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September 30th, 2009

Eliminating health plan dependents



Sanford Altman, Esq.

Question: I am a retiree from my job with New York State and recently received a strongly worded demand for information about my dependent on my State Health Plan. They seem to be threatening to remove coverage from my wife. Can they do this?

Answer:

This is a widespread investigation (it’s not just you) that seems to have been conceived by someone who saw the movie, "I Now Pronounce You Chuck and Larry". The plot of this movie, for those of you who missed it, is where two New York City firefighters pretend to be gay partners so one of them can get on the other’s health plan. The theory behind the investigation is apparently that if they ask for a huge amount of information from enough people, some won’t have it and they can eliminate enough dependents to, perhaps, pay the cost of the investigation.

This investigation hit close to home for me when my ninety-year-old father received a notification from the New York State Health Insurance Program (NYSHIP) seeking verification of his relationship with his domestic partner, age eighty-five, who is on his health plan. Now, my father is a retired New York State Acting Supreme Court Judge who still serves as a Judicial Hearing Officer handling court calendars several times per week. He and his partner only became official domestic partners a few years ago, which entailed supplying an immense amount of documentation in and of itself (joint residence, financial interdependence, etc.). In addition, she finally accepted his proposal and they were married a few weeks ago. In any event, one would think that under the circumstances, if the state was going to give anyone a pass on this investigation, my father would be the perfect candidate. But that was not the case.

In short, this investigation is serious and all inclusive. The State is looking to cut down the numbers on its health plan and no one is exempt. Further, they have placed the burden of proving eligibility on the program member and they have made this burden difficult. How have they made it difficult? First, they give very lengthy and specific instructions as to the type of documents that must be submitted – instructions that are even hard for a lawyer to understand. The instructions for a domestic partner, as was the case with my father during the time period they are examining, divides the type of documents into three categories: Categories "A" and "B" are financial interdependence, such as joint accounts, joint insurance, names on each other’s Wills, etc. and Category "3" (not "C" as one would think) proving the same residence, such as Driver’s License, utility bills, etc. You need either two from Category "A", or one from Category "A" and one from Category "B" and an unspecified number from Category "3"– the Chinese Restaurant Model. You can have ten documents from Category "B" and you are still out of luck.

The second way that it has been made difficult is the deadline – October 5, 2009. If all the required documents are not in by that date, your dependent will be judged ineligible retroactively to February 1, 2009. This means that any medical services you may have thought were covered for them will not be. It is unclear as to whether you have to repay the State for medical care for dependents declared ineligible, but I would be surprised if there is no provision for such repayment. Finally, to add insult to injury, if you submit your documents in a timely fashion and they ask for additional documentation which arrives from you after the cutoff date, it is simply too late.

While it is clear that the State has the right to disqualify those who are fraudulently claiming a relationship in order to obtain coverage, this system is set up so that many will lose coverage by default. They may get documents in late. They may misunderstand the instructions, especially if they are elderly or incapacitated. They may not have all of the documents readily available (think about how long it takes to get a copy of your marriage certificate). Or, perhaps they are even on a long vacation and don’t get their mail on time, or the request gets lost in the mail. In any of these cases and many more, deserving individuals will be excluded with a heavy price to pay.

The best advice that I can give for anyone who has received this notification from the State is to follow all of the instructions carefully, submit many more documents than the minimum that they require and get it in as early as possible, well before the date by the quickest method possible. As always, when dealing with the State, hope for the best.

Sanford R. Altman is an Elder Law Attorney with a firm in Orange, Dutchess and Sullivan Counties, a member attorney of the AARP Legal Services Network, a member of National Academy of Elder Law Attorneys (NAELA), and frequently writes on Elder Law issues for local publications. He may be reached at the following number (845) 778-2121. Please note that while this column is intended to give general legal information, everyone’s circumstances differ. This column is not a substitute for obtaining legal advice directly from an attorney which will address your particular circumstances.

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