Same issue with the under 25 crowd. Not sure what the complaint is other than the State department is being incompetent in execution in checking out make sure the State isn’t getting bilked.
[quote=bearishgurl]Okay, my peeps (both over 55) are gone now and had documentation in their CC accounts that they had proved their (W-2) incomes to CC in January and early February and have been reinstated … for now, retroactive back to 2/1. CC had bumped them off their plans without even reading their uploads, which is typical.
CC has access to both of their tax return numbers until 2020 and has had that access since the beginning of last year.
However, one of them is likely going to have to “re-prove” her income to CC come June or July. We’ll see what happens. She’s going to check her CC account the 2nd business day of every month (after her premium is paid) to make sure her plan is still active.
enron, yes, the people who create an account on CC and state they are not seeking a subsidy and purchase a CC plan without a subsidy don’t have any problems. But why would anyone want to go thru a bureaucratic gubment middleman (CC) to buy a healthplan if they weren’t eligible for subsidy? What would be the purpose of doing that? They could just log onto a carrier’s website or “ehealthinsurance” as you listed here and probably get the same plan for $14-15 month less because the plan isn’t paying any monthly “commissions” to CC!
I know about all those ways to purchase healthplans off the exchange and will be doing so myself for 2017. I actually purchased my former (“grandfathered”) healthplan online in 2004 but they bumped me off the plan at the end of 2013 when they left CA’s individual market (with 5 other large carriers) because they refused to offer “ACA compliant” plans in CA.
[quote=spdrun] . . . Also, with the realtor example, aren’t most salesmen paid on 1099? That’s not reported till the end of the year, not reported monthly. . . . [/quote]If a CC enrollee who is accepting a subsidy is over 55 and DID NOT prove their income last year with W2’s, then they will likely find themselves having to prove their income several times annually to keep their subsidy. If any of their reported income was through commissions, then yes, they wouldn’t get that 1099 until the following January and CC knows this. The commissioned salesperson over 55 years of age will be required to prove when they were paid commissions by scanning and uploading their (dated) commission stmts or checkstubs into the CC website.
An “over-55” CC enrollees’ CC file is automatically sent electronically to their County SS Dept who will “work it up” for Medi-Cal eligibility at the same time the enrollee is covered with a subsidy helping to pay their premiums. County Medi-Cal workers have the authority to go into a CC enrollee’s CC case and change their income numbers as they see fit, without informing the enrollee and often do. (For instance, remove military retirement income, adjust interest or dividend income or a remove a deduction they don’t feel qualifies for MAGI, etc). For those who have reported W-2 income in the previous year and/or listed it in their current income on CalHEERS, the Medi-Cal worker in their county will cull the state EDD index beginning one month after every quarter (4/30, 7/31, 10/31 and 1/31, after employers have reported earnings) to try to match CC enrollees’ reported or projected earnings with what their employer reported. If employers reported less monthly earnings than the Medi-Cal threshold for the enrollee’s filing status (or in any months leading up to the current month), that is cause for Medi-Cal forced placement. It doesn’t matter if the employee may have been on FML or ran out of leave and that is why their paycheck(s) were short for that month or a period of months. It only matters that their gross pay for one or more months fell below 138% of the “poverty level,” rendering them “Medi-Cal eligible.”
CC enrollees below 55 years of age aren’t scrutinized as closely and their tax returns (usually reporting W-2 income) are accepted at face value because for them, their Medi-Cal premium may cost just as much or more than the subsidy they are receiving and more importantly, the law does not provide for Medi-Cal estate recovery for CC enrollees under the age of 55. There is little incentive for CC or County SS Depts to go through all that extra work of constantly monitoring younger CC enrollees’ CC accounts and hassling them for proof of income when the state wouldn’t be allowed to place any liens on them for the cost of Medi-Cal managed care premiums. In most cases, it’s cheaper to give them a subsidy if they have an easily proveable W-2 income within $15K annually of the Medi-Cal threshold.
Boomers are an absolute cash cow for states who adopted expanded Medicaid under the ACA and CA is wasting no time making sure they are going to get their cut. Our homes and other properties are sitting ducks for attachment and the state is chomping at the bit to obtain the right to start their tab running and lay claim on them.[/quote]
