More confusion caused by the ACA, or ObamaCare, if you prefer.

a reply to: abecedarian

but NOW the ACA and all of its RAM(itupmy)IFICATIONS, under the guise of providing for all,

It was never the intent of the ACE to provide for all.

It was the intent that none could be denied medical insurance. People who could not get medical insurance at any price, can. And yes, because the insurers have more exposure because they can no longer discriminate, premiums and deductible have risen for many.

a reply to: Phage
Actually, that was part of the guise, ruse if you will, behind selling ACA to the people. ... that everyone would be covered based on their ability to pay.

And I will present the following as fact:
- I have no ability to pay.
- I am not covered under ACA.

So, it is not living up to its claim of providing care for those unable to pay.
Plain and simple.

My experience with unACA is that the left hand doesn't know what the right hand is doing.

I had issues with my non-insurance bronze plan....it had to do with the start date.
The insurer said it w s unACA causing the problem....the insurer said it was unACA.
After hours and hours on calls, three-way call, and being on hold....and after about 3 months....I finally got it fixed.

Find someone to call: your congressman, the TV station, DHHS...you need an advocate.
Don't give up....but be prepared and stick to what you are entitled to.

ETA
BTW, I had insurance...for many, many years.
My employer threw me and many others under the bus...because they could.
And, now I cannot afford to go to the doctor.
But I have [un]insurance.

a reply to: abecedarian

I understand you are frustrated. I totally hear that. I wish I could help you! I'm not offended by your condescension - I did not mean to seem condescending in turn!

Serious question, and answers from the website.
Have you tried enrolling in Medi-Cal? I'm not from there, but went to the website. The page on "qualifying events" says you have 60 days to enroll after a "qualifying life event," which yours seems to be. If you attempted to enroll after the 60 day period for special enrollment, you will have to wait until open enrollment, or you can apply for Medi-Cal at any time. You can also challenge the denial, from what I understand? At least you can on the Federal ACA...

Since you qualify, according to DHHS, then is it possible to sign up for Medi-Cal? Or, if you were past the 60 days and don't want to sign up for Medi-Cal (I'm guessing you would qualify with $0 income???), then you have to wait for the next open enrollment period.

I completely empathize with wanting to bang your head against the wall, but all I'm saying is that I wouldn't give up just yet...

peace,
AB

originally posted by: DontTreadOnMe
...
Find someone to call: your congressman, the TV station, DHHS...you need an advocate.
Don't give up....but be prepared and stick to what you are entitled to.

...

That's actually good advice.
I have letters from the county in which I live, which follows state laws, declaring my eligibility.
I have letters from the state in which I live, declaring my ineligibility, but without defining the reason for such.

The fact remains though, that prior to ACA, in the current conditions I face, I would have been covered under various programs, and now those programs are gone, thus rendering me without coverage.

originally posted by: AboveBoard
a reply to: abecedarian

I understand you are frustrated. I totally hear that. I wish I could help you! I'm not offended by your condescension - I did not mean to seem condescending in turn!

Serious question, and answers from the website.
Have you tried enrolling in Medi-Cal? I'm not from there, but went to the website. The page on "qualifying events" says you have 60 days to enroll after a "qualifying life event," which yours seems to be. If you attempted to enroll after the 60 day period for special enrollment, you will have to wait until open enrollment, or you can apply for Medi-Cal at any time. You can also challenge the denial, from what I understand? At least you can on the Federal ACA...

Since you qualify, according to DHHS, then is it possible to sign up for Medi-Cal? Or, if you were past the 60 days and don't want to sign up for Medi-Cal (I'm guessing you would qualify with $0 income???), then you have to wait for the next open enrollment period.

I completely empathize with wanting to bang your head against the wall, but all I'm saying is that I wouldn't give up just yet...

peace,
AB

This is the problem.
My county says I'm eligible for Medi-Cal.
The State said I'm not eligible, then a week later said I am and asked me to chose a provider / doctor.
The State then said, two weeks after sending in the provider choice, that I'm not eligible.

The State says talk to the County, and the County says I'm eligible so talk to the State provider.

a reply to: abecedarian

that everyone would be covered based on their ability to pay.

It was never claimed that everyone would be covered under ACA provisions.

And I will present the following as fact:
- I have no ability to pay.
- I am not covered under ACA.

