Advance Payments of the Premium Tax Credit APTC

ARPA American Rescue Plan Act

What’s on this page?

• Section 1.36 B exact legal definition of subsidy calculation
• Simple calculator
• COVID 19 ARPA
• MAGI Definition
• Native Americans
• Report Changes
• Inflation Reduction Act
• Do you qualify for Medi Cal and NOT Covered CA with subsidies if you have NEGATIVE AGI?

Steve Shorr VIDEO on subsidies
Health Care Reform

CMS VIDEO explains the advance premium tax credit and the different ways in which you can apply it to lower the cost of insurance for you and your family.

FAQ's  #Negative MAGI Income – Qualification for Medi Cal? Subsidies?”

• Question  If your MAGI Income is negative, can you still qualify for Covered CA subsidies APTC even if you have some income, before you get to line 11 of your 1040?
  .
• Answer - NO!  See the income chart.  Your MAGI Income - AGI needs to be over 138% of FPL Federal Poverty Level
  • CFR 1.36 B C how APTC Premium Assistance is calculated
  • We also have no idea how long a tax loss will show up on line 11   adjusted gross income line  of your 1040?  See the IRS publications on Long Term Capital gains, above.
  • No problem getting health coverage, you just won’t get subsidies. Click here to get quotes and enroll online.
  • Sources 
    • Western Poverty Law and go over them with appropriate counsel.
    • How to calculate MAGI Income
    • Q & A on Intuit Site
    • See publication 536 Net Operating Loss
    • Form 8962 Reconcile Premium Tax Credit  You must enter your Modified Adjusted Gross Income  MAGI
    • IRS FAQ - What are the Income Limits
    • Covered CA online application asks for Tax Deductions ^{Email dated Wed 11/29/2023 8:54 AM}  Click on image to enlarge
• Question If your carry over net operating loss (from prior years) is allowed to be taken into account, is it part of the Federal Modified Adjusted Gross Income number ) or does California specifically require you to take it out of the equation?
  • Answer  Please see above  on the definition of MAGI Income. I’m not aware of states having any authority over your Federal Tax return.
    • Covered CA does not authorize agents to give tax advise. They suggest you get it from Volunteers at VITA.
    • Note that the Income Chart says FEDERAL Poverty Level!

    • ftb.ca.gov/net-operating-loss

    • irs.gov/publications/p536

    • Be sure to read everything 3 times and then when you think you understand it, read it again.

    • Do you really expect a clerk at Medi Cal to answer this kind of question?

    • We can help you with Covered CA when your income reaches 138% or more of FPL or if you go direct. Get quotes here. 

       

       

       

• MAGI details from a Higher Up at Medi Cal

  • Medi Cal agrees that MAGI can be negative and will educate the Counties...
  • Good afternoon Steve,Thank you for raising this issue with DHCS. Without a signed Medi-Cal Authorized Representative form MC 382 on file with the county or provided to DHCS, I cannot speak to any specifics surrounding a Medi-Cal case.However, speaking in general terms, when a case is escalated to DHCS typically we will do direct outreach with the county involved and Covered California (if needed). If training issues are identified such as incorrect information being provided, then training and resources will be provided.

    Additionally, DHCS has flagged “negative” reported loss income as a policy clarification area to provide further guidance on in future for counties, since it is not uncommon but can be a confusing area to make sure the information is captured correctly in the systems and the policy is clear.

    Thank you for raising this and helping identify this opportunity for improvement, and have a wonderful rest of your day!

  • Kathryn Floto, MPA | Health Program Specialist II
    Medi-Cal Eligibility Division
    California Department of Health Care Services

  • Good morning,

    For Modified Adjusted Gross Income (MAGI) Medi-Cal income and deductions policy, DHCS published All County Welfare Director’s Letter (ACWDL 21-04).

    Page 2, Section 1 provides guidance on policy for countable income for MAGI program calculation, which is federal taxable income minus any allowable (post-tax) deductions under federal code. Page 3 links to an Income and Deductions chart tool to determine if a post-tax deduction can be used for MAGI-based Medi-Cal and for Covered California eligibility. Please note that the chart and the Covered California website deductions are post-tax deductions, and pre-tax deductions are already included when calculating AGI.

    Tax loss is not considered an acceptable post-deduction for MAGI Medi-Cal or Covered California per federal code.  The Centers for Medicare and Medicaid Services (CMS) has also published a document detailing MAGI rules with deduction information on page 7.

    If the tax loss is considered as more of a capital gains/loss, or other loss such as real estate reported on Schedule E, then this amount should be entered into the system as an income with a negative (for example: -819,988).  This will tell the system the income is actually at a loss and will reduce the income.

    I would be happy to research your client’s case specifically if you can provide identifying information for me to look her up (name, DOB, SSN).  Please let me know if you or your client are interested and I can initiate a secure e-mail and send over appropriate documents to share private information for your client to fill out in order for me to share back any results.

    Thank you, and please let us know if you have any further questions.

    Kathryn Floto, MPA | Health Program Specialist II
    Medi-Cal Eligibility Division
    California Department of Health Care Services

Child - Subpages 

• 8962 Premium Tax Credit Reconciliation APTC Instructions
  • 1095 A, B & C & FTB 3895 Covered CA Statement of Subsidy & Proof of Coverage
• Age 65 – Can you get Tax Credits Subsidies Covered CA?
• Employer Coverage available? Updated rules – Family Glitch
• Premium Subsidy to 600% FPL
  • Mandate Penalty California – MEC – QHP – 5000 A
    • Employer Mandate for Health Insurance ACA 4980 h
      • 6056 – w -2 – spd etc Reporting
        • ERISA Employee Retirement Income Security Act — 1974
      • FTE – ALE Full Time & Equivalent Employees
    • Health Sharing Ministries – Not Protected by Insurance Guarantees

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