| Read Time: 4 minutes | Medicaid

Many people receive Medicaid benefits based on how much they make and who is in their household. So, a Medicaid recipient’s marriage status is a big deal. If you’re newly married, congratulations! But while you’re embarking on the next stage in life with your new spouse, don’t forget to let the government know. The government doesn’t need a wedding invitation, but you do need to fill out paperwork to notify them about your union. 

Not reporting a marriage to Medicaid can result in serious penalties and consequences that range from financial sanctions to criminal liability. However, you can avoid or reduce these liabilities by speaking to an experienced Medicaid attorney right away. The award-winning Law Office of Andrew M. Lamkin, P.C. is focused on helping people experiencing government benefit issues.

A Brief Review of Medicaid

Medicaid, a joint federal and state program, provides health coverage to eligible low-income individuals and families. Under federal law, Medicaid benefits cover all children whose parents have income up to at least 133% of the federal poverty level. Many states have chosen to also extend benefits to adults who have income up to 133% of the poverty level. However, states cannot grant Medicaid benefits to individuals whose income exceeds 133% of the poverty level. In general, the following sources of income for you and the other adults in your household are counted toward Medicaid income thresholds:

  • Taxable income,
  • Tax-exempt interest,
  • Social Security benefits that aren’t part of taxable income, and
  • Foreign earned income.

Given the significant impact that marital status can have on the level of income in a household, Medicaid requires recipients to promptly report changes to their marital status. Now, let’s take a look at the potential penalties and consequences for not reporting a marriage to Medicaid.

What Is the Penalty for Not Reporting an Income Change to Medicaid or for Not Reporting a Marriage?

Not updating Medicaid about changes in your finances or household can be risky business. You might lose money, you might lose benefits, or you might lose more. 

Financial Sanctions or Losses 

Getting married can mean adding more income to your household or more deductions to your taxes. If your income increases with the addition of a spouse, you may have access to fewer healthcare savings and might have to pay back those savings when you file your federal income taxes. Depending on your spouse’s circumstances, getting married might also lower your income according to the federal poverty level, which could increase your savings and lower your premiums. Missing out on savings because of a failure to report could mean a significant financial loss in the long run.

Losing Healthcare Benefits

If Medicaid determines that you failed to report your marriage and that your marriage affects your eligibility, your benefits may be terminated. While you may lose eligibility regardless of whether you take steps to report, failing to notify Medicaid immediately could delay your ability to find alternative coverage that best suits your needs.

Criminal Liability

Not reporting a new marriage and then submitting a claim for care could be Medicaid fraud or healthcare fraud. Medicaid fraud involves knowingly providing false information or withholding information to receive benefits. Penalties for Medicaid fraud can be severe, including:

  • Fines. Monetary penalties can balloon up to tens of thousands, depending on the extent of the fraud.
  • Criminal charges. Medicaid fraud is a felony in many jurisdictions, potentially resulting in imprisonment. The length of the sentence can vary based on the amount of benefits improperly received and the state’s laws.
  • Civil penalties. Those who commit Medicaid fraud might face civil as well as criminal penalties. These penalties could include a requirement to pay back three times the amount of the benefits improperly received.

Clearly, it is best to inform the government of your change in circumstances as soon as possible after a new marriage—to avoid all these possible unpleasant consequences.

Future Ineligibility

Committing Medicaid fraud by failing to report a marriage could affect your future eligibility for Medicaid and other government assistance programs. If you are found guilty of fraud, you may be barred from receiving Medicaid benefits for a certain period or even permanently.

How to Report a Marriage to Medicaid

In many cases, you can report the change in your marital status to the federal Healthcare Marketplace online, by phone, or in person. You may also need to report changes through your state provider.

Do I Lose Medicaid If I Get Married?

Not necessarily. Your eligibility for continued Medicaid benefits depends on many factors, such as:

  • What amount of combined income you and your spouse have,
  • How many people are in your household,
  • Whether you or your spouse is pregnant,
  • Whether you or your spouse has a disability, and
  • Whether you or your spouse is 65 or older.

You might still qualify for Medicaid after marrying. In fact, the circumstances of a marriage can entitle you to more savings. We can analyze your case and help you make the best decisions regarding your coverage.

Contact Us Today

When you have questions about life-sustaining benefits such as Medicaid, you want to speak to the best professionals on the matter. The Law Office of Andrew M. Lamkin, P.C. has some of the best legal professionals who are seasoned and knowledgeable about Medicaid benefits. Attorney Andrew Lamkin has over a decade of experience, and he has won millions for his clients. For top-level counsel, you can contact our office online or give us a call.


Author Photo

Andrew Lamkin is principal in the law firm of Andrew M. Lamkin, P.C., where he focuses his practice in the areas of elder law, estate planning and special needs planning, including Wills and Trusts, Medicaid planning, estate administration and residential real estate transactions. He is admitted to practice law in New York and New Jersey.

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