Options for health care in Illinois?

February 14, 2015 8:04 PM

Asking for a friend: Friend needs health insurance. He currently has no job or income. We're looking into Medicaid and have some special snowflake questions.

Friend lives part time with me and part time with another friend, pays no rent at either place. He's trying to figure out if he's qualified for Medicaid. We're in Illinois and tomorrow is the deadline for acquiring health care to avoid penalties.

The online info for Medicaid indicates that the income of everyone in a household must be taken into account to assess a person's qualification for the program. However, he's not really part of either household and our finances aren't intertwined, i.e. I don't support him financially, neither does the other friend. No one else in either household is applying for health care.

He thinks that he would be considered part of a household -- so for example if he lists my address as his home address, the agency will want my financial info, even though I'm not applying for Medicaid, nor do I support him financially. I think he'd be considered independent, so that only his own financial info is needed. Has anyone dealt with this sort of situation and could offer some insight? Thanks in advance.

posted by phoenix_rising to Health & Fitness (3 answers total)

You are correct, your friend is wrong (which is good--it means he almost certainly qualifies for Medicaid!).

Under the Affordable Care Act, all states had to move towards using what is called "MAGI income-counting rules" for their Medicaid and CHIP programs (with some exceptions for those over age 65 or disabled). This was done to make sure that the way household income was counted for the purposes of figuring out premium assistance in the healthcare marketplaces was the same as for Medicaid, and people didn't fall into a weird gap where their income was too high for Medicaid (when counted one way) but too low for the marketplaces (when counted using a different method). More info here. This way of counting income for Medicaid eligibility aligns with your tax return, and the really big change for most Medicaid programs was that it meant that they are no longer counting unrelated people living in the same domicile as being part of the "household" except under very specific circumstances (for example, if you have an unmarried partner and you live in the same domicile and you have children together). Unless anyone in those other households is claiming your friend as a legal dependent on their taxes (which, I'm guessing no), then his household would be just himself. Since Illinois is one of the states that expanded Medicaid to all adults up to 138% of the federal poverty line - or $16,104/year for a single adult - it sounds like he'd almost certainly qualify for Medicaid.

As a side note, tomorrow's deadline is only for signing up for (private, potentially-subsidized) insurance through the marketplace on Healthcare.gov. Medicaid is permanently open-enrollment, which means he can apply tomorrow, or next week, or next month, and as long as he's eligible he'll be enrolled. Since the two programs (the marketplace & Medicaid) are meant to work together, with people qualifying for one or the other but not both, it's obviously a good idea to get this straightened out tomorrow just on the slim chance his income is too high for Medicaid and he'd instead qualify for insurance through the marketplace where he would need to apply by tomorrow. But realistically, if he has no job, no income, and filed his taxes last year as a single person, it's almost a certainty that he's going to qualify for Medicaid and the timeline is not as unforgiving as he fears.
posted by iminurmefi at 8:21 PM on February 14, 2015 [8 favorites]

I can't speak for Illinois specifically, as I live in Colorado, but when I did apply for Medicaid here in Colorado, I did list my roommate's well-above-poverty-level income on the "household" list, but since we aren't related and he doesn't claim me on his taxes, it wasn't counted as part of MY income, and my Medicaid was approved.

Ultimately I did list him because I was also applying for food stamps at the same time, and we live an an expensive apartment in downtown, and as part of my proof of residence, I brought in our lease.

So I do agree that your friend should be able to list either of you and your income and not have it count against his eligibility.
posted by Zarya at 8:38 PM on February 14, 2015

FYI if you have no income you do not need to pay "the penalty". There are many exemptions to paying the penalty and he would figure that out when he pays 2015 taxes. If he has no income for the whole year and therefore is not required to file a tax return he will not have a penalty.

But he should get health care coverage and take care of himself anyway.
posted by cda at 3:01 AM on February 15, 2015