I started Part I of this with a statement I heard last night in a YouTube webinar that came up under some series of search terms I put into Google, relating to my speculative ponderings.
I’m going to assume that if you read Part I and have continued here, that you find this topic/situation of interest. And I’m going to assume that I don’t need to specifically reference statements made in this 29-minute video precisely–I’m going to assume that you can listen to it and weigh the contents, alongside what my own summary is of the situation. And if some points are somewhat speculative, the reader will take it for what it is worth: my own “hearing” or “mis-hearing” of things, knowledge of other things at play in our country and not overtly put forth in the video itself, and my own opinions/conclusions at this point (open to clarification should new information be provided to me that would lead me to believe that this is not, in fact, what it strikes me as potentially being…).
So, if I had to summarize this video from Senator Bob Casey’s YouTube channel it would be as follows:
I am hearing the communication that Pennie and DHS are working in some form of tandem–partnering toward a stated goal. This “stated” goal is to make sure no PA resident is left without “protection” or “coverage” during an upcoming and pre-anticipated time when the continuous coverage provision relating to the federal declaration of a public health emergency was to end on April 1, 2023. I’ve learned a lot since opening the DHS letter to me on March 12. I’ve learned that during the pandemic there was an emergency law that states could not disenroll anyone from Medicaid and did not have to verify eligibility. During this time, the Federal Government matched the state contributions for a Medicaid recipient at an even higher rate, and in the video, a number of figures of increased enrollments are seemingly proudly mentioned. When these Pennie/DHS representatives and other “constituents” (as they name themselves/others) speak, I get the impression that the goal is going to be trying to retain as many of these enrollees as possible in the PA Medicaid and other welfare systems. I get the impression that is the ideal goal, but, of course, if federal requirements in this “Wind-down” of the emergency provisions will revert back to normal verifications…”if” someone doesn’t qualify they want to make sure that person gets easily transitioned to Pennie. OK, fair enough. I suppose.
(break in video summary)
I actually support an “Affordable Care Act” because I’ve known first hand following my first divorce in 2005 (I was married twenty years from 1985 to 2005) what it felt like to be a divorced, single mom that could not afford the COBRA coverage at that time. (When I was in Delaware I had applied to Medicaid around 2006 or so and didn’t qualify due both to my income as well as my assets at that time. So, I went a number of years as “self pay” to my doctor and dentist appointments). And to be fair, during a national health emergency, it does seem that many needed the Medicaid provision. That said, there is now pretty clear evidence that this was a man-made pandemic (which we will likely never get the full story about) for years to come. And the damages done to individuals, families and our nation is unspeakable.
But, back to my video summary:
This webinar strikes me as having the vibe of a kind of coded language of anticipated actions/protocols. Again, this is simply my opinion here. Clearly, I’m not a financial whiz but I’m pretty conceptual (most artists are!). My understanding is Medicaid is funded jointly by the state and the federal government. I will be curious if there are public records I can obtain showing numbers of enrollees/categories/budget data, etc going back to 2020.
It would seem to me that if PA received more than typical federal matching dollars per enrollee, could not unenroll anyone/nor need to verify eligibility, and experienced a huge increase in Medicaid recipients…there are two or more possible scenarios. One scenario might be that PA has benefited from the increased federal cash flow. PA could either be in Medicaid budget deficits or in more than enough funds–I do not know. I don’t know how payments are made. Does Pennsylvania receive a specified amount for a person based on some criteria (age, health, single or with children, or even by being part of some “underserved” demographic–for example, someone needing “gender affirming care” as just one example). I don’t know the answers to this. I did just Google and saw this article from 2016 Pennsylvania Medicaid Removes Trans Health Exclusions!
