Also fits this series: Medical Waste: An occasional series on the
absurdity to be found in the U.S.
health-care system
Also somewhat fits this series
[assuming there was other content unspecific to the health-care practical mess
I had to describe]: Off the Scales: A
comment series on excesses in the U.S. legal profession
But I lost steam (mostly by my discretion) for doing the
entry, though a chunky draft was made. As one reason for holding off, I thought
I would wait to see what I would do (regarding the specific procedural mess
that prompted the entry) at tax time, early this 2016. Turns out, the tax issue
was pretty simple, and was as I pretty much expected it would and should be.
Subsections below:
Reapplication comes,
innocently enough; bureaucratic bungling ensues
The illusion about my being “head of the household”
The mess involving reapplication, due to the Medicaid office’s crazily
slow handling of incoming mail
Left in vexation and
a sort of procedural limbo in the summer
Now, what about
tax-filing time?
[Edit 2/11/16. Edits 2/12/16.]
Reapplication comes,
innocently enough; bureaucratic bungling ensues
The way the mess started is
that, in spring 2015, per the perfectly normal and to-be-expected situation of the
state Medicaid office needing to review your case and having you fill out an
application again to see if you still qualify for Medicaid, I got a
reapplication mailing from the Medicaid office in about early May 2015 (as with
so much else in this mess, there were delays: the first renewal letter was
postmarked May 5, and received May 7; a later letter said the first letter was
sent “April 30”).
I didn’t wait too long to fill the
application out; I took a few weeks to do so, and had to get information from
my mother, in whose house I live, to include in the application, among
information routinely requested on people in your household.
The second of two problems is what is of more importance here. But the first one I will spell out in some
detail, for your full appreciation of how the Medicaid expansion under the
Affordable Care act has been fumbled with in New Jersey.
The illusion about my being “head
of the household.” Incidentally, the form I got, which had some info
about me preprinted, was presented in such a way that I was referred to as the “head” of the household. This is because
of a standard, characteristic heuristic of NJ FamilyCare—the more special-focus-oriented
office in New Jersey that handles all Medicaid applications in the state (which,
I think, was originally for ordinary Medicaid recipients before the Affordable
Care Act was implemented; then, in early 2014, it started clumsily including
applicants under the ACA “Medicaid expansion”). This heuristic matter meant
that anyone in the state who applies for Medicaid, according to their old (pre-ACA)
system, was the head of a household,
often with children.
So much for adjusting their
forms, as late as 2015, to reality under what should have been implied by the
ACA expansion. Of course, the ACA, in its Medicaid expansion component, made it
possible for those eligible for Medicaid to be other than single parents with children at home (which is also the
sort of criterion that has defined the more parsimonious forms of welfare in
the country). I was among these without-children people (and as it happens, my
mother doesn’t get Medicaid—she is retired and on Medicare—while I am not on
disability and I, not she, earn money from work: I am among the working poor,
as being an editor in New Jersey can easily make you).
My entering into the Medicaid
system followed exactly what I was federally required to do: originally, in
late 2013, I had filled out the form on the federal “Marketplace” Web site, and
I qualified for Medicaid in early 2014. The info I had entered was sent by the
federal “Marketplace” office to, I’m speculating, the New Jersey state offices
of Medicaid (in 2015 I was in touch with what implies that there is a more
bureaucratic, central office for this than the NJ FamilyCare office). (Of course,
in 2014, bureaucratic bungling, mostly on the New Jersey end, started very
soon; although the NJ FamilyCare office or the state’s main Medicaid office
supposedly sent me a Medicaid card in about March 2014, they had the wrong
mailing address for me, though I’d provided the right one on the federal Web
site. So I didn’t finally get all my signing up done until November-December
2014.)
Also, as I’ve talked about in
entries in early 2014, New Jersey’s
NJ FamilyCare office (and maybe also, in the same period, the more central
Medicaid office, though I don’t have firsthand knowledge of this) was hugely
backlogged and ill-equipped to deal with the new influx of Medicaid
applications through the Obamacare enrollment. (This I addressed deep in this entry, especially the end note [where a
news article is cited], in my series on signing up for Obamacare.)
Anyway, on the reapplication
form in spring 2015, I hand-wrote a footnote explaining that, while I was
labeled as the head of the household, I was not really; I added that my mother
was, but I was the one who applied for Medicaid. Well, this specific bit turned
out not to be an issue down the road. With me, NJ FamilyCare didn’t have a hard
time digesting this inability to square with their own form-bound presumptions
about who applied for Medicaid.
And it was the least of the
problems.
The mess involving reapplication,
due to the Medicaid office’s crazily slow handling of incoming mail. The
initial big problem was that, after I
mailed off the reapplication form plus a copy of my 2014 federal tax form to NJ
FamilyCare, in its own return,
postage-paid envelope, about 12 days before the deadline, I got a
letter from them dated June 5, 2015—five days before my deadline—saying I was “disenrolled” from Medicaid because
(they claimed) I hadn’t reapplied by
the deadline, which was five days after
the date of their disenrollment letter, June
10. I received this “disenrollment” letter June 11.
(Adding to all the bureaucratic
messiness is that I had mailed my reapplication Friday, May 29; the deadline,
as I said, was June 10. But NJ FamilyCare sent a “final reminder” letter dated
May 29, postmarked June 2, which I received June 4. So their disenrollment letter was dated seven
days after the writing of their “final reminder,” while my deadline was 12 days
after the writing of the “final reminder.”)
