Covered California has added a new Qualifying Life Event for a Special Enrollment Period into health insurance for victims of domestic abuse or spousal abandonment. The new domestic abuse qualification allows the person who has suffered abuse to not only enroll in a health plan outside of the open enrollment period, the individual can also remove the abuser from the current plan or remove themselves, and in certain situations, also the children.
One of the limitations of the Affordable Care Act, and most other government assistance programs, is that they don’t always reflect real world life situations. In other words, the definition of a family from Washington D. C. is not always the reality of a family in California. Covered California has done a good job in trying to address real world family situations when it come to health insurance enrollments and the premium tax credit subsidies.
Covered California also recognizes the constraints of the Affordable Care Act (ACA) when it comes to eligibility for the premium tax credit subsidies. The ACA states that if a married couple apply for the premium tax credit subsidy through Covered California, they must agree to a Married Filing Joint federal tax return status. If you are the victim of domestic abuse or your spouse leaves you, there is little interest in working with that person to file taxes jointly.
Helping Abuse Victims Separate From Abusers
The IRS does have accommodations for individuals who may have received the ACA premium tax credits, but when individuals go to file their tax return, can’t mark Married Filing Jointly. This allows the person filing the return to claim part of the tax credit without having to repay all of the subsidy. The new domestic abuse qualifying event allows the victim to uncouple from the abuser so the health insurance is not controlled by the abuser.
However, there is another complication that manifests itself on the Covered California application. In general, only the primary applicant can make changes to the account such as removing a spouse or dependents. If the victim of the abuse is not the primary applicant, it has been difficult to get removed from the account along with any dependents. The new domestic abuse qualifying event addresses some of the application problems.
Covered California has not stated if they will require any proof or verification for the domestic abuse special enrollment. If your spouse abandons you, it’s usually darn hard to get him or her to send you a letter explaining the condition. An attempt to use the domestic abuse qualifying event to enroll in health insurance, when in fact no such condition exists, would verge on fraud and misrepresentation. I would advise against it. But if you are the victim of domestic abuse, do not hesitate use the qualifying life event to separate you from your abuser.
Covered California Domestic Abuse QLE Application Details
As of October 5, 2020, “Victim of domestic abuse or spousal abandonment” is available as a distinct Qualifying Life Event (QLE) selection on the special enrollment period (SEP) dropdown menu in the CalHEERS application. However, the consumer would need to have prior knowledge of these options and manually enter the reason using the “Other” QLE option on the dropdown menu.
- Starting October 5, 2020, consumers can select the “Victims of domestic abuse or spousal abandonment” QLE to:
- Apply for coverage (for new members).
- Remove self and/or dependents and begin a new case and enrollment (if enrolled on an existing case).
- ·A QLE is NOT needed for coverage terminations, but the authority of the consumer depends on the consumer’s role in the case.
- If the consumer is the Primary Contact or authorized representative of the Primary Contact, the consumer may remove the abuser and/or dependents from the case.
- If the consumer is the spouse or registered domestic partner of the Primary Contact, the consumer may remove self and/or dependents from the case.
- If the consumer is NOT the spouse or registered domestic partner of the Primary Contact, the consumer may remove self from the case but not dependents.
- The only exception is if the consumer is a dependent or unmarried victim of domestic abuse within the same household as the Primary Contact. In that event, they may remove self and/or their dependents from their abuser’s case and plan and then enroll in a new plan under their own case using this QLE.
- The Primary Contact will receive notification of the change to their household plan.
- The consumer can apply using the single or head of household tax filing status on their new application without penalty of misrepresenting marital status or tax filing status.
- Consumer will need to consult a certified public accountant or a tax specialist about the marital and tax filing statuses they must report on their tax returns.
- After selecting the QLE and completing the application, coverage will be effective according to the 15-day rule. (If the application is submitted before or on the 15th of the month, it will be effective the 1st of the next month.)
New vs. Existing Consumers
For New Consumers
- Marital Status: Enter the status as stated by the consumer (single, married, divorced, etc.).
- Note: If consumer states “married,” spousal information is required. Consumers using the “Victim of domestic abuse or spousal abandonment” QLE may choose to declare a different marital status despite being married to avoid the requirement to enter spousal information.
- Tax Filing Status: Enter “head of household” if the consumer claims a dependent child (natural child, stepchild, or foster child) on their tax return, or “single” if not.
- Do NOT enter “married filing jointly” or “married filing separately.”
- Do not enter partner’s income.
- For married individuals who receive federal tax credit and/or state subsidy and will not file taxes as “Married Filing Jointly,” alert the consumer that he or she may need to check the exception box at the top of page 1, IRS Form 8962 and Form FTB 3849, as applicable. Consumers in this situation should talk to a tax advisor about their specific situation.
For Current Covered California Consumers (no Medi-Cal)
- To remove an abuser and/or dependent(s) from a case (if Primary Contact or spouse, registered domestic partner or authorized representative of the Primary Contact:
- “Remove a Member” using the Report a Change process.
- If Open Enrollment (OE), complete application for a new case as usual.
- If not OE, select the “Victim of domestic abuse or spousal abandonment” QLE and follow steps above to begin a new case.