How and when to report changes  of income, address, etc. to Covered CA and/or Medi Cal

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Covered CA Member’s  #Duty to Report Changes in Circumstances

• An enrollee, or application filer on behalf of an enrollee, must report any change of circumstances with respect to the eligibility standards within 30 days of such change. An enrollee, however, who has a change in income that does not impact the amount of the enrollee’s Advance Payments of Premium Tax Credit (APTC) or the level of Cost-Sharing Reduction (CSR) (See income chart or get a quote)  is not required to report such a change. ^{cdss.ca.gov/shd/res/htm/ParaRegs-Covered-California.htm *   (45 C.F.R. § 155.330(b);  *  10 CCR California Code of Regulations § 6496}

§ 6496. Eligibility Redetermination During a Benefit Year.

• (a) The Exchange shall redetermine the eligibility of an enrollee in a QHP through the Exchange during the benefit year if it receives and verifies new information reported by an enrollee or identifies updated information through the data matching described in subdivision (g) of this section.
• (b) Except as specified in subdivisions (c) and (d) of this section, an enrollee, or an application filer on behalf of the enrollee, shall report any change of circumstances with respect to the eligibility standards specified in Sections 6472 and 6474 within 30 days of such change. Changes shall be reported through any of the channels available for the submission of an application, as described in Section 6470(j).
• (c) An enrollee who has not requested an eligibility determination for IAPs shall not be required to report changes that affect eligibility for IAPs.
• (d) An enrollee who experiences a change in income that does not impact the amount of the enrollee’s APTC or the level of CSR for which he or she is eligible shall not be required to report such a change.
• (e) The Exchange shall verify any reported changes in accordance with the process specified in Sections 6478 through 6492 before using such information in an eligibility determination.  ^{Cal. Code Regs., tit. 10, § 6496, subds. (b), (d).)}
• coveredca.com/changes
• healthcare.gov/report-changes
• Our webpage on padding income or deductions
• We can’t give legal advise
• Can’t give tax advise
• Shouse Law on fraud  

Definition of change

1a: to make different in some particular : ALTER never bothered to change the will
b: to make radically different : TRANSFORM can’t change human nature
c: to give a different position, course, or direction to changed his residence from Ohio to California Webster

