HealthSherpa

[houcoogster]

Nilang ,

Why haven't we got an answer on this yet?

Let me clarify to avoid any confusion.

Household of 4 applies for coverage 2 get HI ...2 get sent to Chip... does the household size for subsidy go down to 2 instead of 4?....If so WHY??????

Please answer this question!!!!!

 

[pcbinsurance]

You can't expect they are working over the weekend, can you?

 

[Ann H]

Nilang ,

Why haven't we got an answer on this yet?

Let me clarify to avoid any confusion.

Household of 4 applies for coverage 2 get HI ...2 get sent to Chip... does the household size for subsidy go down to 2 instead of 4?....If so WHY??????

Please answer this question!!!!!

I think you're reading AllenChicago's post a little wrong, Hou. If I understand Allen correctly (please chime in Allen, to make it clear), then he is saying that the family size was reduced from 4 to 2 for ENROLLMENT in the health insurance plan, which affected the subsidy. I don't think he was saying that the family size was reduced from 4 to 2 for calculation of their level of FPL. If he indeed meant it was reduced to 2 for ENROLLMENT, then that part of the calculation is correct. However, it appears in Allen's case that the problem comes in with some nuances in the law where CHIP really wasn't available for those children, and all 4 of the family members should have been enrolled in the health plan, resulting in a higher subsidy. Allen, if I'm wrong, please correct my understanding of the situation.

YGMM, on HealthSherpa today entered data from a recent Special Enrollment Illinois family of 4 whose children were NOT sent to Medicaid. All four were allowed by HC.gov to be on the same private health plan and were subsidy eligible.

However, HealthSherpa said that the two children (ages 3 and 1) were not allowed to be on the family application and would need to apply to Medicaid. Because this reduced the family size from 4 to 2 for subsidy purposes, the $65,000 MAGI made the husband/wife ineligible for a subsidy.

I think HealthSherpa's strength of being very abbreviated in questioning is also a weakness in some family situations.

HC.gov asked what type of coverage this family had. I checked "coming off a group plan that was terminating". There are some nuances to the Medicaid law that allow children to stay with the parent(s), under certain circumstances.

HealthSherpa merely looks at the ages of the children, the income of the family and makes an instant determination. In this case, the children would not be included on whatever enrollment data was sent to the marketplace for subsidy eligibility and enrollment.

I enrolled two families this year who were referred to me by other agents because "something" on the internet told these families that their children had to go on Medicaid. I was able to get them on one family plan, but Now I'm starting to see how that can easily happen. Web-Brokers are geared to be as efficient as possible.
ac

 

[kgmom219]

You can't expect they are working over the weekend, can you?

26 days out....they better be working over the weekend.

 

[taterpeeler]

aca express just called healthsherpa liers or crooks... haven't figured out which yet.. go and check it out... cat fight!!!!!

 

[nliang86]

Apologies for the delay in response. When the children are marked as medicaid / CHIP ineligible in the application, then the total # enrolled will go back up to 4, and we will recalculate the subsidy to be what you expected initially. The subtlety is getting the "< 3 months uninsured" condition into our flow - that will be there shortly.

 

[AllenChicago]

Allen, you discovered a very subtle issue that we are addressing right now. Specifically, children that lost group insurance less than 3 months prior are not eligible for medicaid/CHIP in MI. We are adding this rule in now. I should note that you can still get the kids in on our application by marking them as in-eligible for medicaid. Once we have the rule above implemented, this will be automatic. Sorry about that, and we will get it fixed soon!

NLiang, since your IT people are "addressing" this issue already, I'm not the one who discovered it.

Actually, buried within the 20,000+ pages of ObamaCrap rules and regulations, it says that if a family of 4 earns less than a certain amount of money each year, the non-adult children are to be placed on Medicaid, IN THE STATES THAT EXPANDED MEDICAID. And, as you stated NLiang, there are exceptions...also buried somewhere in the rules/regs.

Whenever we enter on HC.gov that the children were on a parent's group plan, they are kept with the parents, and the subsidy is calculated based on the entire family. When we say that the children had no insurance, they are kicked to Medicaid and the subsidy is calculated solely on the life of the parents. If the children were on an individual plan, it could go either way. I've not found any logical pattern or reason why this happens.

