With thanks to the Pennsylvania Health Access Network (http://www.pahealthaccess.org):
How will job loss affect Medical Assistance for Workers with Disabilities?
Work does not have to be a formalized employment relationship. It can include work done on a cash-basis as long as it occurs at a regular interval and can be documented – even a simple letter will suffice. A navigator is best trained to help folks navigate this.
If someone receives a large lump sum severance in April, but then only has unemployment in May, can they apply for Medical Assistance (Medicaid) under MA Expansion rules in May?
Yes, but they may also be eligible in April. The applicant should look at the annualized income that person has. In this situation, it would be all paid wages during employment, the severance payment, and 26-weeks of unemployment at 50 percent of the base year’s wage (current rules – may change based on pending federal legislation). If that amount is under the yearly income threshold, the individual would also be eligible in April and would not have to wait. Requests to annualize can be made in the comments box. Sample text to include: “Please annualize my income pursuant to DHS Policy Clarification 17446-312.”
Is MA Expansion still retroactive?
Once a person is approved for coverage, their coverage is retroactive to the date of their application. If a person has unpaid medical expenses that happened in the 90-days prior to their application, they can request that the County Assistance Office pay them by creating a Noncontinuous Eligibility for each care date as long as that service is covered by Medicaid and done by a Medicaid registered provider. Contact a navigator if you are having trouble with this.
Has anything changed regarding asset verification?
There are no asset tests for Medicaid Expansion. If a person is income eligible, that applicant cannot be denied for having assets.
Are Marketplace plans able to cut off coverage during the crisis for non-payment?
We have no guidance currently about how premium payments are going to be handled, but at the moment the regulation stands that individuals on Marketplace plans are able to be cut off for non-payment. Recently, the Pennsylvania Insurance Department issued guidance encouraging plans to work with individuals affected by the crisis. We are monitoring how that guidance will be implemented.
Is PHAN doing advocacy work on behalf of County Assistance Office workers related to work conditions or hazard pay?
Yes! Every effort should be taken to protect them with PPE and policies and procedures in place to support them. PHAN, CLS, and Philadelphia Legal Assistance are advocating for their health and safety as well as consumers’.
How does a person pay for health insurance while receiving Unemployment Compensation?
This can be tough and we are advocating that plans will delay or reduce premium payments until after the crisis has subsided. It is important to note that under current law, if a person fails to pay premiums and subsequently cancels the plan or the plan is cancelled for nonpayment, that person is currently unable to re-enroll until the next open enrollment period. It’s important for that individual to contact a navigator to see if they are now eligible for Medicaid or another coverage option (or increased subsidies due to the decreased income). If a person transfers from Marketplace to Medicaid and then becomes ineligible for Medicaid after the crisis, that person would then become eligible for a special enrollment period to re-enroll in Marketplace when their income goes up.
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