I am quite curious how much PA got for “me” if federal enrollee payments actually vary depending on data (60 year old, self-employed, non-hispanic caucasian woman in good health and without children) but apparently, York DHS cannot supply me with that information. The case worker today told me that information might be available through the Fraud Tipline, but I’m slightly unclear I understood that part of the conversation too well. I asked if they had financial records of my specific enrollment date and payments from the federal government (and state matching) to “insure me” in Medicaid. I really don’t know how it works. I am assuming it varies, depending on care needed. I don’t know…maybe the later comment in the office that there were indeed “other factors” besides my income in fact meant my age. For all I know, PA receives more funds for a somewhat older person ( in good health, but “older”).
No one wants an income reduction, and I speculate that PA would not want that either. For all I know, they have run into Medicaid budget deficits since 2020. I don’t know how it works. But, my impression is that Medicaid enrollee retention (advice is given in the webinar to other “community” based advocates to help enrollees anticipate having to re-enroll during the 12 month period from April 2023 to April 2024 and navigate the verification process etc) seems to be the focus of this YouTube webinar.
I would speculate if there are a number of recipients who were ineligible or will be verified as such after Biden’s emergency order ends, that a “system” such as the DHS/Medicaid programs might keep to their budget needs (and deeper agenda? that’s “my insertion of opinion”) by locating others that the Pennie system could channel into Medicaid. (Oh, and in the fine print on Pennie applications, I believe one has 90 days to appeal…hmm…action for me taken November 20, 2023, I am not contacted by DHS until end of February 2024. If I’m counting correctly, that’s past the 90 days I would have had to file an appeal to Pennie. Again, I was entirely unaware of this application sent to Medicaid by Pennie’s “system update” on November 20.
______
So, back to my situation. This is factually what happened to me. Pennie–last year during this “un-wind” time–apparently had an algorithm that did a “system update” on November 20 (see Part I for dates…) that I did not see happen in 2022 during Open Enrollment. Both years, Pennie’s system filed an auto-re-enrollment application prepared in early October on Nov 1. But, only last fall was there a system update prior to Dec 15. While I don’t want to presume any algorithm was changed at Pennie in anticipation of the Medicaid Wind-Down (or through DHS which clearly communicates with Pennie), given many things, it raises questions in my mind.
So, here’s how it went for me today – my 2nd time into the York office. (In Part I, I meant to say that on Tuesday April 2 I got yet a 3rd all that afternoon from COPA–that time it was the original case worker I tried to contact by phone on March 26).
I arrived at the office right about noon and got in line. There were about 5 people in front of me, maybe 16 or so in line or sitting. One person was upset because someone came out and announced that there might be some type of delay since it was lunch hour–I was unclear. The person wanted to know whether they would be served in line during this time or not. The window clerks did seem to still be taking people up. I had met eyes with the person who made the general announcement and said that I had a noon appointment with _______________. They told me they would check with that case worker, and about 10 minutes later the case worker came out and led me back again to the cubicle area.
I had my notebook of communications and relevant information, but I said I had decided to take a different posture. That first, I wanted to listen and ask some questions, and I opened a spiral notebook and indicated I would need time to take notes about each thing. I could feel the tension in the air.
My first question as I recall was along the lines of:
“Have you reviewed all documents in my file?”
They responded that they had.
I then asked, “Am I allowed to know the number of case workers that have handled my file/application and their names?” (paraphrase)
They responded that I was not entitled to that information. Actually in my notes I see now, they said they were “not at liberty to say” and said it would require a “subpoena.”
I asked something like, “Can you show me the rules of what I’m entitled to under the “freedom to know act” from this office?
They responded along the lines that they could provide me with a lengthy document and I could find the relevant part (later). In my notes there is mention of “FOIA” Act.
I then asked, “Can I have a copy of a standard Medicaid (blank) application?” I said that the PDF’s online had sample information in them. I was given an application that contained carbon copy parts.
I then asked that they would re-explain to me (line by line, mathematically from my taxes) how they came to the exact “negative _______” figure given me by phone yesterday. (See Part I, that involves a line of seemingly non-sensical subtractions including my “standard deduction” on the 1040). In other word, I later realized it seemed they were telling me that my “income” didn’t include that which was not taxable. As though I didn’t have that amount at my disposal to use! Perhaps they didn’t understand that the standard deduction is simply the amount the IRS doesn’t tax on.
