My cousin presents her premise re: ACA

[ChisolmTrailDem]

I just received an email from my cousin who lives in Texas and I'm not knowledgeable enough to answer her questions...


"I'm assuming since you are a Democrat and Obama supporter that you might know how Obamacare is going to work for my situation. As you know, I am living with Carol (her sister, who is disabled) in order to assist her and take care of her home. I don't get paid to do this, the trade off is simply that she provides a roof over my head and food and whatever I need for us both to make it each day. In other words, I have no official income and haven't filed a tax return in six years. There was something on the news today about income verification. My first question is: How will this income verification work for me?

Also since I have no income how am I to pay for insurance through Obamacare? How does that work?

I will await your first response before going any further.

Hope to hear from you soon.


Love, Denise"


So she's really unemployed as far as income goes, hasn't filed a tax return. I have a friend in a similar situation who hasn't worked in years and also hasn't been filing a tax return. He does some under-the-table piecework but mostly lives off his elderly father's ret./soc.sec. income while caring for him in his home.

Can any of you ACA-learned DUers weigh in on this kind of scenario?


ETA: My cousin Denise is 48 years old. Both Denise and Carol are conservatives who actually practice (some) of what they preach in the sense that they don't believe in taking assistance from the government; I'm sure they consider Medicaid "government assistance". So perhaps she never considered Medicaid. Finding out she may have to have it anyway will go against her beliefs (which is sort of ironically funny to me ... I think, lol). Bottom line is they simply, as far as I can gather, don't even think about applying for Medicaid, food stamps, etc., much less consider and then decline to do so.

[sinkingfeeling]

1. If she has no income, her insurance would cost her $0. Oh, but Texas

refused to expand Medicaid. However, since she claims no income, she should still be applicable for Medicaid.

[leftstreet]

10. Not all low/zero income people qualify for Medicaid

Regardless of state expansions

Depends on family size, disabilities, pregnancy, etc

[stuckinodi]

11. In TX

she doesn't have to do anything. There's no expanded Medicaid, and you have to make $11,400 to participate in the exchange. If you don't make enough to file taxes, there is no fine. Nothing is any different for her than it was before the ACA.

As a single person with no children, even if she has no income, she cannot get regular Medicaid.

[SamYeager]

2. If she lived in New York, she'd be fine.

She lives in Texas, so she may fall into Rick Perry's Medicaid donut hole.

[denbot]

3. My guess is that she would qualify for Medicare.

My other guess is that the main concern is avoiding penalties for not having insurance, and signing up for Medicare should take care of that.

[sinkingfeeling]

14. Medicare? That's for people 65 and older.

[kelly1mm]

4. Medicaid IF she is in a state that expanded it. Unfortunately she is in TX which I believe

did not expand medicaid. When they verify her income it will come up as $0. The medicaid expansion takes away the requirements some states had for able bodied people not to get medicaid.

[ScreamingMeemie]

8. She would qualify for Medicaid here in Texas with 0 income.

Outside of Medicaid expansion.

[kelly1mm]

12. Awesome! I assumed TX would have had the 'able bodied' exception. My bad. nt

[riderinthestorm]

5. With zero income she could have been on medicaid years ago

Is she on it now? If so nothing will change for her under the ACA.

If she's uninsured now she can apply to Medicaid immediately.

[okaawhatever]

21. I don't know if you know Texas laws or Medicaid in general, but in TN no kids, no medicaid unless u

have breast or cervical cancer as that is funded separately by the federal gov't. Otherwise you're out.

[riderinthestorm]

27. Ah thanks nt

[underthematrix]

6. She is eligible for Medicaid but . . . some red states refused to expand

Medicaid even though there is no cost to them.

[upaloopa]

7. I think there is a hotline number at healthcare.gov

to call. I doubt anyone here is an expert by virtue of being a Democrat.

[notadmblnd]

9. That person will probably qualify for their state's expanded medicaid program

and a statement from the people who give them shelter will probably be required.

I have a sister that lives in my basement who doesn't work. That's what I had to do in order for her to get food stamps and getting medicaid (which she recently received) was not a problem for her.

