NY State of Health issue (plan, coverage, wife, Medicaid)

[NSHL10]

For those in NY who buy their ACA insurance via the Marketplace, please check to see if your insurance has been cancelled. It seems via a computer glitch many had their policies cancelled and they were moved to medicaid, even if they don't qualify. As of yesterday the problem was not resolved.

[ContraPagan]

Originally Posted by NSHL10

For those in NY who buy their ACA insurance via the Marketplace, please check to see if your insurance has been cancelled. It seems via a computer glitch many had their policies cancelled and they were moved to medicaid, even if they don't qualify. As of yesterday the problem was not resolved.

I am a NYSOH call center agent who has been answering NYSOH calls since May 2019, well before the pandemic started.

It is not a glitch. NYSOH is required to follow the Federal legislation that was passed at the beginning of COVID that says that no one who has had Medicaid as of or after March 18, 2020 is supposed to lose their Medicaid unless they state they don't want it, or they move out state.

So what this means is, if someone had a Medicaid eligibility even for one day during the pandemic, the system is set to revert them BACK to Medicaid if they subsequently qualify for a different subsidized insurance program.

I have handled several calls from people who mis-entered their income while doing their renewal for insurance during Open Enrollment, which resulted in them actually getting a Medicaid eligibility. They rerun the application, with corrected income information, and get another, more appropriate eligibility, like Advanced Premium Tax Credit (same as they had in 2021). However, the system WILL revert them back to Medicaid. It is automatic, because that is how the system is set up at the moment.

I had one guy try to argue with me "I never had Medicaid, " but I shut him down by going through the history of updates to his account since the middle of November, when he screwed up his income and put in a total that qualified him and his wife for Medicaid FOR ONE DAY. He corrected his app the following day, but that was enough for the system to revert him from APTC back to Medicaid.

If this happens, there IS a ticket that we agents can file, and I have filed several of them already, where the caller can request to be given the eligibility that they qualified for after correcting their income.

So, again, this is NOT A GLITCH.

PLEASE ALSO NOTE - this only occurs for people applying for financial assistance. If you choose not to, the only eligibility you will receive will be for a full-pay plan.

[NSHL10]

Originally Posted by ContraPagan

I am a NYSOH call center agent who has been answering NYSOH calls since May 2019, well before the pandemic started.

It is not a glitch. NYSOH is required to follow the Federal legislation that was passed at the beginning of COVID that says that no one who has had Medicaid as of or after March 18, 2020 is supposed to lose their Medicaid unless they state they don't want it, or they move out state.

So what this means is, if someone had a Medicaid eligibility even for one day during the pandemic, the system is set to revert them BACK to Medicaid if they subsequently qualify for a different subsidized insurance program.

I have handled several calls from people who mis-entered their income while doing their renewal for insurance during Open Enrollment, which resulted in them actually getting a Medicaid eligibility. They rerun the application, with corrected income information, and get another, more appropriate eligibility, like Advanced Premium Tax Credit (same as they had in 2021). However, the system WILL revert them back to Medicaid. It is automatic, because that is how the system is set up at the moment.

I had one guy try to argue with me "I never had Medicaid, " but I shut him down by going through the history of updates to his account since the middle of November, when he screwed up his income and put in a total that qualified him and his wife for Medicaid FOR ONE DAY. He corrected his app the following day, but that was enough for the system to revert him from APTC back to Medicaid.

If this happens, there IS a ticket that we agents can file, and I have filed several of them already, where the caller can request to be given the eligibility that they qualified for after correcting their income.

So, again, this is NOT A GLITCH.

PLEASE ALSO NOTE - this only occurs for people applying for financial assistance. If you choose not to, the only eligibility you will receive will be for a full-pay plan.

Well, I was told by the call center person who answered my call and dozens of others that it was a glitch.
In my case my salary did not transfer over from IRS website back in November so it wrongly put me on Medicaid. We fixed it and the system put me on Medicaid again from their original mistake. With the new corrected salary in place, why would I be switched over Medicaid? It makes no sense. By updating my salary I have declared that I dont want or qualify for Medicaid so the system is set up incorrectly evidently.

So how long until the ticket actually gets completed? Since Jan 29th when I called them, nothing has been accomplished. So I have paid my premium, yet currently I have no insurance.

I dont qualify for Medicaid so taking it is considered Medicaid fraud.

It is one big **** show.

So is this going to happen every month?

[ContraPagan]

I already explained to you why it is not a glitch, as well as the current policy, which is in line with the federal legislation regarding COVID and Medicaid, which you can research.

You don't want to listen to an experienced agent with over 6,000 calls under my belt, who has been named multiple times as the top agent in my call center based in part on my call matrices (which includes being rated on giving out the correct information to callers rather than pulling it out of my rear end like the agent you spoke to did), than that's your choice.

Fact is, I've been doing a lot of damage control to correct what my so-called coworkers have been telling callers, like the agent who told one woman she didn't have to send in proof of income documents for her husband's income, even though his income is contributing to her eligibility determination, only of her own. This woman has been a Marketplace consumer for years, she knows the policy from previous years. She was lucky to get me on the phone when she decided to call back and verify that information. Her husband is getting social security and a pension, and is pulling from his IRA, all of which is taxable income, so it DOES count, so of course she has to send in documentation of his income.

[NSHL10]

[quote=ContraPagan;62837059]I already explained to you why it is not a glitch, as well as the current policy, which is in line with the federal legislation regarding COVID and Medicaid, which you can research.

You don't want to listen to an experienced agent with over 6,000 calls under my belt, who has been named multiple times as the top agent in my call center based in part on my call matrices (which includes being rated on giving out the correct information to callers rather than pulling it out of my rear end like the agent you spoke to did), than that's your choice.




So in your experience, how long will it take to rectify this situation? My private insurance has been cancelled despite paying over $500 in premiums for the month.

What do I do for healthcare coverage NOW? Do I sign up for Medicaid managed plan knowing that I don't qualify? What will be the financial and civil consequences for that?

What are you telling your callers in my situation? Is there an official policy on what is to be done? All I have been told is I have to wait on DOH to act on the "ticket". No other advice given.

Since I make too much for Medicaid, what happens to the premium I am supposed to be paying? Is Medicaid now free for me or do I get hit with the bill at the end of the year?

Do you have any links for information on this? I dont see anything regarding what happens financially to people in my scenario.

Thanks for any help you can give.