Author Topic: jersey care  (Read 240576 times)

Online ExGingi

  • Dansdeals Lifetime 10K Presidential Platinum Elite
  • *******
  • Join Date: Nov 2015
  • Posts: 15633
  • Total likes: 7720
  • DansDeals.com Hat Tips 19
    • View Profile
  • Location: 770
  • Programs: בשורת הגאולה. From Exile to Redemption. GIYF. AAdvantage Executive Platinum®
Re: jersey care
« Reply #920 on: December 17, 2018, 10:39:23 PM »
Btw, Ime the people who review financial info haven't a clue about profitability or understanding of financial reports..

That is a gross understatement!

The truth of the matter is that none of these income based eligibility programs are adequately equipped to handle business income.
I've been waiting over 5 years with bated breath for someone to say that!
-- Dan

Online S209

  • Dansdeals Lifetime Presidential Platinum Elite
  • *********
  • Join Date: Jun 2016
  • Posts: 7469
  • Total likes: 3930
  • DansDeals.com Hat Tips 1
  • Gender: Male
    • View Profile
    • Gowns By Shevy
  • Location: Lakewood
  • Programs: Marriott Gold, Star Alliance Gold, Hyatt Explorist, Hertz PC, National EE, Rock Royalty Wild Card, Wyndham Diamond, MLife Gold, Caesars Diamond, Hilton Diamond, Uber VIP, IHG Platinum Elite, ANA Platinum, DDF Lifetime Prez Platinum Elite, AmEx Platinum
Re: jersey care
« Reply #921 on: December 18, 2018, 02:24:45 AM »
I can't talk about Jersey Care specifically, but I get these kinds of questions all the time regarding the NY exchange (which I believe operates similarly in regards to income verification).

The truth of the matter is that none of these income based eligibility programs are adequately equipped to handle business income. So if you go with income that qualifies you for an ATPC on the exchange, there's recourse in the form of reconciliation of ATPC with actual Tax Credit that you're eligible for based on filed tax returns.

However, when talking about Medicaid, CHIP or Essential Plan in NY (and IINM also CSR on exchanges) there's very little that could be done. Officially one is required to report every change in income. But as any business owner knows, that's 100% ridiculous, as one often doesn't really know what the actual income is until many months later.

After the above preface, in my experience (on the NY exchange) they ask for either the prior year tax return, or most recent 3 month Profit and Loss statement, broken down month by month (they actually also give an option to submit business records such as bank statements, invoices, etc. but I have no idea what they might do with those. My best guess is that they would look at credits minus debits). They will then average out the 3 months, and count that as your monthly income. IMHO there's absolutely no-way in the world that this could be verified (unless they use costly forensic accounting), and just to be on the safe side, I always recommend that while people submit what they believe to be correct, they should also write on the P&L submitted: UNAUDITED.
This is true of JerseyCare. Just went through this last week, waiting to hear back, but I expect I’ll be fine.

The numbers were very rough at best, off at worst, but they were the best I could come up with.

I know, I know, I should be better with accounting and my numbers, but some things are impossible, and some simply not worth it..
Quote from: YitzyS
Quotes in a signature is annoying, as it comes across as an independent post.

Offline iwlw2

  • Dansdeals Platinum Elite
  • ****
  • Join Date: Nov 2015
  • Posts: 251
  • Total likes: 188
  • DansDeals.com Hat Tips 0
    • View Profile
Re: jersey care
« Reply #922 on: December 18, 2018, 08:34:16 AM »
I have a question about jersey care. I got different information from lrrc and a rep on the phone. Anyone here know if I submit a profit/loss statement to them Will a monthly profit that puts me over the threshold make me ineligible even if I am still good for the year


I just had this exact situation, and to make a long story short, I was denied even though monthly there was no income, because they took the yearly income and divided it by 9 (the application was in September). This was even thought there was zero income over the most recent 3 months.
(If you want the longer story. it was self-employed income for a speech therapist in private practice. They told me submit a profit/loss statement for the year. The speech therapist had not worked since June and was not working now but looking for work (thanks United Healtcare!). Despite that, they took the income from the first six months of the year and divided it by 9 which pushed it over the limits. The best I can offer, is that on the advice of a lady from OC Board of SS, we applied again, but this time as not working, and even though we still had to submit the p/l statement, maybe now they won't apply it the same way. still waiting to hear back on this application.)

