Medicare count as providing health insurance?

[KTRMom]

What is the name of your state (only U.S. law)? Oregon

My CO states that I shall provide health care for my DD at no out-of-pocket cost through my Native American Tribe, as well as that DD is enrolled in Medicare (tribal insurance requires that Medicare is applied for before receiving tribal medical benefits). Today I received a letter from the DOJ stating that my employer is required to enroll my DD with the company's private health insurance. I assumed that because I qualify financially for Medicare and it is stated in my CO that this is how medical insurance shall be provided that I was not required to enroll my DD in my employer's insurance program. Is this incorrect? My ex is ordered to pay CS, but the order has been suspended for 17 months because he only work 20 hours a week and receives food, cash, medical and housing assistance for his other child that lives with him, so it is solely up to me to provide for my child. I have been trying to get a hold of the DOJ office but have only been getting their voice mail, and I did verify that DDs enrollment in Medicare is current through the OHP office.

 

[CSO286]

What is the name of your state (only U.S. law)? Oregon

My CO states that I shall provide health care for my DD at no out-of-pocket cost through my Native American Tribe, as well as that DD is enrolled in Medicare (tribal insurance requires that Medicare is applied for before receiving tribal medical benefits). Today I received a letter from the DOJ stating that my employer is required to enroll my DD with the company's private health insurance. I assumed that because I qualify financially for Medicare and it is stated in my CO that this is how medical insurance shall be provided that I was not required to enroll my DD in my employer's insurance program. Is this incorrect? My ex is ordered to pay CS, but the order has been suspended for 17 months because he only work 20 hours a week and receives food, cash, medical and housing assistance for his other child that lives with him, so it is solely up to me to provide for my child. I have been trying to get a hold of the DOJ office but have only been getting their voice mail, and I did verify that DDs enrollment in Medicare is current through the OHP office.

I have to say, I have yet to see a Medicaid counted as court ordered insurance. (Because you have to qualify for the public assistance program, and you may not meet the requirements....it's kind of an unenforceable order--and I enforce child support orders for a living...)

In order to qualify for medicaid, you either:
1. cannot have other insurance available to you.
2. have employer provided insurance available, however the family premiums are cost-prohibitive.
3.You (or children) have some sort of severe disability where costs associated with treatment are exhorbitant.
4. you must also be income/asset eligible.
5. Other guideleines I may be unaware of.

Now, as I understand it, Medicaid is going to require that you enroll your children in your employer ins. They may pick up the tab on the costs not covered by that coverage, and after that, anything not covered, would be by your tribal coverage.

Please, seniors, feel free to correct me and/or elaborate.

 

[justalayman]

qualify financially for Medicare

do you mean medic aid?

but the point is: what is the problem with enrolling the child on the insurance plan?

what is a DOJ?

 

[haiku]

The Native American status possibly supercedes those guidelines. I would look into those laws.

 

[WittyUserName]

do you mean medic aid?

but the point is: what is the problem with enrolling the child on the insurance plan?

what is a DOJ?

DOJ = Oregon Department of Justice. In OR, this is the CSE agency.

 

[justalayman]

DOJ = Oregon Department of Justice. In OR, this is the CSE agency.

thanks.

...

 

[KTRMom]

Sorry if I am not being clear enough or making much sense, I am extremely sleep deprived at the moment. Yes, DOJ it is the Department of Justice. The insurance is the state-funded Medicaid insurance "Oregon Health Plan".

Until a few months ago DD was on my Native American insurance because I made too much money to qualify for state insurance, unfortunately there have been issues in the last few months and my income has dropped severely. So I applied for Medicare (as the tribal insurance requires with a significant change in income) for my children and was approved. I assumed since DD still had insurance of some sort it was within the parameters of the court order. The problem I have is that DD is guaranteed free health insurance through the tribal insurance as long as we do not qualify for state assistance. Unfortunately at this point we do. So the state is going to make me pay for health care coverage while I am making less, whereas I would get it for free (from the tribe) if I made more money. At this point I do not know if health insurance through my employer would exceed the 5% of my gross income that would excuse me from having to enroll them at work.

