Medicaid Abuse

[MemoryMakers2669]

I know someone that was out of work about 9 months, collected unemployement. The wife didn't (doesn't, wont) work though she could have, wont start a bash on my thoughts on that. A few months into the no job thing, they got Medicaid for her and the kids (he is a ex-military)....makes sense.

However now, the father has a great job, pays VERY well, GREAT insurance benefits. BUT, they aren't goign to bother getting the Insurance offered through the new job...since they are covered by Medicaid.

Is that allowed? There is NO reason why they don't get the job offered plan and pay for it (its not expensive). They already live cost free in her parents home, they have only a cell phone bill right now. They just don't want to have to pay for it, he figures since imigrants get it, they should be allowed as well.

 

[*pixie*dust*]

I am pretty sure they have to periodically update their status. In this case they will have it until their file is updated, I would think.

 

[MemoryMakers2669]

I told them that, at some point the goverment will know he is making good money....like when they file their taxes next year and it will catch up with them.

 

[NatashaDisneyCM]

yes, you do need to do a yearly update...but you are allowed to work and get medicaid! So I do not see it as abuse! many years ago, I had a great job and I did not have any coverage, I was able to get it also then for my daughter to.

I would really just stay out of it. I think things like this are for the couple to worry about, not the world!

 

[MemoryMakers2669]

I understand you can work and recieve it...if eligible, but with his income and the great affordable plan his company (major company) offers, why should they be allowed to any longer?

I would hate to see them get into trouble for not reporting the fact that they are no longer eligible for it?! Like the unemployment, he can't keep asking for that, cause they check that constantly......or he would keep taking it.

 

[MemoryMakers2669]

Oh and............

Experts estimate that abuses of Medicaid eat up at least 10 percent of the program’s total cost nationwide—a waste of $30 billion a year.

is this really not the worlds problem? Just curious!

 

[Holly]

I think busybodies are one of the world's problems, too.

The income guidelines for Medicaid are fairly high. What you think of as a good salary may still fall within the guidelines.

Having private insurance doesn't disqualify families from receiving Medicaid, either. If they still meet the requirements then Medicaid becomes the secondary insurance.

How do you know the details of the insurance plan offered? Perhaps it was too much for them to afford?

A "great salary" (which is relative) doesn't always go far when you are paying over $1000 per month for private insurance.


I think it's pretty harsh to judge this family without knowing all of the details of their situation.

 

[denisenh]

OP....here you go, if it helps http://www.cms.gov/FraudAbuseforConsumers/

 

[Buckeye Princess]

Who pays $1000 a month for private insurance. My sister only pays $3000 a year and she has many pre-exisiting conditions.

 

[MomRN]

I was on Medicaid for my son while I was in nursing school. I had work insurance start last May, with dental in October. I knew my letter would be coming anytime, so I waited for them to send it to me. Wrong, probably, but if you've ever had to "work" with the state of Indiana, you learn to work on their time and value whatever you can get to work. In October the letter for yearly update came said if you don't return this within 3 days (yes, seriously) you will be cancelled by the end of the month... so I just didn't turn it in. Started using work insurance.

Got the letter that his Medicaid was really, really going to be cancelled at the end of last month (6 months later).

 

[Holly]

Who pays $1000 a month for private insurance. My sister only pays $3000 a year and she has many pre-exisiting conditions.

Plenty of people.


•On average, the annual premium was $2,985 for a single person and $6,328 for a family.
•The annual premium differed from state to state. For example, the premium for a family health plan in New York was $13,296, while a similar plan in Iowa was $5609.
•The annual premiums for health plans were also different depending if the annual deductible was high or low. For example, family plans with no deductible had an average premium of $12686 each year, while plans with an annual deductible of $10,000 had an average premium of $5380 each year.


http://www.ahipresearch.org/pdfs/2009IndividualMarketSurveyFinalReport.pdf

 

[Feralpeg]

Who pays $1000 a month for private insurance. My sister only pays $3000 a year and she has many pre-exisiting conditions.

I pay $689 a month for private insurance and that is with a $5000 deductible. I had cancer at age 31. It doesn't pay to have had an illness.

 

[61292cna]

Many people don't realize that qualifying for Medicaid is based on a ratio of income/family size. Since you said kids, I'll assume a family of 4, which means he can make a decent amount & still qualify. The max allowed before cutoff then increases by each additional family member.

 

[denisenh]

yes, you do need to do a yearly update...but you are allowed to work and get medicaid! So I do not see it as abuse! many years ago, I had a great job and I did not have any coverage, I was able to get it also then for my daughter to.

