Medicaid vs. Provided Health Insurance

[temper76]

I'm curious about this... maybe someone can help me out here.

I provide health insurance coverage for my kids through my employer.  I pay a monthly premium for insurance.  My paying for the insurance was factored into the child support amount I pay.  Like most non-custodial parents, the kids' mom and I split the deductible per child as well as anything after that.

My kids' mom, has elected to use Medicaid since she qualifies.  Her using medicaid means that she doesn't have to pay anything.  It also means I don't have to pay anything... except the cost of the premium of my employer's health insurance (which is rather significant).  

I've tried researching medicaid to find out if she can legally use it for my kids if they already have health insurance that is provided by me through my employer.  I have found nothing.

I don't mind paying for my kids' health insurance.  However, I do mind paying a monthly premium that just isn't necessary if my kids' mom can use (abuse?) the system like she is.  I don't agree with what she is doing simply because there are people out there who truly do need that kind of help.    

Something tells me my kids' mom is bucking the system and she is doing it legally.  But, it doesn't seem right.

Help?

[FatherTime]

I'm not sure but I would think that your state Child Support Enforcement Agency may come after you for the money to repay the government subsidy.

You may be able to call your local child support office to verify.

FatherTime

[mistoffolees]

>I'm not sure but I would think that your state Child Support
>Enforcement Agency may come after you for the money to repay
>the government subsidy.
>
>You may be able to call your local child support office to
>verify.
>
>FatherTime

I believe you're right, but you might be understating the case. While he should definitely check with someone to make sure, this sounds like Medicaid fraud. If he's a party to it, he could also be charged. I don't know what the penalties for Medicaid fraud are, but I'll bet they're fairly significant.

[Giggles]

Medicaid eligibality is based on the children...not the parents.  Here are a couple links that might help:

http://www.cms.hhs.gov/MedicaidEligibility/02_AreYouEligible_.asp#TopOfPage

http://www.cms.hhs.gov/apps/contacts/

I also found this...she is WRONG as Medicaid is designed to be "Last Resort" medical coverage...

"Third Party Liability (TPL) refers to the legal obligation of third parties, i.e., certain individuals, entities, or programs, to pay all or part of the expenditures for medical assistance furnished under a State plan. The Medicaid program by law is intended to be the payer of last resort; that is, all other available third party resources must meet their legal obligation to pay claims before the Medicaid program pays for the care of an individual eligible for Medicaid.  Examples of third parties which may be liable to pay for services include private health insurance, Medicare, employment-related health insurance, court-ordered health insurance derived by noncustodial parents, court judgements or settlements from a liability insurer, workers' compensation, first party probate-estate recoveries, long-term care insurance, and other State and Federal programs (unless specifically excluded by Federal statute). "

[Tikki]

I'm not sure what her (your Ex's) situation is but if its anything like my DH's ex, then she's just using the system because she CAN...that doesn't mean she should.

For the first 1.5 years DH and I were married, he and I both provided ins. on the kids via our work.  BM qualified for medicaid.  Sometimes she told them about our ins, sometimes she didn't, despite being told in the CO that these were to be used FIRST and the state aid only to be used for what ins. didn't cover.  She used it so she didnt' have to pay the 15% medical costs she was required to pay at that time.  God forbid she be responsible for a $6.00 bill...oh wait...yeah, she can use that money for cigarettes.  What was I thinking?

So many of these self-centered parents fail to remember or can't comprehend that there are children out there that have a REAL NEED to this state aid.  When parents like us are able to afford the occasional medical expenses, we should...i mean, we did accept that responsibilty when deciding to have babies/children.

There are kids out there with drug addicted parents or just parents who don't wish to raise their children  who have been handed off to the g-parents to raise on nothing but Social security income.  They really need the state aid for helping the their grandkids.  Or those kids whose parent(s) have become disabled somehow after having their childrne and are unable to work now....

Its a moral issue.  I know a couple who have two children.  They decided to have children even though neither of them was working....why?  Because STATE AID was available to them.  That would now be YOU and ME paying for their children.....

Your kids mom shouldn't be utilizing the medicaid system IMO if she is able to work and provide for them......I think however, the case is, she's just utilizing it because she can.

[Sherry1]

As the other poster said, god forbid that BM had to pay any copays.  Basically DH's insurance became primary and Medicaid became secondary.  Whatever DH's insurance didn't pay Medicaid would.

I don't think you could be legally responsible if she doesn't present your insurance first to the docs.  You have fulfilled your obligation by having insuance on them.  You can't force her to whip out your insurance card first.

[mistoffolees]

>As the other poster said, god forbid that BM had to pay any
>copays.  Basically DH's insurance became primary and Medicaid
>became secondary.  Whatever DH's insurance didn't pay Medicaid
>would.
>
>I don't think you could be legally responsible if she doesn't
>present your insurance first to the docs.  You have fulfilled
>your obligation by having insuance on them.  You can't force
>her to whip out your insurance card first.

Fraud is somewhat different. IF they could prove that he knew about it and condones it (such as the message he just posted pointing out that he'll save his copay), then he could be guilty of fraud, as well.

Of course, it's unlikely that he would be caught, but:
1. If he IS caught, the consequences could be severe, and
2. It's just not right - basically, they're making taxpayers pay something that is legally and morally their responsiblity. Medicaid is for people who can't AFFORD to pay, not for those who don't wish to pay.

[Sherry1]

He said she uses medicaid, he did not say it was in lieu of using his medical insurance also.  She is probably using it as a secondary payor for his primary insurance.