Offline yesitsme

  • Dansdeals Lifetime Presidential Platinum Elite
  • *********
  • Join Date: Dec 2014
  • Posts: 5020
  • Total likes: 2237
  • DansDeals.com Hat Tips 4
  • Gender: Male
    • View Profile
Re: jersey care
« Reply #923 on: December 18, 2018, 09:13:10 AM »
why don't you give them projected profit/loss for year 2018?
["-"]

Online ExGingi

  • Dansdeals Lifetime 10K Presidential Platinum Elite
  • *******
  • Join Date: Nov 2015
  • Posts: 15633
  • Total likes: 7720
  • DansDeals.com Hat Tips 19
    • View Profile
  • Location: 770
  • Programs: בשורת הגאולה. From Exile to Redemption. GIYF. AAdvantage Executive Platinum®
Re: jersey care
« Reply #924 on: December 18, 2018, 10:49:47 AM »

I just had this exact situation, and to make a long story short, I was denied even though monthly there was no income, because they took the yearly income and divided it by 9 (the application was in September). This was even thought there was zero income over the most recent 3 months.
(If you want the longer story. it was self-employed income for a speech therapist in private practice. They told me submit a profit/loss statement for the year. The speech therapist had not worked since June and was not working now but looking for work (thanks United Healtcare!). Despite that, they took the income from the first six months of the year and divided it by 9 which pushed it over the limits. The best I can offer, is that on the advice of a lady from OC Board of SS, we applied again, but this time as not working, and even though we still had to submit the p/l statement, maybe now they won't apply it the same way. still waiting to hear back on this application.)

Just giving a 9 month P&L doesn't help. You need to tell them that your income/situation CHANGED, such as a reduction in work hours, loss of client, etc.

As I said before, they're simply not designed or equipped to deal with business income, especially when it's inconsistent. So they make up some rules/guidelines, but the people reviewing don't really understand any of this, nor does it have to make any sense.
I've been waiting over 5 years with bated breath for someone to say that!
-- Dan

Offline iwlw2

  • Dansdeals Platinum Elite
  • ****
  • Join Date: Nov 2015
  • Posts: 251
  • Total likes: 188
  • DansDeals.com Hat Tips 0
    • View Profile
Re: jersey care
« Reply #925 on: December 18, 2018, 02:38:31 PM »
Just giving a 9 month P&L doesn't help. You need to tell them that your income/situation CHANGED, such as a reduction in work hours, loss of client, etc.
I had told them before that application that it changed, and in fact showed them that the past 3 months were zero income to prove my point (i even explained the whole United Healthcare speech therapy thing). However, they told me (initially) too bad, they have to work with your entire income and divide it by the number of months as is it was being earned equally in all the months. More recently, they told me to change it to not working and just include the info, still waiting to see if that works.....

As I said before, they're simply not designed or equipped to deal with business income, especially when it's inconsistent. So they make up some rules/guidelines, but the people reviewing don't really understand any of this, nor does it have to make any sense.

Yah in general I think as much as the whole thing confuses applicants, it confuses the people who work there even more...


Online S209

  • Dansdeals Lifetime Presidential Platinum Elite
  • *********
  • Join Date: Jun 2016
  • Posts: 7469
  • Total likes: 3930
  • DansDeals.com Hat Tips 1
  • Gender: Male
    • View Profile
    • Gowns By Shevy
  • Location: Lakewood
  • Programs: Marriott Gold, Star Alliance Gold, Hyatt Explorist, Hertz PC, National EE, Rock Royalty Wild Card, Wyndham Diamond, MLife Gold, Caesars Diamond, Hilton Diamond, Uber VIP, IHG Platinum Elite, ANA Platinum, DDF Lifetime Prez Platinum Elite, AmEx Platinum
Re: jersey care
« Reply #926 on: December 18, 2018, 03:40:48 PM »
As I said before, they're simply not designed or equipped to deal with business income, especially when it's inconsistent. So they make up some rules/guidelines, but the people reviewing don't really understand any of this, nor does it have to make any sense.
+1000 I have found them to be the most yeshivishe agency/business/group I've ever dealt with, everything'sflying, they have no idea what's flying.