On June 11, I called NJ
FamilyCare right away. I ended up finding that they had my reapplication; they
had received it, according to the person I spoke to, that day, June 11. My obvious question: HOW COULD IT TAKE A
REAPPLICATION, MAILED TO THEIR OWN ADDRESS, VIA THEIR OWN POSTAGE-PAID
ENVELOPE, 12 DAYS TO GET INTO THEIR
HANDS?
Left in vexation and a sort of procedural limbo in the summer
The “disenrollment” letter, in
legally required style, explained how I could appeal by X date, etc. For some
days or weeks, I debated on whether to appeal, for what legal rights it could
respect for me, even though it seemed the Medicaid office was processing my
reapplication; but there was an air, I felt, that I was not in a normal
reapplication process. This was bolstered when, adding to the grim comedy, a
letter arrived from them June 17, postmarked June 15, and dated June 11, saying
thanks for my interest; they had received my application and were reviewing it;
they would be in touch if they needed more info.
Anyway, I ended up choosing not
to appeal (and this was not a totally easy bit of deliberation). And on their
end, though I wasn’t 100 percent sure, it seemed they were disregarding the
disenrollment issue, while now my reapplication was “pending.”
And indeed I was told it was “pending”
when, for a coincidental standing appointment, I visited my doctor on June 16,
and his workers checked into the matter, apparently with the Medicaid office
directly.
But by July 4, I figured I had
been without Medicaid insurance for almost a month [adjustment 2/12/16: this isn't quite true; the effective date for coverage stopping was June 30, according to the state's letter; and see update added below]. And I didn’t know how long
it would be when I am covered again, or whether I even would be covered. [In general, true later in the summer.]
I seem to recall that, sometime
in the period of my application’s being pending, they also wrote me asking for
more info to be sent, and I did this, this time sending back the answer by
Priority Mail, which should have reached them after no more than two days. I
think there was a phone call where I heard from them they hadn’t received my
additional info yet, and this was several days, maybe a week, after I’d sent
it. Who, or what, was manning their mailroom? Snails?
Meanwhile, in July, I paid the
doctor appointment of June 16 out of my pocket, explaining to them that with
the Medicaid approval not being certain, and since I didn’t want the unpaid
doctor bill hanging over my head, I wanted to pay them (as I had routinely done
for years anyway, before I was ever enrolled in Medicaid) and get it out of the
way.
In about late July, I got a
notice from the state Medicaid office saying I was approved for continued
enrollment, and my insurance would officially restart in very early August. So
by what this verbally implied, I was supposedly without Medicaid coverage
almost two months.
##
A few months later—this was
probably September 2015—I asked the doctor’s office for some kind of receipt or
such reflecting that the [important correction of month] June appointment had been paid; or maybe I asked
something about my Medicaid coverage. (I probably have records on the precise
query, but it isn’t important now.) I was told by them that Medicaid had paid
for the June visit. I was surprised, of course; Medicaid had paid when I was
supposedly disenrolled at the time?
I asked for the money back that
I’d paid the doc’s office in July, and they did some research, and found that,
yes, I had paid when it turned out I needn’t have, and they gave me a check for
the money back.
Now, what about tax-filing time?
So my next question was, what
would I do at income-tax (1040) time? There is a form (8965) you fill out if
you have not had health insurance coverage, per the ACA. Last tax year (2014),
following this form’s instructions, I got a hardship exemption from paying a
penalty. What about this year?
The problem was, the state had
said in 2015 I was disenrolled for about two months [update 2/12/16: the state's early-June letter said the effective date of disenrollment was June 30, so technically my June visit to the doctor would have been covered; but I've always intuitively remembered the discontinuation of the coverage as from the time I got the letter, in early June; see also second footnote to this entry, in the February 12 entry], but the doctor had been
paid by the insurer for my July visit anyway. Would I represent to the IRS I
had had coverage from early June to early August, or not?
It turns out, I qualified for a
hardship exemption again, so the “enrolled or not” issue wasn’t necessary to
represent in Form 8965.
##
Add to this the fact that I
don’t really trust this insurance, enough to get any service beyond the minimum
I’ve usually gotten (because what if I went for, say, a heart stress test, and
then found I was being billed directly for some aspect of it for which the
service-provider wouldn’t take Medicaid?), and sometimes I feel it would be a
lot easier not to have the insurance.
(Plus, the insurer
UnitedHealthcare—which handles my Medicaid insurance, and which normally is as
trustworthy as any U.S. health insurer—has spoken as if it might leave the ACA
insurance market in 2017, though I don’t know if that means both the
individual-insurance market and Medicaid, or just one or the other. Who knows
what I would find it suitable to do if I no longer had them for Medicaid
insurance.)
Also, having Medicaid means I
don’t have medical expenses by which to get a deduction on my New Jersey state income tax, but that’s
another story, and not a big deal.
##
Here is the last in the OFAD
series, which series tailed off in 2014:
OFAD 7: Connecting with Lefty: Finally getting my Medicaid card, to
square with the ACA demand
URL:
http://gregoryludwig.blogspot.com/2014/11/ofad-7-connecting-with-lefty-finally.html
