November 11, 2013
This is installment #2 in a continuing series of Washington Elder Law Practice Reports.
The Washington State Health Benefits Exchange (located online at www.wahealthplanfinder.org ) is serving as a one-stop entry portal that individuals and small businesses may use to obtain health care coverage.
For individuals with incomes of less than 138 percent of the Federal Poverty Level (FPL), or $15,856 for a single person, the web page provides a pathway to applying for the expanded Medicaid program (now called Washington Apple Health, or WAH).
For single persons with a Modified Adjusted Gross Income (MAGI) above this level, an application may be submitted for private health insurance, with a possible subsidy.
Significant insight may be gained by examining the hard-copy “Application for Health Care Coverage” that is available from the above web page.
Part 1 of the Application starts off with identifying information (name, mail address, telephone number and email address) along with a stated preference for method of contact.
The applicant is then given the opportunity to appoint an authorized representative for the application process, who may be “any adult”, including an attorney. A legal guardianship or durable power of attorney is not necessary for such an appointment.
Next, information is requested about family relationships—including a spouse (or other partner, if living in the home) and children (or tax dependents)—and about tax filing status (for the previous and current calendar years).
In order to calculate available subsidies, married couples must submit joint returns. Otherwise, there is no way to complete the MAGI determination.
The form then asks whether or not the applicant is a Washington resident, This is important to determine potential eligibility for expanded Medicaid or purchase of an ACA-approved policy.
Under new WAC 182-503-0520, a (non-institutionalized) resident is someone who is in WashingtonState and intends to reside in the State, or entered looking for a job or with a job commitment. There is no specific requirement for length-of-living in the State.
However, a person who enters the State only for health care is not considered to be a resident. (Rules for institutionalized persons are covered separately).
The Application also asks about tobacco use for the past six months. The ACA allows higher premiums to be charged for those using tobacco products.
This is the total information needed if an applicant does not want to be considered for “free or low cost” coverage, but only wants to purchase a (non-subsidized) Qualified Health Plan (QHP).
For those who want to be considered for a subsidy, the form becomes more complicated, requiring information about existing health insurance, unpaid medical bills, non-citizen emergencies, or any pregnancy.
Detailed income information must then be provided to determine the applicant’s MAGI.
In order to calculate the key MAGI value, certain types of income are excluded, including spousal maintenance, interest on student loans, tuition and school fees, health savings accounts, retirement account payments, recent moving costs, self-employment tax, retirement plans and health insurance premiums, and other items. This makes the determination of the MAGI quite complex.
Many individuals may prefer to have an attorney assist them with completion of the application process.
Elder Law Practice in Washington is discussed by Cheryl and Ferd Mitchell of Mitchell Law Office in volumes 26 to 26B of Washington Practice. Further information about the ACA and LTC may be found in a series of blog postings and in a recent book by the authors.