Coverage for mentally ill 21-year-old

My stepson is 21 years old.  He is unemployed and has schizoid-affective disorder.  His mother told him that his father (my husband) is required to put him on health insurance or pay the penalty.  I told him that we can put him on our insurance because he is under 26 but it would be wiser for him to get on Medicaid since he has no job and they will pay more than our plan would for his mental illness.  His mother also told him that we are required to pay his medical bills until he is 26.  What I want to know is whether we are required to pay for everything including his insurance or be penalized? Or will he have to pay (which I do not believe he will because he makes under the appointed amount).  Thanks so much!


Texas Step Mom

Dear Texas Step Mom,

You know a lot about your stepson’s health insurance options already!  I will confirm your understanding on several things: you are correct that his father will not have to pay a penalty for his adult son’s lack of insurance.  You are also not required to pay his medical bills or cover his health insurance for the next five years, unless there is some agreement between your husband and the child’s mother that says otherwise.

You are also correct that your stepson will not have to pay the penalty if he earns less than the tax filing threshold, which is $9,750 for a one-person household.

He would qualify for Medicaid if he were declared disabled by Social Security.  If his mental illness is severe, he should apply for Social Security disability.  This is a lengthy process, so he should get started on this sooner rather than later.  Without the disability recognized by Social Security, he will not be able to get Medicaid coverage in Texas.

I would suggest that you contact your local health and human services agency to find out what services and supports are available to him, assuming that his mental illness prevents him from working.  They may have ideas for you and help for him to live on his own.

Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.