I’m not an accountant but it appears to me that line 2a on the form 8962 which reconciles the ACA’s Premium Tax Credit asks for the modified AGI, not line 15 from the Form 1040 which is the taxable income. I suppose either way, in my case the number is negative so it may be moot in some regards. But it is also “to a different degree” and references to line 15 were made multiple times to me. Perhaps I should have written zero instead of the exact subtraction.
I felt this part of the conversation was obscured and I wasn’t getting any clear, direct answers to my questions. I was feeling there was some type of circular, evasive explanation and the case worker seemed to indicate I was twisting his words. (I would repeat and point to figures he told me, what I understood him to be saying).
At some point, I inquired the date of my Medicaid enrollment–the recent packet sending me an “access” card seemed to indicate it was back dated to last November. The case worker confirmed that was true.
I asked if I could get my user name and password to the COMPASS site. They stated they did not have that information and I would have to get it from COMPASS. They pulled up the website showing me I had to “register” the account. I explained what I was told yesterday (this is in Part I) and there was a kind of argumentiveness in the air over this. In my notes, the case worker told me they didn’t have “the skills” to provide me with my user name and password (created by DHS to submit an application to Medicaid without my specific knowledge/consent/notification of the process) and that I should call 1-800-692-7462.
At this point, another person came and stood behind the case worker at the cubicle desk, listening. The person identified themselves as an Office Manager of some sort, and said they just wanted to listen. I asked for the person’s name and wrote it down.
I seemed to be at the point of confirming “income numbers” put on my Medicaid application (not by me) verbally with the case worker, who was referring to a computer screen. I had also asked for a printed copy of this “application” and as I recall, they were hesitant but indicated they would get it for me. They may have even said that was “being done” already and possibly (I don’t know) perhaps that is why the other person showed up around that time.
I do recall being asked why I needed a copy of the Medicaid application if I had already had it emailed to me yesterday after not being able to access my own information online (see Part I). I indicated I wanted to make sure everything matched what I was sent. I already knew the numbers he was telling me were different from other numbers on another notice (my enrollment packet).
At this point, I asked for a printout of what was being read from on the computer screen, my “case file” basically. I was told I could not have that. The Office Manager now got involved, wanting to know why I wanted it (or something to that effect). I asked, “Am I entitled to that information?”
The repeated response was seeming avoidance of direct answer, and I made note of (in front of them, in my notebook) that this person was said they were “trying to figure out what we’re doing.” The implication was that they wouldn’t answer whether I was entitled to these computer notes until they figured out “why” I wanted them.
I continued to ask, “Am I entitled to a print-out of what the case worker is reading from in the computer?” (paraphrase) and the Office Manager said something to the effect of “No, that is our ‘narrative.'” (maybe they said case narrative, not sure…I was startled by the word “narrative.”)
What is a “narrative” in this situation? I was then told it was “our notes to us.” Eventually, I was told they would need a subpoena.
Next, I browsed the application they printed me and it was identical to that which was emailed me. (But, there’s more to it. Again, the figures were different from other DHS documents, and it contained incorrect info.)
I was being told that whatever info on the Medicaid application was supplied “by me” (into Pennie) but without stating at that point the discrepencies, I assured them I would not have stated those things.
One issue (and why I asked to see a blank application) was that the application summary listed me as “Single/Never Married.”
As a hurting, twice-divorced woman, this not only felt insulting (personally) but I rightfully should ask why it said this. I have never in my life seen an application that differentiated between someone “single” and someone “single/never married.” Sure enough on the blank paper application I was given, the options are: Single, Divorced, Widowed, Separated…
On the paper form with carbon copies, there is no option to tell Medicaid that one is “single/never married.” I just don’t get it. If one never marries, they are single. Stating that one is single AND never has married may have unknown future legal implications for me.
