NJ Familcare Medicaid question (supplement, coverage, benefits, New Jersey)
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Hello. This is my first time at the forum because I am trying to help a friend who is getting conflicting information regarding the impact of a Workers Comp settlement on her Medicaid. She has NJ Familycare.
There is a scenario at this link, posted by an attorney, that very closely matches my friend.
EXAMPLE 1: Mark is 57 and has Medicaid because his monthly income is very low. He had a work related accident and is advised by his attorney that he will be awarded a settlement in May, 2017. Mark received a check on May 30th for $150,000. Mark was ineligible for Medicaid from May 1, 2017 – May 31, 2017 (the entire month). Mark must report the award for Medicaid, but can reapply for Medicaid benefits as early as June 1, 2017.
The example indicates that Mark will lose his Medicaid just for the month he receives the settlement, which is May 2017. He can reapply June 1st. No mention is made of the fact that the $150,000 will be an asset in Mark's bank account, so the inference is that assets do not count and that Medicaid eligibility is strictly based on income. From what I understand, this seems correct.
Yet my friend is being told by her attorney that assets do count, and that my friend would be ineligible to get back on Medicaid until the amount in her bank account is spent down below a certain level. The attorney is recommending setting up a SPECIAL NEEDS TRUST that would prevent her from losing Medicaid at all. She would not even lose it for the month she eventually receives the settlement.
My friend is getting a net settlement of $29,000 and she is 58 yrs old. She has no income.
Is her attorney correct that having the $29,000 would prevent my friend from getting back on Medicaid the following month? Or does it have no impact as inferred in the example?
SHE needs to talk to someone who is familiar with how Medicaid eligibility is determined in NJ, preferably someone who actually works in that capacity.
SHE needs to talk to someone who is familiar with how Medicaid eligibility is determined in NJ, preferably someone who actually works in that capacity.
Her attorney needs to stay in their lane.
That's the problem, ContraPagan. My friend's attorney IS a Disability attorney who, supposedly, is experienced with Medicaid and how it is affected by Workers Comp settlements. Either her attorney knows something that I can't find backup to anywhere else, or she simply is not adequately experienced with Medicaid after all.
Hence my post here, hoping that someone has real life insight or may even be an experienced Medicaid attorney.
Your friend needs to ask about NJ Medicaid expansion under the ACA which eliminated the assets test for qualifying. NJ did expand Medicaid, so assets should not count when qualifying for Medicaid - but income will.
On its face, the quote you've cited sounds correct. The $29K is income for one month but should not affect her ongoing income status and therefore she will be eligible to reapply for Medicaid.
However, if your friend is disabled, receiving SSDI, and is a Medicare/Medicaid dual eligible, it may be the exemption from assets tests does not apply as it would for a low-income able-bodied person not eligible for Medicare and not receiving SSDI.
Your friend needs to ask the atty specifically why, with NJ Medicaid expansion, assets now matter with this settlement.
In WI, I am acquainted with a 79 y/o woman on Medicare/Medicaid who received a small settlement from an automobile accident. Her personal injury attys who are very experienced with low income people told her she would need to do the same - establish a Special Needs Trust - or lose her Medicaid benefits.
Last edited by Ariadne22; 10-21-2020 at 08:49 PM..
Your friend needs to ask about NJ Medicaid expansion under the ACA which eliminated the assets test for qualifying. NJ did expand Medicaid, so assets should not count when qualifying for Medicaid - but income will.
On its face, the quote you've cited sounds correct. The $29K is income for one month but should not affect her ongoing income status and therefore she will be eligible to reapply for Medicaid.
However, if your friend is disabled, receiving SSDI, and is a Medicare/Medicaid dual eligible, it may be the exemption from assets tests does not apply as it would for a low-income able-bodied person not eligible for Medicare and not receiving SSDI.
Your friend needs to ask the atty specifically why, with NJ Medicaid expansion, assets now matter with this settlement.
In WI, I am acquainted with a 79 y/o woman on Medicare/Medicaid who received a small settlement from an automobile accident. Her personal injury attys who are very experienced with low income people told her she would need to do the same - establish a Special Needs Trust - or lose her Medicaid benefits.
Thank you, Ariadne22. I do believe she is on expanded Medicaid. My friend is not disabled (she is in the midst of an appeal to be granted disability, but has requested an in person hearing and those have not yet resumed here in NJ. So it likely won't be scheduled until early 2021), she is not receiving SSDI, and is not Medicare/Medicaid dual eligible.
Assuming it turns out she can reapply the following month, what do people in the same position do to have coverage for that one month? Do they apply through ACA and get coverage for a month?
Your MAGI income includes any income from you or your household members that is taxable on a federal tax* return. This includes items*listed on lines 1-6*of 2019*Form 1040 and on*lines 1-8*on Schedule 1 of 2019*Form 1040. It is therefore important to know that there are certain types of income that are not taxable to you and therefore not countable as MAGI income. Examples include:
Child support received
Supplemental Security Income (SSI)
Workers compensation benefits
Also this, on the same link:
Quote:
Financial eligibility for these MAGI programs is based solely on income; your resources (assets) are not considered.
Your MAGI income includes any income from you or your household members that is taxable on a federal tax* return. This includes items*listed on lines 1-6*of 2019*Form 1040 and on*lines 1-8*on Schedule 1 of 2019*Form 1040. It is therefore important to know that there are certain types of income that are not taxable to you and therefore not countable as MAGI income. Examples include:
Child support received
Supplemental Security Income (SSI)
Workers compensation benefits
Also this, on the same link:
Financial eligibility for these MAGI programs is based solely on income; your resources (assets) are not considered.
Thank you, ContraPagan. It certainly does seem to be based solely on income. Note that Workers Compensation Benefits is not the same as a Workers Comp Settlement. The settlement, while not taxable, is counted as income for the MAGI calculation. That much seems clear.
I am looking forward to Ariadne22 replying to my question regarding how a persons handles that month without coverage. I am also googling that.
Depends on if the award was reported as w2 or 1099 earnings or a taxed benefit. Check the paystub that came with the check. Make sure she talks to a NJ familycare navigator/expert.
Not liking that she is working with a lawyer if they will take a chunk of that settlement. Also a trust will have fees associated with the setup.
She might be able to get a good lead by calling 211 helpline.
Edited: did not realize njfamilycare is now the same program as Medicaid expansion in NJ
Last edited by foodyum; 10-24-2020 at 06:39 AM..
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