Sounds like your problem is with California's medicaid admin. Not the ACA.

a reply to: abecedarian

Ah. NOW I fully understand.

Seriously, you are eligible and have letters to prove this. I agree with DTOM that you need an advocate and that the right and left hand don't always know what the other is doing. You have a right to coverage, according to the County.
I encourage you to fight for it.

Would any other organization be able to act on your behalf??
Maybe these folks?? They were listed on the Covered California website...

If you would like help working with Covered California or your health insurance company, contact the Health Consumer Alliance, which offers free local assistance. Call the Health Consumer Alliance at (888) 804-3536 or visit the alliance's website at www.healthconsumer.org.

I know how horrible it is to run into health insurance issues and the worry that comes of it, not to mention the frustration. I'm cheering you on!!

peace,
AB

ETA - More information for you...they list the same source... LINK

Q: Is there anything else I can do if I believe I was incorrectly denied Medi-Cal coverage?

A: Yes. Appeal the decision.

When you receive your denial letter, there will be directions on how to appeal, says Cava.

You really should do so if you believe you were wrongly denied, says Jen Flory, senior attorney at the Western Center on Law & Poverty.

Flory confirms that there have been problems as Californians have tried to apply for the expanded Medi-Cal program. Most complaints come from people who applied through the Covered California website, she says.

“People have gotten some notices that have confusing information,” she says. “One said something like, ‘You may be eligible for Medi-Cal, but here’s how you pick your Covered California plan’.”

If you’re planning to appeal, you have to do so within 90 days. Once you do, you are entitled to a hearing within 45 days, she says.

However, people often avoid hearings because they “are able to resolve the issue with a county worker ahead of time,” she says.

If you do end up at a hearing, you generally will receive a decision within a month.

Sounds like fun, doesn’t it? Luckily help is available. Flory points to the Health Consumer Alliance website: healthconsumer.org. The alliance offers programs across the state that can assist you.

originally posted by: Phage
a reply to: abecedarian

that everyone would be covered based on their ability to pay.

It was never claimed that everyone would be covered under ACA provisions.

At the very least you should agree that people with low income should be covered, at least to some extent, correct? And similarly, you should agree that even those with any income are required, by law, to register for coverage which levies taxes / co-payment levels based on their ability to pay, right?

And I will present the following as fact:
- I have no ability to pay.
- I am not covered under ACA.
Sounds like your problem is with California's medicaid program. Not the ACA.

The program is borked because of ACA, or at least that's what I'm gathering from the discussions I've had with both state and county 'officials'. I'm eligible because I'm unemployed and have no income... and am not eligible for unemployment benefits either. I'm ineligible because ACA uses the previous year's income to determine eligibility.

The system, prior to ACA worked, and post ACA enactment, works not so good.

My purpose in starting this topic wasn't to draw attention to my specific situation, per se, though that is the topic... yes, I'm confused now, even.

It was meant to draw attention to the fact the system is broken. The county, following state laws, says "this and that" and the state, following state laws and federal regulations says "the other".

There's OBVIOUSLY a disconnect somewhere, and I'm at the receiving end.

One would think that with 1000+ pages in the ACA, a simple case such as mine would be enumerated, no?



I do, fully intend to escalate this up through the electorate. My district representatives will hear about this in the coming days, as will the state Senators and Representatives.

What is going on, what I'm going through makes no sense, hence why I titled the topic using the work "confusion".

a reply to: abecedarian

At the very least you should agree that people with low income should be covered, at least to some extent, correct?

Yes.

And similarly, you should agree that even those with modest income are required, by law, to register for coverage which levies taxes / co-payment levels based on their ability to pay, right?

If they can pay. Yes.

I'm ineligible because ACA uses the previous year's income to determine eligibility.

No.

Income levels that qualify for lower health coverage costs

To learn if you qualify for lower costs on health coverage, find your estimated 2014 household income and household size on the chart below.

www.healthcare.gov...

The ACA does not determine eligibility for state programs. States do. That's why it's different from state to state.
www.medicaid.gov...

The system, prior to ACA worked, and post ACA enactment, works not so good.

That would depend on your point of view. I think people who could not have gotten medical insurance at any price might disagree with you.

a reply to: abecedarian

From the second resource I posted, the problem seems to be coming from sign-ups on the Covered California website, but I can't say if that is the only reason. From what I read, due to the Medicaid Expansion (which was part of the ACA), the criteria for Medi-Cal coverage has changed (for the better in some ways - you can still own a car or other property, for example), however, this may be the source of some of the confusion in their computer system? I dunno. Whatever it is, it ain't right.

