Not Reporting Marriage To Medicaid


Ssi And Medicaid Recipient And An Inheritance

Do You Qualify for a Special Enrollment Period?

SSI/Medicaid treats any influx of cash as income in the same calendar month it is received. Generally speaking, if an amount of money is left over in the next calendar month, it is deemed an asset.

  • SSI Recipients: must have $2,000.00 or less to their name on the 1st of each and every calendar month.
  • Medicaid Recipients : must have at least one day of each month where they have $2,000.00 or less to their name.

So, if any money is suddenly received , it is important to consult with an elder law attorney who handles Medicaid planning to discuss how to remain Medicaid eligible after receiving an inheritance.

If a Medicaid recipient knows that they are in the Will of a loved one, it would be important to have a conversation with them and an Elder law attorney about amending the Will to leave the Medicaid-recipientâs portion of the proceeds in what is known as a âtestamentary special needs trust.â This will avoid the hassle of having to rush into a Medicaid attorneyâs office upon the death of the loved one in attempt to preserve their Medicaid or SSI .

How to report a change in circumstances to Florida Medicaid

The Florida DCF Change in Circumstances Form can be found here, then mail or fax:

  • Mailing Address: ACCESS Central Mail Center: P.O. Box 1770, Ocala, FL 34478-1770
  • Fax: 866-886-4342

For customer service, call 850-300-4323 .

How to report a change in circumstances to Social Security

Changes In Household Size

Your household size relative to your income can also impact your Medicaid eligibility and what you may need to contribute financially to your Medicaid coverage. So when your household size becomes larger or smaller than you originally said in your application, you will need to report that change.

Some common changes in household size are those that are the result of marriage, death, birth, divorce, adoption, or placement of a child into foster care. Keep in mind that the Marketplace counts foster children as part of your household size. However, the income you receive as compensation for their care is not counted.

What Is A Domestic Partnership

The meaning of this term is rapidly changing as more and more couples choose to identify as domestic partners. The purpose of this designation is to provide two individuals who live together and share a common domestic life with some of the benefits that married couples are entitled to.

Until 2015, many states did not recognize same-sex marriage. However, to meet demand, a number of states passed laws recognizing same-sex domestic partnerships. Then on June 26, 2015, the United States Supreme Court ruled in Obergefell v. Hodges that state-level bans on same-sex marriage were unconstitutional. As a result, same-sex marriages are now legal and recognized in all 50 U.S. states, Washington, D.C., and U.S. Territories.

Each states specific legal definition of a domestic partnership varies slightly, and it may be possible for opposite-sex partners as well as same-sex partners to avail themselves of this option. Some states still have laws on the books regarding common law marriages and civil unions, so it is important to be familiar with your own states legal definitions and requirements.

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Who What When And How Of Reporting Changes

Who must make reports? The person responsible for making required reports to HHSC include an:

  • eligible individual
  • applicant awaiting a final determination upon an application.


  • If the applicant/recipient has an authorized representative and has not been legally adjudged incompetent, either the applicant/recipient or the authorized representative must make the required reports.
  • If the recipients co-payment is impacted by either the community spouse or a dependent family member, the recipient, authorized representative, community spouse or dependent family member is responsible for making required reports to HHSC.
  • If the applicant/recipient has an authorized representative and has been legally adjudged incompetent, the authorized representative is responsible for making required reports to HHSC.

Medicaid And Unmarried Couples

Medicaid Planning for Married Couples

In most cases, Medicaid eligibility is dependent on financial need. People with high incomes or too many assets may not qualify for Medicaid benefits. Medicaid often evaluates a person’s eligibility based on Modified Adjusted Gross Income which considers a person’s household size and income. Understanding what constitutes a household can help you evaluate whether you will qualify for Medicaid.

Generally, Medicaid doesn’t consider unmarried couples to be a household. That means even if you live with a boyfriend or girlfriend, Medicaid will likely treat you as if you were single. Medicaid’s treatment of unmarried couples is good news if you or your partner want to qualify for benefits, but the other person’s income or assets would create an eligibility problem.

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Why Opt For A Domestic Partnership Over Marriage

In situations where both partners have similar annual incomes, there is an income tax disadvantage for having to file a federal tax return as a married couple. A couple could avoid this so-called marriage penalty by registering as domestic partners.

Additionally, if one partner needs to enter a nursing home and apply for Medicaid, the partner living in the community will have their assets exposed to the cost of the nursing home if the couple is legally married, but not if they are just domestic partners. That is because under Medicaid rules the assets of both spouses are combined for calculation purposes and the spouse at home is only permitted to protect $119,220 .