DH was court ordered to have medical insurance on his kids.  When BM applied for medicaid for the kids, The department of CS enforcement sent DH a letter asking for copies of his medical insurance cards.  He sent them.  She was still able to use medicaid so that she had no copays.

[mistoffolees]

>He said she uses medicaid, he did not say it was in lieu of
>using his medical insurance also.  She is probably using it as
>a secondary payor for his primary insurance.
>

Did you read the same original post as I did?

"My kids' mom, has elected to use Medicaid since she qualifies. Her using medicaid means that she doesn't have to pay anything. It also means I don't have to pay anything... "

Sounds to me like they're clearly trying to use it in lieu of using his medical insurance.

[MixedBag]

that's not what I read either.

I read it like Sherry said.

And if Medicaid knows there is another policy, chances are they will deny the claim until the primary (other) insurance pays first.

[mistoffolees]

>that's not what I read either.
>
>I read it like Sherry said.

Then please explain why he said that it would save him from paying copays. The only way that statement makes sense is if he thought she would use Medicaid instead of private insurance.

If he used Medicaid in addition to private insurance, then it would not have had any impact on his copay.

>
>And if Medicaid knows there is another policy, chances are
>they will deny the claim until the primary (other) insurance
>pays first.

If the find out about it. That's what I said.

[MixedBag]

Primary insurance pays all except $25 co-pay.

Medicaid picks up the co-pay.

So it really saves both parents from sharing the $25 expense.

Medicaid doesn't pick up the entire tab because the private insurance pays first according to their rules.

[mistoffolees]

>Primary insurance pays all except $25 co-pay.
>
>Medicaid picks up the co-pay.
>
>So it really saves both parents from sharing the $25 expense.
>
>Medicaid doesn't pick up the entire tab because the private
>insurance pays first according to their rules.

I guess that's one possible reading - but it would make the OP even more guilty since they would be directly accepting payment from Medicaid even if they're not eligible.

[MixedBag]

no, because payment goes directly to doctor, not to either parent.

And if the eligibility is based on the parent (see, I don't know this part), and that parent truly does qualify for medicaid....how is it wrong?

Because the other parent benefits who carries other insurance?

I know that when Tri-Care picks up the rest of the tab, they are happy that there was a Primary Insurance who paid the bulk of it.  

And I just had a conversation with EX#1 who told me that there's a law effective Jan 1st that says IF there is other insurance available through employment, the employee has to enroll if they are also eligible for Tri-Care.  Translation:  The law cuts the cost of Tri-Care payouts by tons and military (active duty and retired) now have an increased expense IF insurance is available to either the member or their spouse.

I didn't dig into it because it doesn't affect me.  

But it would make me wonder.....our son is covered under my Tri-Care (retired).  I am CP (now).  EX covers him under his BC/BS.  And I know Tri-Care will say BC/BS is still primary (federal law somewhere).  And I wonder how or what Tri-Care would say if EX were to drop the BC/BS coverage????  oh well, a whole nother thought and thread.

[mistoffolees]

If one parent does not qualify while the other parent does qualify, then it would be legitimate for Medicaid to pick up the copay for the parent who qualifies. It would be fraudulent for Medicaid to be asked to pay the copay for the parent who does not qualify - which is what was being suggested here.

[lucky]

I'm sorry, Mist, but I didn't read it that way.

I read it that the poster doesn't think it's right, and was questioning that but he noted that he kind of gets a "bonus" out of it because his ex qualifies and Medicaid will pick up the co-pay - therefore he legitimately doesn't have to pay his half because there IS NO co-pay to be paid now.  Medicaid pays it.

I don't think the poster meant to defraud anyone.  I think the poster was looking for info to [em]make sure[/em] neither he nor his ex was defrauding anyone by his ex using Medicaid.


[em]Lucky

Lead your life so you wouldn't be ashamed to sell the family parrot to the town gossip.
- Will Rogers[em]

[mistoffolees]

One could question what he meant, but the result is the same.

Note that he said that he and his ex split the deductible. Then he said if she uses Medicaid, he doesn't have to pay anything. He therefore benefits from the fraudulent use of Medicaid.

Whether he intends to defraud is irrelevant. He is clearly benefiting - since he is responsible for half of the deductible.

[lucky]

Mist,

What part of "if the ex is eligible there is no fraud" do you not understand?

The only way it IS fraud is if neither the ex nor he is eligible - it appears that the ex IS legally eligible therefore no fraud on ANYONE'S part.

When it comes to Medicaid, the fact that there is other insurance from the applicant's ex available for the children is irrelevant as it pertains to eligibility.  It's THAT simple.

I re-read his post and the only thing I see is that he wishes he didn't have to pay the premium, not that he won't, but that he doesn't like it.

I can't see how you can justifiably claim that this poster is commiting fraud.

[em]Lucky

Lead your life so you wouldn't be ashamed to sell the family parrot to the town gossip.
- Will Rogers[em]

[Mamacass]

I feel the same, that it is a moral issue.  We carry insurance on SS, and BM is on disability, so she has suggested to us several times that we can use his medicaid to save money.  I'm assuming she is talking about the copays.
I just can't feel good about using medicaid when we can afford health care.  To me that is taking advantage of a system that is there to help those who can't afford health care.  

[Sherry1]

Washington State Medicaid contacted my DH directly and asked him to mail them a copy of his insurance cards, which he did.  DH's insurance became primary then medicaid paid whatever his insurance didn't.  It's a pretty common practice.

[MixedBag]

and since the focus is on the child and getting the CHILD covered, I don't understand the point of view that the parent who carries the primary insurance and then ends up paying "nothing" when the rest is picked up can be considered "wrongly benefiting" -- when it's the child receiving the care and coverage.