It's very convenient sometimes, because if you know how to deal with them, it's better and easier than dealing with the rigid bureaucracy of some other departments, even though it can frustrate those who don't know how to work with their system. The problem is if you face legal issues at some point it'll probably be harder to track down/defend, and as we've seen in the Lakewood Medicaid issues, Jews are always assumed guilty until proven innocent.
Quote from: YitzyS
Quotes in a signature is annoying, as it comes across as an independent post.

Online ExGingi

  • Dansdeals Lifetime 10K Presidential Platinum Elite
  • *******
  • Join Date: Nov 2015
  • Posts: 15633
  • Total likes: 7720
  • DansDeals.com Hat Tips 19
    • View Profile
  • Location: 770
  • Programs: בשורת הגאולה. From Exile to Redemption. GIYF. AAdvantage Executive Platinum®
Re: jersey care
« Reply #927 on: December 18, 2018, 05:36:22 PM »
+1000 I have found them to be the most yeshivishe agency/business/group I've ever dealt with, everything'sflying, they have no idea what's flying.

It's very convenient sometimes, because if you know how to deal with them, it's better and easier than dealing with the rigid bureaucracy of some other departments, even though it can frustrate those who don't know how to work with their system. The problem is if you face legal issues at some point it'll probably be harder to track down/defend, and as we've seen in the Lakewood Medicaid issues, Jews are always assumed guilty until proven innocent.

I haven't followed the Lakewood story so closely, but I will not be surprised if it was big headlines with a big Chilul Hashem, but in reality might have all been 100% legal - but the media would never report that.

A real estate investor could have millions in positive cash flow, but if his tax return shows an AGI that is below 138% FPL, he is LEGALLY eligible for Medicaid ever since Obamacare was enacted.
I've been waiting over 5 years with bated breath for someone to say that!
-- Dan

Offline zevi

  • Dansdeals Platinum Elite + Lifetime Gold Elite
  • ******
  • Join Date: Jul 2014
  • Posts: 921
  • Total likes: 164
  • DansDeals.com Hat Tips 2
    • View Profile
jersey care
« Reply #928 on: December 18, 2018, 10:15:18 PM »
What is there do until you get approved/denied for jersey care? Is there some sort of temporary insurance you can get ?

Offline shulem92

  • Dansdeals Presidential Platinum Elite
  • ********
  • Join Date: Feb 2015
  • Posts: 2955
  • Total likes: 122
  • DansDeals.com Hat Tips 1
    • View Profile
  • Location: Lakewood
Re: jersey care
« Reply #929 on: December 18, 2018, 10:48:26 PM »
What is there do until you get approved/denied for jersey care? Is there some sort of temporary insurance you can get ?
if its open enrollment or you recently lost coverage, you can sign up for insurance. otherwise you're screwed

Offline aygart

  • Dansdeals Lifetime 10K Presidential Platinum Elite
  • *******
  • Join Date: May 2008
  • Posts: 17404
  • Total likes: 14340
  • DansDeals.com Hat Tips 14
    • View Profile
    • Lower Watt Energy Brokers
  • Programs: www.lowerwatt.com
Re: jersey care
« Reply #930 on: December 18, 2018, 10:55:27 PM »
if its open enrollment or you recently lost coverage, you can sign up for insurance. otherwise you're screwed
Or open a business or get hired
Feelings don't care about your facts

Online ExGingi

  • Dansdeals Lifetime 10K Presidential Platinum Elite
  • *******
  • Join Date: Nov 2015
  • Posts: 15633
  • Total likes: 7720
  • DansDeals.com Hat Tips 19
    • View Profile
  • Location: 770
  • Programs: בשורת הגאולה. From Exile to Redemption. GIYF. AAdvantage Executive Platinum®
Re: jersey care
« Reply #931 on: December 18, 2018, 10:56:36 PM »
Or open a business
With payroll and have at least one non-owner enroll too...
I've been waiting over 5 years with bated breath for someone to say that!
-- Dan

Offline aygart

  • Dansdeals Lifetime 10K Presidential Platinum Elite
  • *******
  • Join Date: May 2008
  • Posts: 17404
  • Total likes: 14340
  • DansDeals.com Hat Tips 14
    • View Profile
    • Lower Watt Energy Brokers
  • Programs: www.lowerwatt.com
Re: jersey care
« Reply #932 on: December 18, 2018, 10:57:37 PM »
With payroll and have at least one non-owner enroll too...
Yup. BTDT
Feelings don't care about your facts

Offline Definitions

  • Dansdeals Lifetime Platinum Elite
  • *******
  • Join Date: Jan 2018
  • Posts: 1748
  • Total likes: 480
  • DansDeals.com Hat Tips 3
    • View Profile
Re: jersey care
« Reply #933 on: December 18, 2018, 11:04:58 PM »
Isn't there something that if you know you're eligible for Jersey care they can pay for bills during the application process?
I think I heard that on the lrrc phone system.
My Tapatalk notifications don't always work.