Apparently, you are not alone, and I fully agree that "glitches" like this are unacceptable and need to be ironed out fast for the benefit of all. It's too important. My absolute best to you in your advocacy.

peace,
AB

ignore... post quotations and such got lost in translation.

originally posted by: AboveBoard
a reply to: abecedarian

From the second resource I posted, the problem seems to be coming from sign-ups on the Covered California website, but I can't say if that is the only reason. From what I read, due to the Medicaid Expansion (which was part of the ACA), the criteria for Medi-Cal coverage has changed (for the better in some ways - you can still own a car or other property, for example), however, this may be the source of some of the confusion in their computer system? I dunno. Whatever it is, it ain't right.

Apparently, you are not alone, and I fully agree that "glitches" like this are unacceptable and need to be ironed out fast for the benefit of all. It's too important. My absolute best to you in your advocacy.

peace,
AB

Thank you.

And it's already been codified that owning property and vehicles, outright, or even still being paid towards owning, that there is some level where the value of said properties, vehicle or land, does not affect the benefit award. To the best of my recollection, mostly, those levels / values mirror similar bankruptcy limitations / qualifications.

It's very frustrating, to say the least.

I go down to the local DHHS office and leave my 1991 Toyota pickup with faded paint, parked next to a girl with a Cadillac Escalade and iPhone, and she gets benefits whilst I get nothing. I was there and overheard her meeting with the worker, where she was 'gifted' nearly $1000 monthly in food and cash aid, for two children.

So, I have to respect that, sort of. But, if you can show up at the DHHS office in a Cadillac... and get more than the person next to you in a Toyota... someone is more honest than the next.

a reply to: abecedarian

If I am not mistaken it is the value of the assets you have, if you own your own home forget about it. A friend went through this some back and ran into the same problem. Again it's been a while but I believe the threshold is 30K.

a reply to: abecedarian

Actually, that was part of the guise, ruse if you will, behind selling ACA to the people. ... that everyone would be covered based on their ability to pay.

No it wasn't. It was to make insurance available to the (then) uninsurable, and it has done a pretty darn good job of that.

Most people in the US are convered through employer plans. Over 10 million were not covered in anyway what-so-ever. The social cost of that pool of people was enormous and going up. It is now on the way down. The ACA is SAVING society billions, if not trillions, and the only thing that has changed in the health care industry is that the insurance companies are making more money because they have a larger pool of paying customers. Oh, sorry, I fib. The ACA has cost some people their job ( and they are delighted about it).



If you can't be bothered to watch the video, the take away message is "Obamacare forces health worker into sex slave trade".

For most people the cost of self insurance has gone down. Significantly. It is inevitable that some people are paying more, especially if they live in a state that has thumbed its nose at the ACA system. Perhaps they should move to a more enlightened state.

a reply to: abecedarian

The program is borked because of ACA, or at least that's what I'm gathering from the discussions I've had with both state and county 'officials'.

You have a frustrating situation, and I don't mean to throw gasoline onto the fire here, but are you saying that the ACA ("the program") is borked because of ACA? I'm not sure of what other 'program' you could be talking about.

As a comparison point, what 'program' was in place to deal with your situation BEFORE the ACA went into effect? Am I right that you would have had to take your luck on the open marketplace and deal with waiting periods, coverage limits, and random cancellations? And that "old system" is less 'borked' that the current ACA influenced system?

originally posted by: abecedarian
Can someone explain why I'm not eligible for any benefits, at all, despite my contributions to the system?

I suggest you speak to a tax advisor instead of trying to get financial advice from a conspiracy forum.

a reply to: rnaa

For most people the cost of self insurance has gone down. Significantly. It is inevitable that some people are paying more, especially if they live in a state that has thumbed its nose at the ACA system. Perhaps they should move to a more enlightened state.

Can you provide a reliable non-kool-aid website with stats that support this statement? This has not been my experience. My coverage was better, I paid less, and I didn't have the frustration dealing with it that I have now.

a reply to: rnaa
He already answered the question of what program was in place before this one, and what it would have covered. Look at a few of his previous posts.