#Redetermination when Pandemic Ends
Medi-cal [Medicaid nationally] has not disenrolled anyone for say the past year and a half due to the COVID 19 pandemic. When the pandemic emergency is declared over it’s estimated that millions will lose coverage. Those whose incomes are over 138% of Federal Poverty level can get Covered CA, FREE QUOTES.
Learn More ==> Our webpage on Redetermination
Medi Cal Qualification under MAGI Income
For most individuals, Medi-Cal eligibility will be #based on your household size and your Federal MAGI – Income. Dhcs.gov * My Medi Cal * Western Poverty Law * If you have less than 138% of Federal Poverty Level, for children 266%, that’s it.
Medi Cal eligibility under Health Care Reform expanded is when you have family household income (MAGI) under 138% of Federal Poverty Level (subsidy income chart for ObamaCare) dhcs.gov for the parents and 266% for children and no more asset or means testing, there is no more estate recovery for health insurance.
If your children qualify for Medi Cal, and the parents for Covered CA – Private Insurance with subsidies you can now apply for both using the Covered CA online application Cbp.org page 65, with us as your agent at no additional charge, just follow these instructions, starting with find help in the upper right hand corner if you fill out the Covered CA application ONLINE, yourself.
If you are not applying for a subsidized private plan with us as your agent, no charge through Covered CA the easiest and fastest way to apply for or renew Medi-Cal is:
- Directly though your local county human service agency CA State wide listing
- Benefits Cal.org for all Welfare Benefits…
Please note that we can no longer do extensive research on Medi Cal questions as we are not authorized representatives for Medi Cal, nor do we get compensated one nickel for this website or our time. Please contact Medi Cal or your Medi Cal HMO directly. We will do research and education for a fee.
- Assets are no longer counted! VIDEO * Western Poverty Law Page 24 *
- Covered CA Income and FPL Federal Poverty Level Chart
- Covered CA Medi-Cal Overview
- There are nominal premiums for children if you’re at more than 160% of FPL DHCS *
- The County Children’s Health Initiative Program (C-CHIP) a health insurance program (Medi-Cal) that offers affordable and comprehensive medical, dental, and vision insurance for children age 0-19 who qualify. Qualification is in 3 Northern CA counties and is for those who are just out of the normal Medi Cal income limits 266-322% Federal Poverty Level (FPL).
- Learn more by clicking on the links below:
- InsureKidsNow.gov
- Health Care.Gov
- Medicaid.gov
- LA County.Gov
- Children’s Health Outreach
- cchi 4 families.org
- Disability Benefits 101 – Excellent explanation!
- Los Angeles ONLINE Enrollment – Contact Information for other counties
- Work Requirements?
- CHIP Children’s Health Insurance Program
- Hospital Presumptive Eligibility HPE
- Undocumented age 50 & over
- Learn more by clicking on the links below:
- The County Children’s Health Initiative Program (C-CHIP) a health insurance program (Medi-Cal) that offers affordable and comprehensive medical, dental, and vision insurance for children age 0-19 who qualify. Qualification is in 3 Northern CA counties and is for those who are just out of the normal Medi Cal income limits 266-322% Federal Poverty Level (FPL).
FAQ’s
How does Covered California work with Medi-Cal?
Covered California will act as a “one-stop shop” for health insurance. Through Covered California, you will be able to apply for Medi-Cal benefits electronically and receive a real-time eligibility results. You will also be able to report changes online and receive real-time customer support 24 hours a day. dhcs.gov More FAQ’s DHCS ♦ Insure Me Kevin.com
Disability Benefits 101 – Medi-Cal The Details
California Advancing and Innovating Medi-Cal (CalAIM)
Cal Aim is a long-term commitment to transform and strengthen Medi-Cal, offering Californians a more equitable, coordinated, and person-centered approach to maximizing their health and life trajectory.
Goals of CalAIM
1. Identify and manage comprehensive needs through whole person care approaches and social drivers of health.
2. Improve quality outcomes, reduce health disparities, and transform the delivery system through value‑based initiatives, modernization, and payment reform.