Learn More about Medi Cal Fraud

MAGI Modified Adjusted Gross Income  Definition and where to find it 

Estimating Income

Tons of FAQ’s #about estimating Income

• Our combined household income will put us over the limit to qualify for any subsidy. I’m ok with paying out of pocket full premium but this article seems to make even that impossible.
  california healthline.org/this-family-says-no-to-medi-cal-but-a-computer-wont-listen/
• Is this still an issue since the article is from 2016 ? Or do I need to buy insurance directly from insurers rather than on covered CA. Would that fix the problem?
  • Did you check the income chart? Two people would be $100K
  • Please use our quote engine cited above.
  • What Special Enrollment Reason will we use?
  • There is a Special Enrollment for those who don’t have coverage due to COVID 19. We might be able to do that.
  • It’s my understanding only Covered CA has the Special Enrollment for COVID 19. I can double check.
  • Our webpage on Insurance and COVID 19.
  • Our webpage for Health Net PPO & HMO Individual
  • Our webpage on dual coverage.
• Yes income is much higher than that so I’m sure we won’t qualify for subsidies.
• When I enter our ZIP code on covered CA the health net plan doesn’t show up. So I believe I’ll have to buy it outside covered CA.
• Does special enrollment apply to health net plan purchased directly through them as well?
  • Please use OUR quote engine, so that we can follow what you are doing. Also, we only get compensated if you purchase through our affiliate link, no extra charge.
  • We do not accept hearsay. We need to see the exact stuff!
  • Covered CA not Health Net pay us for our second to none website. Nor for the time it saves their personnel on the phone.
  • Here’s our online enrollment link and quoter for Health Net.
  • Yes, since everything under ACA/Health Care Reform/Obamacare is guaranteed issue, no pre-x, you can only buy at Open or Special Enrollment. Not when you get diagnosed with cancer and have MAJOR bills ahead!
  • If you can get Medi-Cal to disenroll you, that would be a special enrollment for loss of coverage.
  • Here’s an excerpt of Health Net’s bulletin about the COVID 19 special enrollment
  • Here’s what you need to know about the SEP:
    • Any uninsured individual or family can use this SEP to apply for 2020 health coverage.
    • This SEP is for new enrollment only and not available for plan changes.
    • To enroll in one of our off-exchange plans, go to http://www.myhealthnetca.com. Proof of a qualifying event is not needed to enroll under this SEP. You may also use the existing 2020 IFP enrollment forms to apply by mail.
    • Effective dates of coverage are:
    Enroll by Effective date
    May 31 June 1, 2020
    June 30 July 1, 2020
  • • After June 30, 2020, the regular special enrollment period qualifying events apply.
    • First month’s premium payment is required to activate coverage.
    • The impact of COVID-19 on small businesses may be causing some people to lose employer based health coverage. Individuals can use this SEP to enroll with Health Net to regain health coverage.
  • So, it looks like, if you take your Mom as a dependent, Medi-Cal will kick you out.
  • Then you would have a special enrollment period for loss of coverage.
  • Here’s a list on Stanford’s website of the plans they take.
  • Please use OUR quote engine so we can properly consult with you.
  • Medi Cal Plans
  • Santa Clara Family Health Plan
  • Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.
  • In order to be seen at Stanford Health Care, your primary care physician would need to refer you and your medical group or health plan would need to authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.
  • Our webpage on appeals & grievances
  • Santa Clara Family Health Plan Medi Cal Website
  • Member Handbook
  • See page 36 for information on getting a second opinion
• I have been looking online for some answers and I hope that you guys can help
• I live far away from town and have not yet filed for a 1040 Tax return I never filed a tax return last year either
• I do not work I haven’t for quite some time but I am on record the secretary for a non-profit company I’m not too sure if he has filed anything.
• Will not filing a tax return affect my Medi Cal application for claiming my daughter as a dependent.
• I am not married I am single. I have enrolled into medi-cal when I was pregnant
• I had gotten food stamps and CalWORKs 4 maybe 5 months
• I do not get that anymore.
• Does that affect my tax return as well.
• I have a daughter and people were telling me that I should have filed for a return for a dependent for this year and last year
• I do not know the process and how this works
• so please give me a call or email at your earliest convenience
• hopefully you guys can help thank you have a good night
  • It sounds to me like you have zero income. Thus there is no mandate to file a return. Here’s the IRS tool to determine if you need to file a return. Here’s a website that says if you are head of household, you don’t need to file a return if you earn less than $18k.
  • I’m not authorized to give you tax advice. Try VITA.
  • I don’t listen to “what other people say.” Yes, it’s cost me friendships and people in charge or think they are in charge don’t like it, but the law is the law and what is right is right, not just because something was given some authority somewhere or they were told by an expert…. One needs to actually read the law 3x, then when you think you understand it, read it again.
  • Medi-Cal beneficiaries are not required to file a federal income tax return and many Medi-Cal beneficiaries have household income well below the minimum income level at which a U.S. citizen or resident must file an income tax return. Some beneficiaries may still choose to file taxes to collect other federal tax credits. With the implementation of the Modified Adjusted Gross Income (MAGI) income counting methodology, this has been a source of confusion for some county eligibility workers.
  • However, Medi-Cal does not require applicants or beneficiaries to file taxes and, in fact, has special “non-filer” rules for determining the household size for those who do not file taxes. Copied from Western Poverty Law
  • Did you need term life insurance, see above for quotes.
  • Are you getting alimony or child support?
  • Have you been asked to Redetermine?
  • If one no longer has his job and expects his income for this year to be low (pursuing a new self-employment business) and thus qualify for Medi-Cal, how can one prove this in applying in order to be accepted for Medi-Cal. (The tax returns would show too much income from the previous year in order to qualify.)

    • See our web pages on

    • accepted proofs of income
      proof-income-accepted-documents/

    • Then scroll down and get more details on:

    • Business records such as profit and loss statements

    • Excel Template
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    • Self employed Health Insurance Deduction

    • Home Office Deduction

    • Computing Subsidies and Health Insurance Deduction

    • Premium Subsidy reconciliation – it’s not what you made in 2019, it’s what do you expect to make in 2020!

    • Be sure to report changes in income within 10 days.

    • There might be criminal penalties if you don’t!

