What can you do if you can’t afford health insurance and don’t believe you qualify for Medicaid? Are there other ways to receive care?
Arizona’s Medicaid Program
Medicaid in Arizona is provided under the Arizona Long-Term Care System (ALTCS). ALTCS provides long-term care for financially and medically qualified individuals living in Arizona. This system provides free or low-cost services for disabled, blind, and elderly residents. The state also has other assistance available for people who don’t fall into these categories.
If you meet the financial and medical eligibility requirements for ALTCS benefits, you’ll work with a case manager who will help you design a plan for care. The plan may include hospice services, prescription medications and doctor visits, a mix of out-patient and in-home services, nursing facility residency, and more.
What Income Level Qualifies for Medicaid?
If your family earns 138 percent or less of the FPL (Federal Poverty Level), you might be able to get Medicaid services. As of 2019, this is $17,236 per year as a single person. Children 18 years old or younger may qualify for KidsCare if their family earns 205% or less of the Federal Poverty Guidelines.
How do I Calculate My Income for Medicaid?
The Affordable Care Act designed a method to determine financial eligibility for Medicaid benefits and bases qualification on your MAGI (Modified Adjusted Gross Income). This basis determines income eligibility for adults, parents, pregnant women, and most children. MAGI methodology looks at both taxable income and your filing relationships to determine whether you’re qualified.
How can you calculate your Modified Adjusted Gross Income? To identify your adjusted gross income, look at Line 37 on your 1040 form (or Line 37 on a 1040 EZ). Add this amount to your tax-exempt interest, excluded foreign income, and the non-taxable amount of your Social Security income to get your MAGI.
Note that some Arizona residents are exempt from the rules based on MAGI. Exempt individuals include those 65 years old or older, disabled residents, legally blind people, and some others.
What about Assets?
Is Medicaid based on income or assets? Income-based Medicaid counts most of your unearned and earned income. Not all income counts, however, including SSI (Supplemental Security Income) and certain retirement account contributions.
When it comes to eligibility for Medicaid, your assets will also play a role. If your assets and income are worth more than a certain amount, you won’t qualify. Here are some of the assets you’ll need to think about:
- Cash (above $2000) and bank accounts
- Burial funds and funeral costs
- Certain insurance policies
Going to a Hospital Without Insurance
Can you be denied health care if you don’t have insurance? Both private and public hospitals are legally required to give you care if it’s an emergency. If it’s a non-emergency and you go to a privately-owned hospital, they may turn you away for not having insurance. However, public hospitals are held to another standard.
The Emergency Medical and Treatment Labor Act
The EMTALA (Emergency Medical and Treatment Labor Act) forbids medical institutions from refusing to care for uninsured patients based on the fact that they can’t pay for the services. While the EMTALA doesn’t forbid medical providers from inquiring about payment, they aren’t allowed to delay treatment while they check on the patient’s ability to pay.
It’s worth keeping in mind that hospitals will typically be persistent in collecting on unpaid bills. They may include their billing department, lawsuits, and collection agencies when attempting to receive payment. Keep in mind that private hospitals can discontinue or deny non-emergency care for uninsured people.
If you received subpar treatment or you believe you’ve been unlawfully denied care due to a lack of insurance, speaking with a malpractice attorney is advisable.
If you can’t afford ordinary healthcare and don’t qualify for Medicaid, short-term health insurance is one alternative option. These plans offer some advantages, including far cheaper costs and increased availability. You may apply for this type of plan any time, instead of only during open enrollment.
There are a few drawbacks to short-term plans, though. The Affordable Care Act barred insurers from turning people down for coverage due to pre-existing health conditions. Short-term plans, however, don’t have to follow these rules. If you have a chronic condition, short-term care providers may bar you from signing up or cancel your policy if they find out about an undisclosed, preexisting health issue.
Is Short-Term Healthcare Right for You?
Some short-term healthcare plans place limits on how much they’ll cover for specific treatments. If you’re hospitalized, for example, some short-term insurers will only cover a stay for a certain number of days or a certain amount per day. If the costs go above this maximum, you’ll have to cover it out of pocket. It’s also possible that short-term insurers could use your medical history to deny a claim, if you had to get surgery in the same area twice, for example.
These plans also leave out coverage for many types of treatment. According to the Affordable Care Act, insurance agencies may not charge people more based on their gender, health, or other factors. The Act also mandates that these companies spend a minimum of 80 percent of the profit earned on premium payments on quality improvement and health care services.
Keep in mind that a short-term healthcare plan may not have to follow all these rules. While other insurers have to cover certain treatments, short-term plans don’t necessarily have to. For example, short-term plans usually don’t cover maternity care, and most won’t provide coverage for prescription drugs.
Before you sign up for a short-term plan, always check what’s covered first. This type of plan can be a good temporary option when you need care for a condition that will clear up soon. If you have a serious condition or need significant ongoing care, it probably won’t work for you.
Seeking Legal Guidance in Arizona
If you’ve been injured, turned away for care illegally, or need help filing an insurance claim, speaking with a personal injury attorney is a smart next step. Navigating the law when it comes to insurance coverage and medical care can be complex and frustrating. Let someone who is familiar with the information answer your questions and help you out.
Need Help Applying for ALTCS in Arizona?
If you need help setting up Medicaid, speaking with a lawyer is a good place to start. The application process itself can be complex and confusing, and making mistakes can set you back in attaining benefits and services. If your situation is complicated or you need help meeting the eligibility requirements, one of our attorneys can answer your questions.
Contact the JacksonWhite Elder Law team today at (480)467-4337 and learn how we can help to ensure you receive the maximum ALTCS benefits available, while preserving as many of your assets as possible.
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