I don't think applicant families in the states that HAVE NOT EXPANDED MEDICAID have this issue.

Hopefully, due to so much uproar/anger, HC.gov will give parents the option of keeping the family together for 2015, even if no subsidy is granted for the minors.

Since there are only 6 Medicaid physicians serving over 800,000 people in my area, people HATE HATE HATE Medicaid! Every family I've worked with so far has purchased individual off-exchange plans (at $150 per child) for their children who were forced to Medicaid. Sometimes it's best financially for the entire family to simply purchase an off-exchange, non-subsidized plan.
allen

 

[nliang86]

Good point, Allen. We do handle the "standard" medicaid rules completely in our application, i.e. % FPL levels based on household size, children's age, pregnancy status, parent status, state medicaid expansion status, etc. These cover the vast majority of medicaid qualifications.

The group plan exception is found in a handful of states, and we are getting that in now. There are a few other rules that are hard to replicate - for example, certain states have pilot programs with a limited # of slots.

We do agree that the medicaid / CHIP rules are frustrating, especially in situations where only the kids are sent to medicaid / CHIP. The benchmark plan gets cheaper (parents only) whereas the "maximum family contribution" remains the same, hence decreasing the subsidy.

There are other frustrating situations too - ESI affordability is based on the ratio of premium for just the primary employee to the income of the entire family. Employers often heavily subsidize the primary employee while offering little for spouses and dependents, meaning that many people are left unable to afford their employer's insurance, while also not eligible for subsidy.

There's also the notorious "medigap" in non-expansion states, where ppl under 100% of FPL are left without any affordable options.

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p.s. we have actually enrolled folks that way - parents on subsidy, kids subsidy-less. The result is two policies but the family is effectively kept together.

 

[AllenChicago]

I think you're reading AllenChicago's post a little wrong, Hou. If I understand Allen correctly (please chime in Allen, to make it clear), then he is saying that the family size was reduced from 4 to 2 for ENROLLMENT in the health insurance plan, which affected the subsidy. I don't think he was saying that the family size was reduced from 4 to 2 for calculation of their level of FPL. If he indeed meant it was reduced to 2 for ENROLLMENT, then that part of the calculation is correct. However, it appears in Allen's case that the problem comes in with some nuances in the law where CHIP really wasn't available for those children, and all 4 of the family members should have been enrolled in the health plan, resulting in a higher subsidy. Allen, if I'm wrong, please correct my understanding of the situation.

I don't know what to say, Ann. Crazy heavy-handed ObamaCare disallows children from being on the subsidized family health insurance policy. And, the subsidy is reduced to the level it would be if it was just a 2 person household, with no children. I've got one (family of 4) coming up for O.E. where the subsidy will be eradicated all-together because the family earns $65,000. As you know, $65,000 is a subsidy-eligible income for a family of 4, but not for a family of 2.
ac

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Good point, Allen. We do handle the "standard" medicaid rules completely in our application, i.e. % FPL levels based on household size, children's age, pregnancy status, parent status, state medicaid expansion status, etc. These cover the vast majority of medicaid qualifications.

p.s. we have actually enrolled folks that way - parents on subsidy, kids subsidy-less. The result is two policies but the family is effectively kept together.

How do you get all the children on one policy? (One for Parent(s) + One for children). I have to do a policy per child.
-ac

 

[Ann H]

I don't know what to say, Ann. Crazy heavy-handed ObamaCare disallows children from being on the subsidized family health insurance policy. And, the subsidy is reduced to the level it would be if it was just a 2 person household, with no children. I've got one (family of 4) coming up for O.E. where the subsidy will be eradicated all-together because the family earns $65,000. As you know, $65,000 is a subsidy-eligible income for a family of 4, but not for a family of 2.

I am confused. As Nliang said, I can see that putting only 2 people (the parents) on the insurance reduces the benchmark premium, and therefore reduces the subsidy. But it shouldn't reduce the household size to 2. They should still have a household size of 4, with about $94,200 being 400% of FPL.