I guess I can lie to the state about my income (state it is higher than it is) so that I won't qualify for medicaid, in turn qualifying for health insurance through the tribe. Hopefully within a few months I will be back to my regular income anyways, at this point I am just trying to keep my head above water. Thank you for the advice.

 

[mistoffolees]

Sorry if I am not being clear enough or making much sense, I am extremely sleep deprived at the moment. Yes, DOJ it is the Department of Justice. The insurance is the state-funded Medicaid insurance "Oregon Health Plan".

Until a few months ago DD was on my Native American insurance because I made too much money to qualify for state insurance, unfortunately there have been issues in the last few months and my income has dropped severely. So I applied for Medicare (as the tribal insurance requires with a significant change in income) for my children and was approved. I assumed since DD still had insurance of some sort it was within the parameters of the court order. The problem I have is that DD is guaranteed free health insurance through the tribal insurance as long as we do not qualify for state assistance. Unfortunately at this point we do. So the state is going to make me pay for health care coverage while I am making less, whereas I would get it for free (from the tribe) if I made more money. At this point I do not know if health insurance through my employer would exceed the 5% of my gross income that would excuse me from having to enroll them at work.

I guess I can lie to the state about my income (state it is higher than it is) so that I won't qualify for medicaid, in turn qualifying for health insurance through the tribe. Hopefully within a few months I will be back to my regular income anyways, at this point I am just trying to keep my head above water. Thank you for the advice.

Or you could work more hours or get a second job so you'd have more money and wouldn't have to commit a felony by lying on the Medicaid forms.

 

[LdiJ]

Sorry if I am not being clear enough or making much sense, I am extremely sleep deprived at the moment. Yes, DOJ it is the Department of Justice. The insurance is the state-funded Medicaid insurance "Oregon Health Plan".

Until a few months ago DD was on my Native American insurance because I made too much money to qualify for state insurance, unfortunately there have been issues in the last few months and my income has dropped severely. So I applied for Medicare (as the tribal insurance requires with a significant change in income) for my children and was approved. I assumed since DD still had insurance of some sort it was within the parameters of the court order. The problem I have is that DD is guaranteed free health insurance through the tribal insurance as long as we do not qualify for state assistance. Unfortunately at this point we do. So the state is going to make me pay for health care coverage while I am making less, whereas I would get it for free (from the tribe) if I made more money. At this point I do not know if health insurance through my employer would exceed the 5% of my gross income that would excuse me from having to enroll them at work.

I guess I can lie to the state about my income (state it is higher than it is) so that I won't qualify for medicaid, in turn qualifying for health insurance through the tribe. Hopefully within a few months I will be back to my regular income anyways, at this point I am just trying to keep my head above water. Thank you for the advice.

I think that you should consult your employer as to how much family coverage would be. I do not think that you should falsify your income, nor do I think that you would even be able to do so.

Odds are that the family coverage would be more than 5% of your gross. If that is the case, get a letter from your employer proving that, and send it with a letter of response to the DOJ.

The fact that they sent the letter to you, rather than directly to your employer kind of makes it sound like they are not certain that your children need to be covered under your employer's policy.

 

[KTRMom]

Thank you for the advice LdiJ. Just to clarify, the letter they sent me was in addition to the one sent to my employer.

The DOJ office called me back and I explained the situation. Basically I have to copy and fax the insurance card for the tribal insurance coverage. They cannot list medicaid as fulfilling the court-ordered insurance, but she said they can use the tribal insurance info to do so, even if DD is currently on medicaid. So once they get the fax, she will put a 'stop action' on the file and sent a letter to the employer to disregard the first notice.

Mistoffolees, I do not feel the need to explain my circumstances, or explain myself. But I am in awe of your omniscience.

 

[CSO286]

Mistoffolees...... I am in awe of your omniscience.

You know, most people are.

**giggles**