you or members of your family may need to meet special criteria set by your state in order to qualify for Medicaid. This changed I believe in Jan of 16.

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    Tkruger, Mar 30, 2016
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  5. kgmom219
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    kgmom219 What's Next?

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    Kruger is right.

    And from a practical perspective, she's below 100% (or 138) of the FPL. She makes less than $15K a year. She's not paying taxes anyway.
     
    kgmom219, Mar 30, 2016
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  6. saintstigers
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    Would you happen to know exactly where it is stated in the healthcare reform law it is so I can provide it to my client.?
     
  7. kgmom219
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    kgmom219 What's Next?

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    Its not. There was an IRS (Regtap?) Directive last spring. And its on the forum somewhere. But I would start at irs.gov
     
    kgmom219, Mar 30, 2016
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  8. Tkruger
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    It is clearly outlined in the pdf file I uploaded to the conversation.

    If you have trouble finding it please let me know.
     
    Tkruger, Mar 30, 2016
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  9. MBSC
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    See below.
    Reference: https://www.law.cornell.edu/cfr/text/26/1.36B-2

    This translates into the instructions for lines 5-7 of IRS income tax form 8962.

    Reference: https://www.irs.gov/instructions/i8962/ch02.html#d0e789
     
    MBSC, Mar 31, 2016
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  10. saintstigers
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    Thank for the specific reference
     
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