• I have a part time job and earn less than $2k/month, do I still qualify for Medi-Cal? I have over $3k in assets, is that relevant to getting Medi-Cal?
  • See our income chart or use the instant quote calculator.
  • We need an actual # for your income. If you are single, if you earn over $17k gets you Covered CA subsidies. Medi Cal is if you are less than $17k. So, telling us under $2k means nothing.
  • There is NO Asset test for MAGI Income Medi-Cal qualification.
  • If you earn more than Medi Cal Limits 138% of income, do you have to repay the premiums that Medi Cal paid to the HMO, if you didn’t tell Medi Cal that you were earning more?
  • Usually no. Learn More @ Insure Me Kevin.com
• Can I get Medi-Cal if I get  unemployment?
  • Qualifying for MAGI Medi-Cal a function of the number of people in your family – tax return and your expected MAGI income for the current tax year.
  • Please use our complementary subsidy, premium and benefits calculator   and then we can help you better.
  • Medi-Cal has year around enrollment.
  • Please review the special enrollment qualifications.
  • There used to be temporary plans and Mr. Mip, which is minimum essential coverage and covers pre-existing conditions.
• I’m on Medi-Cal as I have no income. I just turned 65.
• Did I have to apply for Medicare A Hospital?
• Part B Doctor Visits?
• I can’t afford the $135/month premium.
  • Yes, I believe so. Please note that I’m not an authorized Medi Cal agent or employee. Contact Medi Cal to double check, they make excellent salaries with benefits and vacations and are paid to help you.
    • adults aged 19 through 64, who are not pregnant, not eligible for Medicare, and with incomes below 138% of the FPL became eligible for Medi-Cal as of January 1, 2014 – the start of ACA/Obamacare.
    • Here’s my research:
    • Beneficiaries who turn 65 while they are enrolled in Medi-Cal as an Expansion Adult must be evaluated for eligibility in all other Medi-Cal programs, i.e., non-MAGI programs such as for the aged, blind or disabled, before they are disenrolled.  Citation Western Poverty Law Page 2.36
  • Here’s the link to Enroll in Medicare
  • Once you get Medicare A & B we can set you up with a Medicare Advantage Plan with Blue Shield, AARP or Blue Cross. Most of these plans have ZERO premium and all include Part D Rx.
  • You can pay your Part B Hospital premium of $135 from Medicare from your Social Security check.
• I got a new job in April. My company will be offering me health benefits starting in June. But job is not certain, they might let me go anytime.  1. What do you recommend regarding Medi-Cal? 2. can i continue with Medi cal? 3. if i cancel medi cal do you think if i loose my job i will be again eligible for the medi cal?
  • Glad to hear you got a new job with benefits.
  • 1. Medi-Cal and Covered CA require that you report changes within 30 days, here’s the instructions.  Do you have a Medi Cal ONLINE account?
  • 2. If your income is below 138% of poverty level, I guess you could have both Medi Cal and your Group Coverage. Here’s information on dual coverage.
  • 3. Yes, depending on your income. If you lose your job, report that to Medi-Cal.
  • I don’t get paid to help the public with Medi-Cal. Here’s their contact page.
  • If the Company you worked at got bought out by another company, and your status changes from contractor to full time employee, are you still eligible for Medical [Medi-Cal] if you can’t afford the premiums or out of pocket [deductibles, co-pays] insurance plans they offer, based on your annual [MAGI} income?
• My position is outside sales, with a home office, now I am having even more expenses than before, due to the new company’s contract. I can not afford what they offer in regards to healthcare coverage.
  • If you qualify for Medi-Cal is based on your MAGI income being above or below 138% of Federal Poverty Level FPL. In 2018 for a single person that would be $16,644, see chart.
  • If your income is between 138 and 400% of FPL, you can probably get Covered CA subsidies to help pay your premium. Use our complementary instant quote engine to find out.
  • Your statement about affordability of health insurance premiums for your employers plan has to do with getting Covered CA subsidies, not Medi-Cal. Basically, it depends on if the premiums are more or less than 9.66% of income. We deal with the affordability issue for Covered CA subsidies on this page.
• Kentucky Gets exemptions so that they can require Medicaid recipients to work modern health care.com   La times latimes.com/
• I am 70 years of age and have been on medi cal due to low income. I recently applied for my ex husbands social security and my income increased to $1379.10. Can I still qualify for medi cal?
  • ***We are setting up a new page to discuss Medi-Cal Qualification for Seniors. Please click and visit us there.
• I am single, and unemployed.  In January 2021, I made over $100k from a stock sale. For the rest of the year, I will make around $1,200/mo. Question:  Is it my annual income or my current monthly income ($1,200/mo) that determines Medi-Cal eligibility?  My annual income will be large because of the stock sale in January 2021.  However, my current monthly income is low.  Am I eligible for Medi-Cal?
  • That’s what our webpage and citations say. I’m not an authorized Medi Cal agent, nor am I compensated to help people with Medi-Cal. So, just enroll online here.
  • Check back around April 14, when we have all the information on ARPA COVID Stimulus... things might change?
  • Did you want to look at Long Term Care, Life Insurance, Medicare, etc?
• FAQ’s on Premium Subsidy & Projected Income
• I am not getting APTC, and will get PTC next year, at tax time,  does it matter what I make monthly; in other words, if one month I make under $1,833, is that relevant?
  • ***I understand how confusing it is, especially when Covered CA asks so many questions about monthly income.  The point is when you file your taxes, what goes on line 37* Magi Income.