Offline Eliyohu

  • Dansdeals Lifetime Platinum Elite
  • *******
  • Join Date: Oct 2015
  • Posts: 1003
  • Total likes: 83
  • DansDeals.com Hat Tips 2
    • View Profile
Re: jersey care
« Reply #934 on: December 18, 2018, 11:06:51 PM »
What is there do until you get approved/denied for jersey care? Is there some sort of temporary insurance you can get ?
Go to Chemed, they can get you "emergency coverage" of straight medicaid for 3 months that can be used in hospitals and clinics. If not they'll at least give you a sliding scale on paying for a doctors visits there..

Offline Eliyohu

  • Dansdeals Lifetime Platinum Elite
  • *******
  • Join Date: Oct 2015
  • Posts: 1003
  • Total likes: 83
  • DansDeals.com Hat Tips 2
    • View Profile
Re: jersey care
« Reply #935 on: December 18, 2018, 11:08:17 PM »
With payroll and have at least one non-owner enroll too...

I haven't followed the Lakewood story so closely, but I will not be surprised if it was big headlines with a big Chilul Hashem, but in reality might have all been 100% legal - but the media would never report that.


Um ye...

Offline aygart

  • Dansdeals Lifetime 10K Presidential Platinum Elite
  • *******
  • Join Date: May 2008
  • Posts: 17404
  • Total likes: 14340
  • DansDeals.com Hat Tips 14
    • View Profile
    • Lower Watt Energy Brokers
  • Programs: www.lowerwatt.com
Re: jersey care
« Reply #936 on: December 18, 2018, 11:20:45 PM »

Um ye...

Are you trying to connect those two? How?
Feelings don't care about your facts

Offline Eliyohu

  • Dansdeals Lifetime Platinum Elite
  • *******
  • Join Date: Oct 2015
  • Posts: 1003
  • Total likes: 83
  • DansDeals.com Hat Tips 2
    • View Profile
Re: jersey care
« Reply #937 on: December 18, 2018, 11:24:37 PM »
Are you trying to connect those two? How?
Fresh story within the last 24 hours.. you can look at app/nj.com/patch/jerseyshoreonline etc yourself..

..Or you can just Google "Lakewood man $10 million insurance fraud...
« Last Edit: December 18, 2018, 11:34:02 PM by Eliyohu »

Offline YesThatsMe

  • Dansdeals Platinum Elite + Lifetime Silver Elite
  • *****
  • Join Date: May 2017
  • Posts: 736
  • Total likes: 128
  • DansDeals.com Hat Tips 0
    • View Profile
Re: jersey care
« Reply #938 on: December 18, 2018, 11:46:53 PM »
I live in NJ and work for a KY based company. Naturally the premiums are way lower (by $300 a head a month) than what they would be here for same coverage. I once told a friend, he’s begged me to take him and family on the plan, and he’ll pay all costs involved (payroll taxes etc). I literally had to scream at him for 2 hours about the fact it’s fraud.

But I understand the pain. Insurance is just so expensive.

Offline shulem92

  • Dansdeals Presidential Platinum Elite
  • ********
  • Join Date: Feb 2015
  • Posts: 2955
  • Total likes: 122
  • DansDeals.com Hat Tips 1
    • View Profile
  • Location: Lakewood
Re: jersey care
« Reply #939 on: December 18, 2018, 11:53:19 PM »
I live in NJ and work for a KY based company. Naturally the premiums are way lower (by $300 a head a month) than what they would be here for same coverage. I once told a friend, he’s begged me to take him and family on the plan, and he’ll pay all costs involved (payroll taxes etc). I literally had to scream at him for 2 hours about the fact it’s fraud.

But I understand the pain. Insurance is just so expensive.
it isnt just the expenses. business plans are able to offer far better insurance