Your Marriage and Medicaid: Separating Fact from Fiction

Your Marriage and Medicaid: Separating Fact from Fiction?

Yes, our marital status can impact your eligibility for Medicaid benefits. Even if you’re currently receiving Medicaid, getting married to someone with substantial assets or income might render you ineligible to continue receiving benefits

If you are currently enrolled in Medicaid and concerned about the potential loss of coverage, we empathize with the stress this situation may bring.

Medicaid serves as a crucial support system, assisting over 75 million individuals with medical expenses, including doctor visits and prescriptions.

However, if marriage is on the horizon, you might wonder: could your upcoming change in relationship status jeopardize your coverage?


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How to Prepare Before My Wedding?

If you are concerned that marriage could impact your Medicaid coverage, there are steps you can take to prepare.

First, assess your finances by calculating your combined income and assets. This will help you understand your current situation and whether you might be at risk of losing Medicaid coverage.

Next, familiarize yourself with your state’s specific Medicaid rules and regulations. Each state has its eligibility criteria, so it’s crucial to understand the requirements in your state.

This way, you can ensure you’re taking all necessary steps to maintain your coverage.

Lastly, have an open conversation with your future spouse about finances and Medicaid coverage.

It’s important to be transparent and aligned on financial matters, ensuring you’re both working together to safeguard your coverage.

If your partner has existing health insurance, explore options to join their plan at a discounted rate potentially.

Can I Keep My Coverage If I Don’t Report My Marriage to Medicaid?

Failing to report your marriage to Medicaid could lead to penalties.

Medicaid operates on a needs-based system, where eligibility hinges on income and assets. Not disclosing a change in marital status may be deemed as fraudulent behavior.

While in some instances, you may be excused from penalties if you can demonstrate that the omission was unintentional, it’s advisable to promptly inform Medicaid of any changes in your situation.

Consequences for Medicaid fraud can include a fine of $500, a one-year imprisonment term, and subsequent probation.

Concealing your marriage from federal authorities can also invite fraud charges from agencies like Social Security, the IRS, and Medicaid.

Thus, it is in your best interest to be forthright with Medicaid regarding changes in your marital status.

How to Access Healthcare Insurance Through the Affordable Healthcare Act

If you find yourself without Medicaid coverage following marriage, there’s an option to obtain health insurance through the Affordable Care Act (ACA).

Mandated by federal law, the ACA requires all Americans to have health insurance.

If you lack coverage through your employer or another avenue, you can purchase a plan via the ACA Marketplace.

The ACA presents a range of health insurance plans, some of which receive government subsidies.

This could potentially reduce your monthly premiums, rendering health insurance more affordable.

Moreover, the ACA provides financial aid to alleviate out-of-pocket expenses like deductibles and copayments.

To learn more about the ACA and securing health insurance, visit the ACA website or consult with a healthcare navigator in your state.

Though ACA insurance isn’t free, policies offering comprehensive coverage can be found for as little as $47 per month post-subsidies.

What Happens If I Get a Divorce?

A divorce is unlikely to impact your coverage if you’re currently married and receiving Medicaid.

Medicaid eligibility hinges on income, and divorcing your partner typically reduces your total annual income, potentially reinforcing your eligibility.

However, securing a higher-paying job may elevate your income, potentially jeopardizing your coverage.

If I Get Married, Will I Lose My Medicaid?

If you are presently enrolled in Medicaid and have marriage plans, your upcoming change in marital status may impact your coverage.

Medicaid operates on a needs-based system, assessing eligibility based on your yearly income and assets.

Should you marry an individual with substantial income or assets, your joint financial situation could surpass the threshold for Medicaid coverage.

It’s crucial to note that Medicaid evaluates various factors beyond income when determining eligibility.

Your residence, personal possessions, and additional considerations are taken into account.

Therefore, even if your combined income exceeds Medicaid limits, you might still qualify for coverage if your other assets are limited.

How Does Medicaid Decide Eligibility?

To be eligible for Medicaid, an individual’s annual income must typically fall below a specified threshold, which varies by state and is generally tied to the federal poverty level.

Additionally, applicants must be U.S. citizens or legal residents and residents of the state where they’re applying for Medicaid.

Moreover, meeting the following criteria may still qualify you for Medicaid coverage:

  •  Having a long-term disability or visual impairment
  •  Being under 18 years old
  •  Being pregnant, a parent, or a caretaker
  • Being a former foster child

If you fit into any of these categories, you might retain Medicaid eligibility even if your income exceeds the financial limit.

For further details on Medicaid eligibility criteria specific to your state, please consult your state’s official website.

Are there any costs associated with medical services?

Most adults covered by Medicaid have small copayments for certain services, typically ranging from $1.00 to $3.00 per service.

Inpatient hospitalization carries a copayment of $100.00.

However, medical providers cannot refuse treatment if individuals are unable to pay the copayment, though they remain responsible for it.

Children under 21, pregnant women, hospice care recipients, and those in institutional or long-term care generally do not have copayments.

However, long-term care recipients may have a patient pay amount.

Children enrolled in FAMIS through fee-for-service arrangements do not have copayments, while those in Managed Care Organizations may have small copayments for select services.

For more information on copayments for each program, consult the Medicaid and FAMIS Plus Handbook and the FAMIS Member Handbook.

What services are covered by Medicaid, FAMIS Plus, and FAMIS?

Medicaid, FAMIS Plus (Medicaid for children), and FAMIS provide coverage for a variety of services, including:


For more detailed information about covered services for each program, you can refer to the Medicaid and FAMIS Plus Handbook and the FAMIS Member Handbook.

Medicaid also covers Medicare premiums, copayments, and deductibles for eligible individuals who also have Medicare.

Even if income and resources exceed the limit for full Medicaid coverage, individuals with Medicare Part A may still be eligible for assistance with Medicare Part B premiums.

How can I locate providers accepting Medicaid?

Verify that your provider accepts Medicaid, FAMIS Plus, or FAMIS before seeking care, as utilizing non-participating providers could result in personal financial responsibility.

The DMAS website offers a provider search tool, while MCO members should use their network providers.

Contact the DMAS Recipient Helpline or the respective MCO’s customer care line for assistance.


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Frequently Asked Questions

What distinguishes Medicare from Medicaid?

Medicare is a federal health insurance program available to individuals aged 65 or older or those receiving Social Security benefits based on disability for at least 24 months.

While some individuals qualify for both Medicare and full Medicaid coverage, Medicare generally serves as the primary payer for services.

For those over the income/resource limit for full Medicaid but eligible for Medicare, a Medicare Savings Program may assist with some out-of-pocket Medicare Part B costs.

 Is transportation covered by Medical Assistance? How do I arrange it?

Medicaid and FAMIS Plus cover non-emergency transportation when medically necessary and no other options exist. For fee-for-service recipients, LogistiCare manages transportation requests.

MCO enrollees should refer to their handbooks for transportation guidelines.

MCO members should contact their MCO directly for replacement cards.

How do I report suspected Medical Assistance fraud?

Suspected fraud, such as unauthorized card use, should be reported to the Recipient Audit Fraud and Abuse Hotline at 1-866-486-1971.


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