In 2011 the Obama administration via the U.S. Department of Health and Human Services announced that if a state so desired, it could adopt changes to its Medicaid regulations that would grant same-sex domestic partners the same status as married couples for eligibility purposes. Since the Obergefell case discussed above, it is no longer necessary for a state to have such a regulation, and further, it is questionable whether such regulations would apply to opposite-sex domestic partners.

Options For Reporting A Change For Apple Health Coverage

You have several options to report a change for Apple Health coverage:

  • Online: Go to Washington Healthplanfinder – log in and select “Report a change in income or household” under Quick Links.
  • Phone: Call the Washington Healthplanfinder Customer Support Center at 1-855-923-4633.
  • Email:
  • Paper: Submit verification of the change to: HCA-MEDS, PO Box 45531, Olympia WA 98504

Once your change has been processed, you’ll receive a notification explaining any changes to your coverage or any next steps.

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Affordable Care Act Subsidized Plans After Medicaid

Special Enrollment Status: If you lose your Medicaid health coverage, a Special Enrollment Period opens up for you. During an , you can obtain full-featured health insurance known as an Affordable Care Act plan.

The SEP is only a 60-day window, so you have to act quickly. Tools like help you determine which plan is best for your needs and budget.

Without a Special Enrollment Period, you can enroll in a health plan only during the annual Open Enrollment Period, which generally lasts from November 1 through January 15. Once the window closes, you will be unable to enroll in healthcare coverage until the next open enrollment period.

For example, if your Medicaid is canceled as of March 1, you will have 60 days to enroll in a health plan through Obamacare. If you dont enroll by the end of that 60-day window, you will have to wait until the next open enrollment period, and the coverage would not be effective until January 1 of the following year.

If you know when your Medicaid plan ends, you can sign up in advance. Health insurance plans are generally effective the first day of the following month after you apply, but a new application may take some time to process.

ACA Discounts for Low and Moderate Incomes: The cost of health insurance premiums can be intimidating, but help is available. Depending on your income level, you might receive a subsidy for ACA coverage.

Review Your Options And Stay Covered

What Are The Illinois Medicaid Eligibility Guidelines?

Losing Medicaid coverage can be very scary and shocking at first, especially if you have ongoing health issues.

If you are dealing with losing Medicaid, remember that it is not the end of the road. You have multiple options. Keep both your healthcare needs and budget in mind when making a decision about how to move forward. And if you end up at the hospital without insurance coverage, there are options even in that situation.

No matter what path you choose to follow once youre denied Medicaid or you are dropped from Medicaid, the most important thing to do is to obtain some type of coverage. The physical and financial safety that you get from having health insurance can end up being well worth any cost.

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If Im No Longer Eligible For Medicaid What Are My Other Insurance Options

You have several other coverage options.

  • You can enroll in a Marketplace health insurance plan, also known as Obamacare or Affordable Care Act insurance. See plans and prices here.
  • Medicaid. You also may be eligible for Medicaid, depending on your income. You can see if youre eligible and apply here.
  • COBRA. If youve been laid off recently, you usually have the option of COBRA, where you pay the full premium of the same insurance your employer purchased for you. COBRA is typically much more expensive than Marketplace insurance, but it allows you to continue the coverage you already had. Learn more about comparing COBRA with Obamacare health insurance.
  • Medicare. Once you turn 65, youre eligible for Medicare. Call us to enroll at 677-3060.

    Changes To Your Income

    When you apply for Medicaid, youll need to disclose and document your household income. But of course, the unexpected can always happen. And if your income changes significantly, either increasing or decreasing, you will need to report it.

    Because Medicaid eligibility is determined based on MAGI , there are some kinds of income changes you wont need to report. These include inheritance, child support received, a teenage child who has a job earning less than $6,300, or any kinds of educational scholarships for tuition and fees.

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    What Must Be Reported

    Although not all inclusive, events that must be reported are:

    • Change of address Report any change in mailing address and any change in the address where the person lives.
    • Change in living arrangements Report any change in the make-up of the household that is, any person who comes to live in the household and any person who moves out of the household.
    • Change in income Report any increase or decrease in income, and any increase or decrease in the income of:
    • the ineligible spouse who lives with the recipient
    • the community spouse or dependent family member
    • the parent, if the recipient is an eligible child and the parent lives with the eligible child or
    • an ineligible child who lives with the eligible child.
  • Change in resources Report any resources received or parted with by the:
  • applicant/recipient
  • parent who lives with the eligible child or
  • spouse or dependent family member.Additionally, report the marriage of an ineligible child who lives with an eligible individual.
  • Medical improvements If eligible for Medicaid because of disability or blindness, report any medical condition improvement.
  • A termination of residence in the U.S. Report leaving the U.S. voluntarily with the intention of abandoning residence in the U.S. or leaving the U.S. involuntarily.
  • Leaving the U.S. temporarily Report leaving the U.S. for 30 or more consecutive days or for a full calendar month .
  • It’s Important To Keep Your Contact Information Up To Date

    Medicaid Planning for Married Couples

    Need to update your contact information? Don’t wait. Contact us today!

