Compassion, and understanding of people who struggle, and take jobs, work their way to earn enough for their family, is something I do understand, and I admire such folks, who make good use of the opportunities and skills they have to make it in a difficult local economy, or geographic area.
My hope is your Sister, her Dependent, and Mom, find ways to better their lives with the new position and increased take home pay she earned through her hard work. Rising out of "poverty" as described by whoever sets out the Medicaid qualifications, is a complication I hope is at least partially offset by her job security and wages.
My issue, and lack of patience, the reason for my reply rhetoric to your post, Jed_, was more to do with your comment about how you would be happy to pay $200 more per month in taxes (provided it was required for upper income folks across the board), if it would keep your Sister's Healthcare intact. That was the issue I sought to address, not the unfortunate economy and coping with it that faces your Sister, who obviously is doing her part, and is valued at her work for the effort she shows there.
Your Qualification, the slam at the recent tax reform bill, the attitude is all should pay more to subsidize programs like Medicaid, and by inference other means tested 'poverty' programs, is where we differ, and differ greatly.
You are free to donate any added tax amount you wish, just send it in to IRS and they will accept it, if you feel guilt about receiving too much compensation for the work you perform. Go for it. On the other hand, you wishing OTHERS had their work product, wages, compensation, confiscated so your relative, and countless others can continue to benefit from government program largess is our difference.
The solution is as you decided, prior to my suggestion, that you assist your extended family, to make life easier for your relatives. It was what came to my mind as a first solution; as well to yours, and you are already doing so. You are to be commended for putting your money up, for a cause you believe in.
Charity begins at home, is a valid statement.
Beyond giving money, or paying bills for your family members, so hey have more control over the money they earn going to increased benefit directly, is helping your family seek assistance from Churches or other groups who may be available to them, whether Meals On Wheels type of thing, or transportation assistance from volunteers to get to Medical appointments, helping them think outside the box would benefit, in my imagination.
What does not help your family in WV, is confiscation of wages of others, in the long run, as some may 'teeter' on the edges of means tested subsidies. If the amount of income is 'set' too low, then lobby, contribute to efforts, toward adjusting what counts as 'income' for such subsidy, and to insure your family is well represented when providing information to whoever makes such decisions.
I hope that helps clarify my remarks, as to the point I wanted to make. It is all too easy sometimes to critique, and I did not wish to add to your family's burden, only to help you make the correct choices, which obviously you are doing, regardless of your view about income confiscation for others.