If I had filled anything out, I certainly would have said “divorced.” On social media I list myself as “divorced.” The “single” status used by divorce people might give the vibe of being open to online “interests”—the term “divorced” communicates “I am in grief…my marital covenant has ended…don’t go flirting with me online.”
Right?
But back to the details here. I wanted to know and asked, “where does this information go?” I communicated my offense–that I had been married twice, listed “alimony” on my Pennie application and a “pension” from my first marriage. No one will ever convince me that I wrote somewhere on anything that I was single and “never married.”
The case worker said something about “Med Penn Legal” would have put it (that’s the best I could quickly notate…). They seemed to be telling me this information came from me AND from some legal place in PA…I guess??? I raised the issue that if this gets in some system, how do I know that in the future when I go to collect social security that it won’t cause me some issue. I mean, given all things that seems a reasonable question?
I do see more notes in my spiral book and an “arrow” drawn from the “never married” notation downward to the case worker stating that “my lawyers called legislative branch and they created it, not us.” (as I proofread this I now wonder, did the case worker mean THEIR lawyers called some legislative branch and they created that marital status for me? How can they keep telling me everything they got came from Pennie with such obvious “human” components/changes?
I told the case worker “I don’t have any lawyer.” (also in the conversation at some point I asked if I was entitled to a public defender if I appealed this!)
On the Medicaid application it also stated that the “last time I received my pension and self-employment” income was 7-1-13.
Yes. Got that? 2013? OK…so they are playing fast and loose with my self-employment reported on a 2023 Tax Return but their “application” states I didn’t receive these things after a date when I lived in Alabama?
My first husband didn’t retire until around 2017 or 2018…so that is categorically wrong, as well.
I was given no explanation of where this date 7-1-13 date came from.
Now to the real kicker. On phone Tuesday the case worker was saying my “self-employment” income was a figure far below “O.” When I first came today and asked the income figures, he quoted the figures I put on my fall 2022 application for 2023 (that which I updated for 2024 on November 28, 2023). This number was not a negative number. The case worker used that figure and my pension amount.
I asked several times of them, “are you sure of this?” Indicating directly or tacitly, “Is this your real answer?” In other words, are you going on record with this? They said yes. And these two figures are in fact what was on the Medicaid application (albeit it also said “last time received” as 7-1-13 on each).
So, then, I proceeded to ask of the two of them today: “Where did this figure of _______ come from?” I then showed the two of them my enrollment mailed March 22 that came in a packet saying I was “approved” and sending me a plastic access card, a directory of provider information (did I mention in the past couple weeks daily getting multiple calls and voice messages from “PA ENROLLMENT” telling me I needed to “select a plan.” At first, I thought this was Pennie. I ignored the numerous robotic calls. Then yesterday I realize it was Medicaid! In my enrollment package was also the previously mentioned Voter Registration form.
And an “income summary.” Here is where there really needs to be an answer.
Shockingly, this approval package lists three lines of income (not the two that was on the Medicaid application): it lists my correct pension amount, an extremely low figure ($65) from my produce stand business, and a quite whopping “monthly income” figure from my art business! Yes, the art business the case worker insisted should be predicted at around “O” again in 2024 (essentially) with the case worker affirming the amount on the Medicaid application that which I specified fall of 2022 for the following year’s estimate.
So here’s the thing. I kept asking them, “Where did this other new figure come from?”
The Office Manager said something about “gross profit” and I asked from which tax line that was taken. I was given evasive, circular, confusing answers that didn’t make sense. At one point, they tried telling me it was some calculation minus “allowable” deductions. I took that FALSE monthly number shown on my enrollment package and multiplied by 12…thinking maybe it would total my 2023 gross receipts, it did not.
I was asked, “What is your income?” I stated the updated income projection figure I gave on March 26 which was $333 per month more than what I projected last November 28. They kept telling me that it all worked “monthly.” I said “On Pennie, they want a monthly but I estimate yearly and divide by 12.” Pennie agents know this…it’s the only way it can work. That is why the law allows an exact reconciliation with the IRS/insurance credit later. It states on healthcare.gov to project the following “year’s” income. I believe the case workers said “Well we do it differently.”
