From Covering Kids & Families of Indiana
With a reported 16 million workers who have lost their jobs due to the pandemic, a new data note from the Kaiser Family Foundation examines how job loss and changes in income may impact access to health coverage through employers, the Affordable Care Act Marketplaces or Medicaid and Medicaid expansion programs.
The data note walks through various scenarios for families in different circumstances to highlight their coverage options, including how state and federal policies may affect their eligibility. The findings are children in families experiencing unemployment are likely to be eligible for Medicaid or the Children’s Health Insurance Program (CHIP) wherever they live, while parental income loss due to unemployment may also make them newly eligible for Medicaid in expansion states. Those who lose employer sponsored coverage may also qualify for a Special Enrollment Period (SEP) in the Affordable Care Act marketplaces in every state and, depending on income, could receive tax credits and subsidies.
People who were already uninsured, however, would not qualify to enroll in states utilizing the federal HealthCare.gov platform. This is due to SEPs typically not being available to those without a loss of coverage, unless another qualifying life event occurs. Several state sponsored exchanges, however, have opted to reopen their exchanges to all applicants during the pandemic.
The data note also explains how the federal recovery rebates and enhanced unemployment benefits in the recently passed Coronavirus Aid, Relief, and Economic Security (CARES) Act are treated in determining eligibility for Medicaid and Marketplace tax credits and subsidies.
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Coverage and COVID-19
There is a lot of new information to be aware of during this time. Here are some key points, helpful documents and recent webinars:
- Losing employer healthcare coverage triggers a Special Enrollment Period (SEP) of 60 days. If COBRA coverage is offered, it is important consumers weigh the cost and benefits of COBRA coverage vs. Marketplace coverage (and potential premium tax credits) during that initial 60 days.
- The CARES Act provides an “economic impact payment” of $1,200 per adult and $500 per dependent child for most families. The payment is phased out at higher income levels. This payment does not count as income for people seeking coverage in Medicaid, CHIP or the Marketplace.
- If applying for Marketplace coverage, consumers may need to provide an explanation for reduced income and/or provide a self attestation if they are unable to attain requested documentation.
- Marketplace already has guidance in place to allow assisters to help consumers over the phone. Assisters should communicate the contents of their organization’s authorization form and document verbal consent.
- In general, state unemployment compensation is taxable income that is included in both Medicaid/CHIP and premium tax credit income calculations. However, under the CARES Act, the federal increase in unemployment benefits of $600 per week for up to four months (ending July 31, 2020) is treated differently. It is excluded from income for Medicaid/CHIP eligibility, but it is included for the determination of income for premium tax credits. HealthCare.gov is unlikely to be able to program this change into its system. People applying for coverage through the Marketplace should be on the lookout for help text or other instructions about how or whether to include this income.
- Certified Application Counselors (CAC) who know their 10-digit ID number can call the Marketplace direct call center line at 855-879-2683 when assisting consumers. The general consumer call center line is 800-318-2596 (TTY: 855-889-4325).
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