Some Parents face loss of their Medicaid coverage in 2006

(Plain Press, December 2005) This is the first in a series of articles by Community Partners for Affordable Accessible Health Care (CPAAHC) on the effect of recent budget cuts at the state level.  In January we will be reporting on a number of co-pays that will be put in place for Medicaid services.

While Medicaid coverage is now available to qualified parents with income not more than 100% of federal poverty guidelines, eligibility will soon be reduced. Starting in January of 2006, parents or guardians with income over 90% of the federal poverty limit will no longer be eligible for Medicaid (see chart).  This means that even if you previously were eligible and received Medicaid and your income is above the levels shown, you will probably lose your Medicaid coverage sometime in 2006.  This is a result of recent state budget cuts.

Cuyahoga County has stated that all parents who may be affected by this change in eligibility will be notified in advance that their Medicaid may be cut. The County emphasizes that parents should immediately meet with their caseworker if parents are notified that they may no longer be eligible for Medicaid.

When the parent(s) meets with their caseworker, there will be a pre-termination review to determine if there is anyway that they still qualify for Medicaid.

If they find the parent is no longer eligible for Medicaid, the caseworker will immediately explore all other options such as transitional Medicaid.

It is important to know that these cuts will not affect children’s Medicaid coverage in any way. Further no change will occur for parents at least until their first re-determination in 2006.

In addition, there are some things you can do to at least keep Medicaid coverage for all of 2006 and in some cases into 2007.

Keeping Medicaid Coverage:

If you are unable to work because of a disability, you may be eligible for disability Medicaid.  You will first need to provide your caseworker with medical records documenting your condition. Upon receiving this information, your caseworker will assess your situation and inform you if you are eligible.

If you are pregnant, you will need to provide your worker with a letter from your doctor confirming your pregnancy.   This will enable you to keep Medicaid at least through the pregnancy.

Transitional Medicaid for parents

a.    You are eligible for transitional Medicaid if your caseworker  rules that you are ineligible for Medicaid because you income is too high and you have had income in any of the 3 months before your re-determination.

b.    Your caseworker should complete the forms for this program to enable you to then receive 6 more months of  transitional Medicaid.

c.    During that 6 months, you should report your income to your caseworker on forms provided in order to receive an additional 6 months of Medicaid, or 12 months in total.  The reporting of income is very important.  You will not receive the second 6 months if you do not do this.  Eventually you will lose all parent coverage but transitional Medicaid can buy some time.

d.    If you are up for recertification in December, be sure to keep your appointment. You will be reviewed according to the old income guidelines, which should keep you on Medicaid until at least your next recertification in June.  Then if you qualify for transitional Medicaid, you could add another 12 months of coverage beyond June of 2006.   However, if you put off your December Appointment until January for any reason, your Medicaid eligibility will be decided by the new income guidelines.   This could cost you 6 months of coverage

Every parent who is affected by the new income eligibility levels should not give up immediately if told by their caseworker that they will lose coverage. They should ask their caseworker about the three areas discussed above.

If you feel that the caseworker has incorrect income information or did not follow guidelines correctly, you can appeal the decision within 15 days.  You will then keep coverage until the appeal is decided.  You should know that you may have to pay back any benefits paid out during the appeal if your appeal is denied.

If you have further questions or feel that you have been treated unfairly you can contact Tim Walters at 631-5800 or Amy Weary at 771-5077.

Income Guidelines.........before jan.2006...........Jan. 2006 and after
Medicaid Eligibility..........100% of poverty...........90% of poverty

for parents
family of 2        $12,830.00        $11,547.00    
family of 3        $16,090.00        $14,481.00
family of 4        $19,350.00        $17,415.00
family of 5        $22,610.00        $20,347.00


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