Should self employment losses be considered when calculating eligibility income?


I applied for Medicaid (Ohio, family of 4). My wife has a salary and we own a couple businesses together. The businesses are currently operating at a loss and I have tax documents from 2017 to back this up. Our AGI sits around 21k. I talked to numerous people at the Medicaid offices who assured me the self employment losses will offset the salary income and I will qualify. But when the results came in I was denied. I reapplied with better documentation (once my taxes were done). Same promises and same denial. clearly states that they should use the Modified AGI and self employment losses should be included but that's obviously not a legally binding document. Where do I find actual rules on how Medicaid uses self employment losses to determine eligibility? Any advice is appreciated.

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Ice - It sounds you’re trying to get ACA health insurance coverage through Medicaid expansion in your state, that’s it, right? The issue will be that what the exact eligibility requirements tweaked by OHio are and these can differ slightly from what the overall federal guidelines are for ACA. is a federal website so is more broad overview of the program.

Medicaid is a joint federal and state program but administered by each state uniquely. For the older Medicaid programs like CHIP, WIC, low income Section 8 eligible folks, LTC NH Medicaid, the asset / income guidelines are well established and fixed. As Jeanne wrote most on this site are dealing with Medicaid eligibility for elderly parents who are already on Medicare but find they now need Medicaid to pay for their long term care needs. 

But for discounted ACA through Medicaid expansion it’s all going to be whatever new guidelines OH has set for expansion. 

I’m going to venture a guess..... for the older Medicaid programs they are all about income & assets, whatever debts you have do not factor in for Medicaid eligibility. Medicaid doesn’t give a rats butt about your debts. Often this poses a crisis as grannies still has credit cards, like insurance premium due or a mortgage on her house but Medicaid requires her income to be paid to the NH as her copay, so grannie defaults on her debts.  I’m gonna guess that for the P&L on your 2 businesses show “income” and that’s whats counting for ACA, the losses (like debts for elderly LTC Medicaid) do not factor in.  The businesses make $.  As you’ve been denied twice, I’d suggest you look at if you can even do another appeal. If not, try to get on your wife’s employer health insurance and make it a job to find out what your financial situation needs to be qualifying for open enrollment for ACA next Nov. /Dec, 2018. Timeframe for ACA open enrollment under Trump administration was like halved for what it was under Obama. So you need to pay attention to when open starts.

Realize that A lot of states - esp more R states - opted to NOT do any Medicaid expansion for ACA at all.
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Can you explain a little more? What Medicaid program are you applying for? Is this for basic health care coverage for your family? Or do you need home care, or a care center? On the site I think we are used to talking about a Medicaid waiver program to provide assistance in the home, or Medicaid to cover a care center such as a nursing home. So if it is something other than that please provide some additional details.

You wife is employed and has a salary. Does she also have an opportunity for insurance coverage through her work? Could there be other factors besides the Modified AGI that impact your family eligibility? 

It must be terribly frustrating to be told one thing and then see different results. I hope you can get this resolved soon!
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Moving your question up so others with answer will see it.
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