A client approached us for assistance after receiving a rejection notice for NJ Family Care administered by the Ocean County Board of Social Services (OCBSS).
The client’s income consisted of earned income from a small business as well as monthly parental support. Upon review of the figures provided, we determined that the ineligibility resulted from the inclusion of the parental support, as the earned income was less than the applicable threshold. However, according to the Obamacare rules, only income which is reportable on the tax return may be included, meaning that parental support should not count.
We therefore contacted the OCBSS on the client’s behalf, and were told that they had recently begun to count parental support again by adding back to taxable income, known as the Modified Adjusted Gross Income (MAGI) , an item as follows: “Cash Support-only for tax dependents not claimed by a parent or spouse on their tax return”. While admitting that the inclusion to MAGI was not understood and in an attempt to clarify exactly what was meant, the State issued new instructions to the OCBSS, informing them to no longer count parental support-however, support given by other relatives such as an aunt or uncle should be added back to MAGI.
In addition, the State advised that at the County level the regulations are stricter. Those applicants who don’t qualify at the County level may still qualify for services at the State level.
We take pleasure in reporting that our clients’ benefits were subsequently approved as a result of the correspondence.
We assert that the support source should be of no significance in the computation of benefits and that benefits were and continue to be incorrectly reduced or denied in contravention of clear Federal rules not to generally include non-taxable income in MAGI. We are advising our clients to check that their benefits were not reduced or denied as a result of the above, and if so to take appropriate action to restore their benefits.
Finally, we question why the State and certainly the County appear not to have fully adopted the Obamacare rules, to the detriment of eligible Family Care participants, and accordingly, if the State and the County have knowingly taken a position in contravention of Obamacare.
This is not even a result of Obamcare. Its a result of the typical ineptness of big government that can be seen daily at the majority of federal, state, and local agencies.
Could someone please explain this “in plain english”?
We were rejected twice and we are both disabled one of us has SSD for 753/mo and the other has a Veterans disabled pension for 1074/mo both of which are NONtaxable, but added together comes out to $50 above the federal poverty levels we are not married but were ‘DEEMED” as a household and denied all extra services even after we pointed out that Medicare deducts $105 for my check a month. Ever try to live in NJ on $1600 a month for 2? No matter who we talked to they say oh thats impossible and we try again only to be denied again…
How many other needy people were denied services they are federally entitled to by this agency is what I’m wondering?
Kudos to the accountant who set the record straight and made a real difference in people’s lives. Sometimes you need professionals like this, that can navigate the complex rules, that apparently even government workers don’t know how to read.
Also, shouldn’t the county personnel be advising applicants that even if they’re deemed not eligible under the stricter County rules, they can still apply with the State directly for potential eligibility. Since, after all, the State is the one funding the County social services departments, there should be an in-place policy to redirect folks to apply for the state-level benefit. The current process is misleading people to believe that they are totally ineligible for critical healthcare benefits and that’s simply not true.
TLS, thank you for this article. I would like to see more of these.
How many other needy people were denied services they are federally entitled to by this agency is what I’m wondering?
Kudos to the accountant who set the record straight and made a real difference in people’s lives. Sometimes you need professionals like this, that can navigate the complex rules, which apparently even government workers don’t know how to read.
Also, shouldn’t the county personnel be advising applicants that even if they’re deemed not eligible under the stricter County rules, they can still apply with the State directly for potential eligibility. Since, after all, the State is the one funding the County social services departments, there should be an in-place policy to redirect folks to apply for the state-level benefit. The current process is misleading people to believe that they are totally ineligible for critical healthcare benefits and that’s simply not true.
TLS, thank you for this article. I would like to see more of these.
There is always the option of asking family to discontinue “support”. If they give the money either as a gift at random times it can not be counted as income. Another option is to have them pay your bills directly-even to pay your credit card bills. This is then called “vendor payments” and thus NOT included in your income!
Basically when ppl apply for jersey care through the ocean county division they get approved for insurance based on income. This client was denied the benefits they were entitled to because of parental suport which the cpas here picked up that they were actually eligible because parental supports is NOT taxable income. Its very nice knowledge- so if anyone was denied they shold check into it. This could potentially save people thousands of dollars…..
Local organizations and professionals that advise ppl on such things cold have been misinformed and misguide ppl.. impt to be informed.
Answer to #6
Dear Shver,
Please discontinue support !. I know you love us dearly but frankly you are interfering with my benefits. How about becoming a “vendor” or giving us a lump-sum for Chanukah or donating it ti charity or taking early retirement?
Thanks
Mr. Options
Answer to #9
“Titen Chochma L’Chochom V’Yoisef Lekach”
here is text of a memo sent by the state
“The goal is to have a “No
Wrong Door” approach to obtaining health insurance coverage. When an individual
is determined ineligible for NJ FamilyCare or any other New Jersey medical
assistance program, their case will be electronically transferred to the FFM.
Conversely, when an individual applying at the FFM is determined eligible for
2
medical assistance, their case will be electronically transferred to the appropriate NJ
eligibility determining agency. ”
the full communication can be found here http://www.state.nj.us/humanservices/dmahs/info/resources/medicaid/2014/14-12_Affordable_Care_Act.pdf
@fred – sounds familiar, my spouse is on disabilty and as the caregiver our finances are drained. We are pretty desperate and just make some ends meet. We work on bitachon and emunah daily. We’re not in same boat-we are the boat. Hang in there!
To Neighbor # 11,
FFM mean Federally-Facilitated Marketplace. If indeed, the applicants were referred by the County directly to the FFM before being transferred to the State-level application process — That is a serious problem with the system and needs immediate correction.
It appears to me that if the system will not fix itself, there should be legislative hearings to address the fallout from this broken system.
I wonder what Valerie Harr has to say on the matter…
To Neighbor # 11,
FFM mean Federally-Facilitated Marketplace. If indeed, the applicants were referred by the County directly to the FFM before being transferred to the State-level application process — There is a serious problem with the system which needs immediate correction.
It appears to me that if the system will not fix itself, there should be legislative hearings to address the fallout from this broken system.
I wonder what Valerie Harr has to say on the matter…
Got a lump sum ofmoney from my parents as a down payment for a house,money went straight to the bank but my worker counted it as income!
We were denied and it took many months until we were able to get back on. We had the extra expense of hiring a lawyer to prove that it was wrong of the worker and so we shouldnt have to reimburse the few months of “unjustified coverage”.
You can’t imagine the stress! Our lawyer told us that it was always the same local department that was disregarding the new rules!
How does the ocean county prosecutor expect people to,know the rules when the State agencies themselves dint know the rules and just make them up as they go along ?
to neighbor says
thanks for the interesting communication link
so according to the rules you don’t need proof of pregnancy just a statement from person… and scholarships r not counted as part of the magi I wonder is that a federal rule (irs) or their own?