    If you have insurance through Vermont Health Connect and have had certain life changes, we need to know. A change in income or family situation can impact your choices and the amount of financial help you can get. If you get financial help from Vermont Health Connect and you dont report a life change, you could owe money to the IRS when you file your federal income taxes.

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    What Couples Need To Know About Medicaid

    A guide to the qualification rules when only one spouse needs benefits

    The rules for Medicaid benefits can be tricky for married couples, especially when only one spouse needs the benefits. Medicaid assumes that both spouses of a married couple are financially responsible for one another. As a result, when Medicaid determines a spouses eligibility for benefits, the assets of the husband or wife who isnt applying known as the community spouse are expected to contribute to the care of the other. The Law Protecting Spouses

    Thats why the full financial history of both spouses is assessed when ascertaining Medicaid eligibility. However, The Spousal Impoverishment Act protects the community spouse from becoming severely impoverished. The guidelines specify the community spouses ability to keep some income and assets, while still allowing the applicant the option to obtain Medicaid benefits.

    As a general rule, the husband or wife who isnt applying for Medicaid benefits may keep up to half of both spouses joint liquid assets. But there is a limit to the amount of countable assets that the non-applicant spouse can keep. Known as the Maximum Community Spouse Resource Allowance , the limit is currently $117,240. Next year, the limit will rise to $119,220.

    Please note: Medicaid qualification guidelines vary from state to state and may change from year to year. An Example of One Married Couple

    Why Its Important To Update Your Application Immediately

    • If your income estimate goes up or you lose a household member:
    • You may qualify for less savings than youre getting now. If you dont report the change, you could have to pay money back when you file your federal tax return.
  • If your income estimate goes down or you gain a household member:
  • You could qualify for more savings than youre getting now. This could lower what you pay in monthly premiums.
  • You could qualify for free or low-cost coverage through Medicaid or the Childrens Health Insurance Program .
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    Monitoring Substitution Of Coverage In Chip

    States are required to include in their state plan a description of procedures used to ensure that CHIP coverage does not substitute for coverage under group health plans. States use various procedures to prevent substitution of coverage, such as monitoring survey data or private insurance databases, or applying a waiting period for individuals who are no longer enrolled in private coverage. This requirement can be found at section 2102 of the Social Security Act. Additional information on states specific CHIP waiting period policies.

    How People Get Caught Lying On A Medicaid Application

    Getting a Medicaid denial letter and living through it

    If you are lying on a Medicaid application, you will eventually get caught. There are multiple signals that can get you caught lying to Medicaid. Medicaid is run by the government, and the government frequently cross-references their Medicaid recipient databases with databases that contain peoples income, asset and household information.

    Some of these databases include

    • IRS tax filings
    • Payroll tax filings from your employer
    • Register of Deeds
    • Utility Bills
    • Records of Using Medicaid

    If you are being accused of Medicaid fraud and you are looking to consult with an attorney, you can send us an email at or call us at .

    IRS tax filings can include form 1040 and the like, and they can show that your income exceeds Medicaid limits. An IRS tax filing can also show that the father is supporting the children, when the father declares the children as his dependents. Payroll tax filings that your employer files with the IRS, which includes form W2 and the like, can also show income.

    Register of Deeds has records of your property ownership, which can indicate that you are receiving rental income or that you are a part of a household.

    A Declaration of Corporation can get you caught lying on a Medicaid application because it indicates that you are receiving business income, including cash income, that you are not reporting to Medicaid.

    Look at the recent high-profile convictions. Most of them had to do with lying to the investigators, some even more than the underlying fraud.

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    Lawfully Residing Targeted Low

    States have the option to provide CHIP and Medicaid coverage to children and pregnant women who are lawfully residing in the United States and are otherwise eligible for coverage, including those within their first five years of having certain legal status. If states do not adopt this option, federal law requires a 5-year waiting period before many legal immigrants are permitted to enroll in Medicaid and CHIP. Learn more about providing health coverage to lawfully residing children and pregnant women at 2107 of the Social Security Act, and in SHO# 10-006 . A list of states providing Medicaid and CHIP coverage to lawfully residing children and/or pregnant women.

    How To Report A Change

    To report a change, contact your states Medicaid office. Theyll tell you what documents they require, and theyll let you know if this changes your eligibility.

    You can also report the change to the federal government through or HealthSherpa to see if youre eligible for other coverage. If you enrolled in Medicaid through HealthSherpa, you can log in to your account to report the change. If you enrolled in Medicaid through or another site, you can create an account with HealthSherpa and still report the change here. Keep in mind that reporting to does not replace reporting the change to your state Medicaid office.

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