What’s this about California increasing the MAGI income  FPL limit so that you can get subsidies from 400 to 600%?


What’s this about having the Mandate Penalty back?

California under Gov Gavin Newsum passed a new budget which increases the premium subsidy qualification amount from 400 to 600% and bring back the mandate penalty CA Health Line * LA Times 6.27.2019Sacramento Bee 6.13.2019 * CA Health Line * to fund it.  Proposition 25 allows the legislature to pass the budget and doesn’t need the Governor to sign it.

President Biden’s plan might make the 600% Federal, rather than state.  Also, updated or new rules about affordability?    LA Times 2.6.2021 *

Federal Poverty Level &
Program Chart

Medi-Cal?  Covered CA Subsidies?  Enhanced Silver?
MAGI Income Chart

Average/Family Subsidy Increase

The average household tax credit in this category would be $144 per month, according to Covered California.  For example, a couple, both 62, living in the San Francisco Bay Area making $72,000 a year doesn’t qualify for federal tax credits. They now pay a $2,414 monthly premium — or about 40% of their income.  That couple could qualify for a $1,613 state tax credit under Newsom’s proposal, lowering the cost of health insurance to about 13% of their income, according to a Covered California analysis.

The budget agreement includes an additional $450 million over three years to fund insurance subsidies after some lawmakers argued mandate revenue alone wouldn’t make health insurance affordable.  Sacramento Bee 6.13.2019  *

Franchise Tax Board (FTB)

Would Administer State Mandate Penalty 

The administration has indicated that FTB, which administers the state’s personal income tax, would implement the proposed state individual mandate penalty. This would be similar to the federal individual mandate penalty that is administered by the federal Internal Revenue Service (IRS).

Covered California Would Administer State Subsidies.

The Governor’s proposal assumes that Covered California would administer the proposed subsidies. Details on implementation are yet to be determined.  Legislative Analysis Office *   Click here to get quotes and FPL analysis.

Get FREE #Instant Individual & Family  California  Quotes – Including Tax Subsidy Calculation – Guaranteed Issue – No Pre-X Claus

Get FREE Instant Quotes - Including Tax Subsidy Calculation - Guaranteed Issue - No Pre-X Clause

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Takes all the complexity out of CFR §1.36B-3 *

how to get quote - full instructions video by steve

Bibliography, Resources & Links

Blue Shield Explanation

CA fights Trumps attacks on ACA/Obamacare LA Times 8.15.2019 *


Actual Bill?

SB 65 Affordable Care Access Plus Program

ACA Signups.net – one guys analysis

Legislative Analysis Office 

KFF FAQ 3 questions

CA State Budget 2019 – 2020

LAO on Budget

Budget Act of 2019—Introduced in the Assembly and Senate

Sacramento Bee 6.13.2019

Covered CA Board Meeting Policy & Action Items – 600%   70 pages power point

Options to improve affordability in CA Health Market 68 pages

AB 1810 Covered CA to issue report on affordability

Uh Oh – Covered CA made a mistake in 2020 premiums, something with the new 600% of FPL from State of CA.  Here’s copies of the emails that are going out.


5 comments on “Premium Subsidy to 600% FPL + Mandate Penalty?

  1. I just got this letter from Covered CA. Is my coverage all messed up? Am I OK?

    Covered California Eligibility

    You qualify for health and dental insurance with premium assistance (a federal tax credit) through Covered California. This was based on your household income of $31,753.00 for the year ($2,646.08 a month). This is the income you said you expected to get for the year you want coverage. You qualify for up to $1525.36 per month in premium assistance to help pay for your health insurance coverage. If you choose a silver plan, you will get lower out-of- pocket expenses, such as lower copays and deductibles. Premium assistance cannot be used to help pay for dental insurance coverage.

    You also qualify for cost-sharing reductions. [Enhanced Silver Cost-sharing reductions are lower out-of-pocket expenses through smaller co-payments and deductibles. If you choose a Silver plan, you will get lower out-of pocket expenses through lower co-payments and deductibles.

    You do not qualify for the California Premium Subsidy because you do not meet the income requirements for the program.

    • Thank you so much for sending me the actual letter so that I can review it. The main thing I learned in my one year of law school was that you have to read something 3 times and then when you think you understand it read it AGAIN. See our page on how to read statutes & contracts.

      What the letter is saying, is that at your income level, you get the Federal Tax Credits, but not the NEW California ones, that go up to 600% of Federal Poverty Level, not just 400%. You also get Enhanced Silver – Cost Sharing Reductions – Silver 87. The letter doesn’t say 87, that’s shown in your quotes and confirmation of coverage.

      California 600% subsidy

  2. Does CA’s new law increasing subsidies do anything to fix the family glitch. That is, where an employer only pays for the employee’s health insurance thus making coverage “affordable” even though the dependents have to pay full pop?

  3. It’s not a done deal.

    There is still massive work to be done between FTB and CC to integrate the system.

    There are still questions as to where the money will come from if the penalties fall short of the expectation.

    Plus who will help consumer navigate the scenario of a family receiving the state subsidy, but when they do their taxes, they are under 400% and don’t qualify for the state subsidy but the federal subsidy?

    Who claws back the state subsidy money because the household didn’t qualify for it, but the family receives a large federal subsidy on their taxes?

    What if the federal subsidy is lower than what the household received from the state subsidy?

    This is going to get nasty complicated.

    We know CC refuses to work on tax related issues.

    That means the work falls to agents.

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