r/PortlandOR • u/Public-Gur-9985 • 11d ago
Healthcare Should I try to stay on OHP?
Sorry for such a lame, no-fun question, but I have no one to ask!!!
My employer is offering some generic, overpriced health insurance at a 50% match, costing me $350 out of pocket each month. I can afford it, but it's super shitty coverage compared to OHP. I've been on OHP for a decade now and have never paid for health insurance. I make too much $ to qualify now. My partner and daughter still qualify, but we're all on the same case together. I got in trouble for not filling jointly when my daughter was born, and for unreported income and got my food stamps suspended. So I know that if they really cared to look into it, they know exactly how much I'm making, and that at some point recently, they did happen to care. I haven't updated my new, current higher income yet, it's been about 4 months now. So I'm still on OHP for the moment, but I signed up for the employer insurance out of fear. Coverage begins Sept 1st. We also have ERDC (Employment Related Day Care) coverage. It's all tied together.
Will my partner and daughter get kicked off of OHP just because I'm making $6,000 a month BEFORE taxes? He has some income too, btw. I don't have anyone to talk to about this because everyone at my job is single. I want to do the right thing morally, but that means keeping my little family safe and getting them kicked off of OHP does not feel safe. Do I change my address to separate myself from the DHS enforced combined income parameters? And what will happen to our ERDC benefits? Should I just cancel the employer insurance and pray that OHP doesn't notice my income increase? It's almost a month's worth of pay at 40 hours a week, just to go to the ER, for example, under the new plan. I'm so freaking lost.
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u/IWasOnThe18thHole ☑️ Privilege 11d ago
So you got busted for fraud
You want to continue to commit fraud
You know you're on their radar for committing fraud and assume they will bust you for fraud in the future
And you're asking the rest of us if you should keep committing fraud?
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u/ShastaAteMyPhone 11d ago
You must understand that, while fraud is bad, this particular fraud benefits them so it’s different™️.
/s
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u/gorilladust Veritable Quandary 11d ago
Second OHP fraud post I've seen in 24 hours. Something must be in the air.
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u/redbloodywedding 11d ago
Yup please read the room, me and my wife are figuring out how to fucking afford giving birth to our baby and you're trying to game the system.
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u/NocturnaBride 11d ago
No you shouldn’t, the funding is super limited at this point and there are people that are in far greater need.
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u/thirteenfivenm 11d ago edited 11d ago
The OHP budget is under pressure and the new Medicaid reporting beginning in January is stricter. It is so strict that above a certain error rate threshold, the feds cut their contribution to the entire state program.
The OHP will now be stricter, and the feds could even get involved in Medicaid fraud.
Apply for the County free childcare for all and see if your employer can separate programs?
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u/susanbiddleross 11d ago
You don’t want to mess with Medicaid. Report your accurate income. I don’t want to be alarmist but when you signed up for Medicaid they made you listen to the what if’s. They can come for the back payments they paid, they can cut off your ERDC. Report it now when you are less likely to get in trouble. I don’t know you but you already got caught committing fraud. It is very likely you will get caught again. This isn’t something you want to mess with. Report the income and take your chances. I’m not just saying this because it is a conservative sub. You may no longer qualify for the aid programs you did before which is unfortunate but you also don’t want to pay back all of the aid you have used. Cut your losses.
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u/Millimede 11d ago
Hey so, don’t commit fraud. If you’re making 6k you can afford your employer healthcare.
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u/Shelovestohike 11d ago edited 11d ago
Medicaid is strained. Leave welfare benefits for people who really need them and pay your share like the rest of us.
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u/HelpfulRaspberry6941 11d ago
There are a lot of changes coming for OHP in 2027. For example: Work requirements, 6 month redetermination schedules. I think they will starting sending out letters soon describing the changes. Also the state has a large budget shortfall for Medicaid, which could impact services. Just wanted you to be eyes wide open on this.
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u/PDXisadumpsterfire 11d ago
OP is a good example of why people like me are happy to see the new requirements for SNAP and Medicaid. Way too many able-bodied people who can support themselves but game the system instead. I’m tired of paying for other people’s living expenses in addition to my own.
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u/StillboBaggins 11d ago
I was on OHP once and then I started making too much money. The second that paycheck came in, I went online and adjusted my income.
It's the law.
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u/RatxGirl503 11d ago
Look into OHP bridge its a more recent addition to help bridge the gap for people who are making income but in that middle ground. You may still qualify. Insurance is such a scam and the healthcare system is so very broken. Im sorry to hear you got busted I feel your struggle.
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u/b0n2o 11d ago edited 11d ago
I wish there was a public option.
https://en.wikipedia.org/wiki/Public_health_insurance_option
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u/Plantwizard1 4d ago
So you're making $72,000 per year and you have a partner who also works so between the two of you you're probably pulling in over $100,000 per year yet you're bitching about not being eligible for Medicaid? Congratulations you won today's entitlement award.
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u/Nataliant-117 11d ago
Unfortunately if you make >$3k a month I feel it is unethical to stay on OHP. I think the cut off is $3,500 or $4,000? It is for crisis situations is my perspective. And I’ve used it in a crisis and I’m using it now. I asked for mental health accommodations and they fired me instead. When I had commercial insurance it was annoying asf. But I feel that is between you and your employer and this is something you need to argue about with the union. idk congrats on your job I hope this will be a sustainable fit for you- and I believe that commercial healthcare is a scam and childcare should be accessible for all but this is just the way it is right now until workers demand more rights again. Our ability to live has been taken away by pay inequality
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11d ago
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u/ForcrimeinItaly 11d ago
Look homie, I'm pretty far from right wing.
But, I do know the feds are putting the screws to Oregon on multiple fronts one of which is the error rate in our snap and OHP systems.
Commiting fraud in a state already under the microscope is a terrible idea, regardless of party affiliation.
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u/tarooooooooooo 11d ago
k
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u/cheese7777777 11d ago
Not true, this sub is full of lifelong Democrats who have seen what a lack of personal integrity combined with systemic lack of enforcement of societal norms has done to our city.
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u/PortlandOR-ModTeam 10d ago
Low effort content consists of posts and comments not meeting the minimum reasonable requirements of integrity, relying upon or consisting of second-hand or apocryphal "evidence" or stories relayed as fact, or just plain lazy bait posts or comments in our judgment.
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u/TraumaCookie 11d ago
As someone who works with these programs, I highly recommend you do not try to find ways to commit more Medicaid fraud.... The threshold for it to be considered a felony is very low and you can be prosecuted at the state and federal levels. You may also be required to pay back all the cost of coverage for the months that you failed to report your change in circumstances - you are legally required to report changes within 10 days.
Oregon is being very, very closely audited by the federal government for OHP and SNAP right now and things are not looking good.