[ScreamingMeemie]

13. Because she has no income, she qualifies for Medicaid outside of the ACA.

http://www.medicaid.gov/medicaid-chip-program-information/by-state/texas.html

The limit for a single person is slightly over $2K income.

As long as her house is not worth more than $500,000, she should have enrolled long ago.

[bluestate10]

15. She should be aiming her ire at the dumb-assed governor that she has in Texas. If she lived in

my state, she could get assistance to help care for her sister and be qualified for Medicaid due to her no/low income, ie, she would pay little to nothing for health insurance.

[bunnies]

17. I can answer this.

First - on income verification:

Under regulations released in July, all the exchanges or marketplaces must first check the income level that an individual reports on his or her application against a federal database that contains data on the applicant's federal income tax returns as well as Social Security and current wage data.

But if an individual projects their income up to 10 percent higher than shown in electronically available data such as a prior tax return, there will be no questions asked. If there is more than a 10 percent discrepancy, the exchanges will ask for more information, such as a pay stub. If an applicant is unable to provide such data, the regulations allow the exchanges in 2014 to rely on the individual's "self-attestation" to determine the subsidy. This applies only when someone overestimates their income, according to a spokeswoman for Health and Human Services.

Second - this amazing little tid-bit that I just learned:

Everyone applying for subsidies must estimate their 2014 income. For the poor, the difference between qualifying -- or not -- could be $1,000 or less a year. Since many rely on hourly or seasonal work, their incomes often fluctuate by a few thousand dollars each year. That's one reason why people often lose eligibility for Medicaid, the state federal insurance program for the poor.

While there are steep fines for knowingly lying on a government application for financial assistance, if someone merely miscalculates their income above the poverty level in 2014, and is later found to have made less than the poverty level, they won't have to pay any money back, according to the Treasury Department.

Both excerpts from here: http://www.kaiserhealthnews.org/Stories/2013/August/12/income-projections-low-income-Obamacare-state-medicaid-marketplace-exchange.aspx

[PasadenaTrudy]

18. I have a friend

in a similar situation. He hasn't "worked" in years, or filed a tax return. He cares full-time for his mother who has dementia. Another brother supports him. He basically gives him money every month. So, I'd like to know what my pal can do for insurance ( he is 51 and has no insurance). We are all in CA

[jeff47]

22. Medicaid

The way the ACA is designed, low/no income people are covered by Medicaid. CA expanded Medicaid, so he should not have a problem getting it.

[displacedtexan]

23. Christ on a cracker!

Get that man to the website. Stat.
Has he not even read one of the thousands of Covered California articles or even visited the site?

You obviously have internet access; therefore you should tell him that California was the first state to go live with info, plans, and coverage comparisons. KRON 4 and every other TV news outlet (except FOX) has detailed how full coverage is free for individuals making less than $15K and families of 4 making less than $32K.

[PasadenaTrudy]

24. I think

he and his wife are getting about $3K from his brother monthly...wife is a full time college student, not working.

[displacedtexan]

26. See post #17. Lots of good info there.

[displacedtexan]

19. From medicaid.gov:

The Affordable Care Act fills in current gaps in coverage for the poorest Americans by creating a minimum Medicaid income eligibility level across the country. Beginning in January 2014, individuals under 65 years of age with income below 133 percent of the federal poverty level (FPL) will be eligible for Medicaid. For the first time, low-income adults without children will be guaranteed coverage through Medicaid in every state without need for a waiver, and parents of children will be eligible at a uniform income level across all states. Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment will be much simpler and will be coordinated with the newly created Affordable Insurance Exchanges.

http://www.medicaid.gov/AffordableCareAct/Provisions/Eligibility.html

[ChisolmTrailDem]

20. FROM THE OP: Thank you all for your replies. I have to step out to

take a relative to an appointment but will come back to dissect your responses and respond later this afternoon/evening.

I have edited my op with additional comments/information.

[sammytko]

25. No Medicaid for people like her in Texas, but

if her sister qualifies for Medicaid and takes it, they might pay her for taking care of the sister.

Even if she is a family member. Probably needs to contact the county health and human services department.

[Lex]

28. No income, no penalty for not having ACA.

That's my understanding.