I would really just stay out of it. I think things like this are for the couple to worry about, not the world!

maybe the world needn't worry about it but where do you think the funding for federal / state programs lke medicaid comes from? a special money tree?

anyway, i don't know anything about medicaid, but as far as updating status goes and i would guess it varies by state... but for NH

Reporting Changes ​

[FONT=Arial,Arial][FONT=Arial,Arial]You will be requi[/FONT][/FONT]red to periodically complete a review of your circumstances. Your cash assistance and Food Stamp case could be closed, and/or your eligibility for Medical Assistance may be affected, if you do not completely fill out the form and return it by the due date and come in for a personal interview, if required.
If you only get Food Stamps and you have a 4, 5, or 6-month eligibility period, you only need to report those changes in household circumstances that would place your household’s income above 130% of the poverty level.
If you receive cash assistance, child care assistance, Medical Assistance, or if your Food Stamp eligibility period is not 4, 5, or 6 months, then you must notify the Department within 10 calendar days after the change happens for changes in:
• source of income;
• hours worked by a household member;
• amount of income of any member in your household;
• assistance group or household composition;
• resources (e.g., cash, stocks, bonds, or money in a bank or savings account);
• receipt of any lump sum payment or settlement;
• residence, or shelter costs; or
• child care costs, child support payments or medical deductions, or other changes that may affect the amount of your household’s benefits.

and:

Medical Assistance Fraud
[FONT=Arial,Arial][FONT=Arial,Arial]Section 1128B of the Social Security Act provides federal penalties for fraudulent acts and false reporting in connection with your application for or receipt of Medical Assistance benefits. [/FONT]
[FONT=Arial,Arial]A person may be prosecuted in Federal Court for deliberate statements that are known to be false and which affect eligibility for any benefit or payment under the Medical Assistance program. [/FONT]
[FONT=Arial,Arial]A person may also be prosecuted for concealing or failing to disclose any event that affects their right to any benefit or payment, or its conversion to a use other than intended. The law also provides a penalty for a kickback, bribe, or rebate in connection with the furnishing of Medical Assistance. [/FONT]
[FONT=Arial,Arial]Conviction of an offense could result in loss of Medical Assistance benefits for a period not to exceed 1 year. Penalties are fines up to $25,000 or imprisonment for not more than 5 years, or both. [/FONT]
[/FONT]

 

[Katie Dawn]

Social Worker here. (I don't work for the government, I work for a non-profit, but I have seen this scenario played out many times)

If the new job's salary is at or below the income guidelines (and any other eligilibity guidelines) they will still qualify for Medicaid & no rules have been broken.

If the new job's salary is above the eligibility guidelines and the family is neglecting to tell their local office about it... never fear. The government has access to that type of information, and the family will be found out. When it is discovered there may very well be consequences beyond just losing their Medicaid (for instance, being forced to pay back the monetary value of the Medicaid benefits they received when they shouldn't have.)

Abuse of the system happens, but folks who think they are going to "get away with" not reporting their income (assuming the job isn't "under the table") have another thing coming.

No worries.

 

[tink_n_pooh]

Put me in the boat of being concerned about the amount of money wasted every day on people who are "working the system" and receiving benefits which they are not really eligible for

Now if they are still eligible for medicaid with the new job, fine, they should certainly accept the assistance. However if they have not reported the income change and are trying to or are getting away with receiving benefits they are not eligible for - not cool And yes, it is all of our problems since we are all paying for it in our tax dollars

I don't know about other states but in NJ a family can not make very much to be eligible for medicaid. Children and pregnant woman are eligible for more than non-pregnant adults, but the income level is still below that which most of us could reasonably live here.

 

[NatashaDisneyCM]

People who have been on it KNOW...you just cannot, get away with NOT giving your income! The system knows when you work, what you make etc!! They will shut you off in a minute! I cannot beleive how high of an income one has to have before being pulled! so it is hard to pull the wool over their eyes! and I stand behind the "busy body" comment!

 

[laurie31]

Who pays $1000 a month for private insurance. My sister only pays $3000 a year and she has many pre-exisiting conditions.

She is very fortunate. My brother pays about $1000/month for his family (only 1 child, all 3 of them healthy) and we pay almost that much as well (me, DH, 2 children, no significant health problems).

ETA - If the $250/month is for just one person, then that is in fact MORE than what we pay, if you break it down per person.

 

[barkley]

they might still be eligible-when i administered medicaid there were programs in my former state that despite how much income a family made, they might be eligible to medicaid for up to a year following becoming employed.

the stupidity in not reporting a change can be that even if you/your family continued to be eligible, if you are found to have committed fraud (via not meeting your reporting responsibilities) all the medicaid services received for that period of time becomes an overpayment which the government has mechanisms to collect (there are states that are very proactive on collections and if people do not cooperate they will also see their credit ratings take a hit b/c the overpayments are reported to the credit bureaus).


the kind of situation the op has posted about will be found out eventualy-with someone having received unemployment (uib) probably sooner vs. later. when someone's uib stopped getting issued it triggered a report to our computer systems that triggered a report to the worker that said the basis for the uib stopping. if it was employment we knew right off the bat. we also got reports that were triggered when a person's first paycheck got issued and their employer started doing payroll (person's ssn was associated with social security and other individual/employer deductions).


i don't know what the current rules are (and they differ from state to state), but when i administered the program even though a person might not have an on paper reporting requirement but once a quarter (fill out a report our system auto sent them), any kind of changes to income or employment had to be reported verbaly or in writing within 10 days, and failing to do so could result in fraud prosecution (and medicaid fraud had a much higher prosecution rate than any of the other programs i ever worked).

 

[Acklander]

Maybe they have to wait for the insurance to kick in at work??? don't you usually have a waiting period before you can get insurance?
but I agree with the others - I can't imagine that he is working for a major corporation "under the table" so they are well aware of what he does and doesn't make, so I wouldn't concern myself with it.