  • Although, Medi-Cal wants to write everyone and their calculations are based on monthly. only the annual sum is important.
  • ***Right. See MAGI Definition   monthly under 1833 for the month.
• ***Please talk to me in the bottom line MAGI income for the end of the year.    I don’t know how many are in your household.  Now I have to multiply 12 x $1,833 = $21,996 if you have a household of 2 it’s borderline, but you are right, that would put you in Medi-Cal.
• Should we make it a point to have at least that much monthly income for the remainder of the year?
  • ***The monthly amounts are all hocus – pocus with smoke and mirrors.   What counts is the annual.  Please use our quote engine and see what happens with your income on an annual basis.  Some people at Medi Cal might disagree.
  • Did you want to look at getting Enhanced Silver – Cost Sharing Reductions?
• Do you sell health insurance not run through covered california?
  • ***Yes.   Get quotes here.  If you want the subsidy though, you must have Covered CA.   Click here for instructions on how to appoint us as your agent, no extra charge.   Did you like our answer better than calling Covered CA?
• income from the IRA – Annuity,
  • ***Line 15 A of the 1040
• Are you saying that I would drop into Medical [Medi-Cal] if the monthly income dropped below $1,833 for the next month or even four months, despite the fact that the annual quota has already been surpassed.
  • ***No, not at all.   It’s all annual MAGI.  This monthly is for people who want subsidies and can’t figure out the annual amount they will put on line 37*   Medi-Cal does want to write everyone and not let them out.
• You said the annual income is what matters,
  • ***Right.  But please do not quote me.  I only read the official IRS publications, namely publication 974 and  Covered CA bulletins.
  • but the part I described above and your response confused me. Are you saying that the annual is what matters as long as you make a minimum of 1833 for each month of the year?
  • ***Yes.   Please, forget the monthly amount.  It’s just crap for those who can’t figure out what their MAGI* incomewill be on line 37.
  • How about appointing us as your agent so that we can get paid to help you.   Sure, Covered CA says find free help, but it’s not free.  It’s slave labor until I get appointed.  There is no extra cost to you.
  •  
• Since you are not taking the advance premium tax credit and if I understand you correctly, are not taking it in advance next year, just put that down and you shouldn’t have to enter an income amount.
  • ***Please use our quote and subsidy calculator.  You will note, it only asks for annual income.
• As I understand it, insurance sign up starts in November.
  • ***Right, now it’s October for a January effective date.
• I have not gotten a subsidy this year, because my projected income is above 63k.
  • ***That’s what the chart shows for a household of two, but it’s best to get a complementary quote and subsidy calculation.
• I did not want to drop into medicare [Medi-Cal] if I made less than $1,833 in a month).
  • ***MAGI Income is ANNUAL – what shows on line 37 of your 1040.
• MAGI Income – Medi-Cal Qualification?  However, I definitely do not want APTC. [Advance Premium Tax Credit]
  • ***That’s what the brochures on the above right and on this page talk about.  Take the credit now or later?  If your income drops below $34k you may qualify for Enhanced Silver Cost Sharing Reductions.
• If I renew for CC in November and I indicate that I don’t want APTC, would I still have to provide a breakdown of projected income, along with documentation?
  • ***No, note the new rule I just found that says Covered CA – the Exchanges MUST vette everyone who asks for Premium Credits.  (42 U.S. Code § 18081  * CFR § 155.320)
• When you asked if I would give up the subsidy, did you mean APTC, or do you mean the PTC that one gets as a refund on taxes.
  • ***You have to stay in Covered CA to get either subsidy.
• Does one have to fill out the financial part of the [Covered CA] application for next year in order to get the PTC on the tax refund following the benefit year?
  • ***Yes, as Covered CA must vette everyone under 42 U.S. Code § 18081  * CFR § 155.320
• Again, I have heard different opinions on this.
  • ***That’s because very few people actually read the CFR’s, actual IRS documents and the documents don’t always refer to the other relevant rules, codes & laws. Check our main page on take it (APTC or PTC)  now or later.
• I was temporarily laid off on March 30.  My income is low and I might be eligible for Medi-cal. Could you look into it for me, please.
  • We had a question just like this a week ago. Please click on the following link, review that and if you have any further questions, ask on the relevant page.
  • If you want us to put in into Medi Cal, where we don’t get paid to help you, we will do that, as you’ve been a client. Please send us a “clear” email as to what your income is, and what you want us to report to Covered CA, under penalty of perjury.
  • Don’t forget, unemployment is taxable.
  • The Feds have a bill pending to pay 100%!
  • As, you’ll see on the Q & A for the other similar question, once you get into Medi Cal, it’s very difficult to get out.
• I’m a real estate agent and my income fluctuates. So, I read the above, but didn’t click on the links – citations. Are you sure the law says monthly?
  • Monthly vs. Annual income: MAGI Medi-Cal rules allow counties to base eligibility on monthly rather than annual income. If an applicant provides both monthly and annual income, counties are instructed to divide the annual income by 12, compare it to the monthly amount also provided, and use the lower of the two amounts Western Poverty Law
  • if the individual’s current monthly income is lower than the projected annual income divided by 12, counties should enter the current monthly income.dhcs

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