Well, of course. One of many reasons I will not be on Medicaid. What working, busy person wants an ongoing, additional clerical hassle and going “on and off ” plans. My goal is to MAKE MORE AND MORE MONEY and work myself back up out of this terrible post-divorce situation. Again, I tried to help them understand it was because of Pennie’s automated computer situation that I was even in the Medicaid office.
So, to that point I was led to believe by both Pennie and Medicaid that it was my “income” only (fast and hard numbers) that pushed me from Pennie into the Medicaid system. I have read the various state poverty level figures which seem also connected to Medicaid expansion. As I understand it, 40 states expanded (which allows a person to earn more than the Federal poverty line and be on Medicaid) but 10 have not (mostly “red” states).
So I don’t know. This income figure on my Medicaid approval packet is actually 74% above my own statement of projected income. I added those three figures together in front of the case worker/manager (and I think they were trying to add to) and I then said if this were my situation, I clearly would NOT be eligible for Medicaid.
I had also in the past week made the point that even my part-year final alimony from 2023 plus my pension would make me “income ineligible” for Medicaid (my self-employment income/loss was, in a way, irrelevant in 2023), so that from my view, back-dating and saying I became “Medicaid eligible” in Nov/Dec 2023 (I have these documents from them) makes no sense. Something in the process picked the date of the Pennie “system update” on November 20 that superseded my November 28 application.
At this point, the Office Manager told me that being “over income limits” actually didn’t necessarily disqualify me from Medicaid. (Pennie told me they couldn’t get me back in their system unless Medicaid issued me a letter saying I didn’t qualify).
It is also worth noting, I have not been unenrolled from Highmark on Pennie’s site, nor have I received anything from Highmark. Pennie agent I first spoke with said something like “I should have been unenrolled…” At this point, I’m guessing there is something else at play.
At one point a Pennie agent had told me “But it’s FREE–you won’t have to pay ANYTHING.” I said, “I don’t want FREE Medicaid. I will not take this.” I was told I could “opt out” of Medicaid, but then I would not receive my health insurance subsidy. At the end of my appointment today, I handed over the Medicaid card I had cut with scissors in my car before the appointment. I was given a form to sign–the case worker made it clear I could just withdraw myself. Then I wouldn’t need to “appeal” anything. They also stated that my voluntary withdraw from Medicaid would serve as being “ineligible” for Pennie’s purposes, which conflicts with what I understood was required. But, maybe that is true. Who knows.
I filled out the form and took a photo of it in front of them before signing. I was told I would get a copy, but I didn’t trust anything at that point. After I next signed it, the case worker ask me to take a photo of it signed, which I did. They provided me with a certified copy. The reason I put on this “Voluntary Withdrawal Form” was as follows: “I am not eligible for Medicaid and false numbers were used without my consent by the Medicaid office.”
Back to that “inflated” monthly figure no one can tell me where it came from. The figure that if multiplied by 12 would create a yearly income that disqualifies me from Medicaid. It was at this point the Office Manager indicated there was “other criteria.”
I asked what this criteria was. I really want to know! Curious minds inquire.
This whole process was demoralizing–for one thing–and I got the vibe that no one could really understand why I was so upset. Why I would refuse this “gift horse”–why I would “look it in the mouth” and say “nope.”
As I walked out of that office around 1:15 today…the waiting room in that hour was filled with so many people I could not count. I’m guessing at least one hundred people…as I walked out the door into the lobby I caught a whiff of strong booze.
I heard various bits of conversations as well…and then I was outside…”Medicaid” free and on my way to pick up some framing supplies for my work…
Tomorrow and next week, I will continue making some follow-up calls and requests…I anticipate writing a Part 3, Part 4 and possibly more….but…who knows…
Below again is the YouTube that seemed the most helpful to me, and a repeating of the footnote articles from Part I.
Thank You For Reading
Please Feel Free To Express Your Thoughts Below