3. Make Medi-Cal a more consistent and seamless system for enrollees to navigate by reducing complexity and increasing flexibility. DHCS *
#Explanation from Western Poverty Law
Chapter 2. MAGI Medi-Cal Programs
1. Tax Filer Rules
2. Non-Filer Rules
3. Counting Households with a Pregnant Woman
B. Counting Income
C. MAGI Medi-Cal Programs
1. Expansion Adults
2. Parents and Caretaker Relatives
3. Pregnant Women
a. MAGI Medi-Cal Programs for Pregnant Women
b. Medi-Cal Access Program (MCAP) for Pregnant Women and Newborns up to Age 2
4. Children: MAGI Medi-Cal, the Targeted Low-Income Children’s Program, and MCAP Infants and Babies
a. Infants: 0 to 1 year old
b. Children: Ages 1 to 6
c. Children: Ages 6 to 19
Medi-Cal Eligibility Procedures Manual
https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/MedEligProcManual.aspx
Medi-Cal determines eligibility based on #monthly, not annual income.
Thus, even you you make $100k per year, but have a month with no income, you would qualify. This can even get you around the Open and Special Enrollment restrictions. That is, if you have a bad month, enroll, then when you get kicked out of Medi-Cal for making too much money, thank G-d, you have a special enrollment into Covered CA or direct with an Insurance Company. No extra charge for us to help you enroll in Covered CA! Insure Me Kevin.com * Western Poverty Law * DHCS ACWDLS * 2015 Medi-Cal Eligibility Division Information Letters (MEDILs) * 15-03 *
Plain English from Covered CA Broker Department Email
In regards to Medi-cal, they review monthly income.
So if a client has been making $2000 a month and they do a report a change and it goes now to $1000 a month for 1 person, they will now be eligible for medi-cal.
If the income goes back up to $2000 a month, they contact [report a change] Medi-cal and they are dis-enrolled from medi-cal and now are eligible for Covered CA. Response By Email (Argelia) (09/08/2016 11:56 AM)
FAQ’s on Monthly Income
Links & Resources
- Covered CA Agent Certification Circa 11.2013 Page 4 et seq
- Medi-Cal Info on Covered CA Website
- wikipedia.org on Medi Cal
- Medi Cal facts & figures 2019
- Medi-Cal Facts and Figures, 2019: Crucial Coverage for Low-Income Californians (PDF)
- Medi-Cal Facts and Figures, 2019 — Quick Reference Guide (PDF)
- Medi-Cal Facts and Figures, 2019 — Charts (ZIP)
- Mental Health
- Eligibility
- Payments to HMO’s
- Medi Cal budget
- Insurers make billions off Medicaid in California during Obamacare expansion LA Times 11.5.2017
-
ObamaCare – #Expansion to 138% of FPL
-
Utilizing Medi-Cal Expansion to Increase Health-Care Access VIDEO
#My Medi-Cal
How to get the Health Care You Need
24 pages
Smart Phones - try turning sideways to view pdf better
- Medi Cal Explained CHCF
- More
- Historical Guide 2006 CHCF 174 pages
- Cal AIM California Advancing and Innovating Medi-Cal — is a far-reaching, multiyear plan to transform California’s Medi-Cal program and to make it integrate more seamlessly with other social services. The goal of CalAIM is to improve outcomes for the millions of Californians covered by Medi-Cal, especially those with the most complex needs.
- Medi Cal Contact Information
- 10 Essential Health Benefits
- Our Webpage on Medi Cal Benefits
- Denti Cal
******************************************
- Western #Poverty Law - Exact Legal Rules on Coverage for Low Income Californian's
Nolo Social Security, Medicare, Medi Cal & Government Pensions
-
Our Webpage on COVID 19
- CA State Senator Steven Bradford 35th District
- His Webpage on COVID 19 Resources
-
BIC Benefits Identification Card
Medi Cal Contact Information
- Medi Cal Contact Sheet
- [email protected] regarding general Medi-Cal eligibility. If the question contains specific details the county or the district office that handles your case must answer.
- Medi-Cal Member & Provider helpline, at (800) 541-5555.
- California Department of Health Care Services 1-844-253-0883
- [email protected]
- [email protected] Ms. Leslie Benson
- IHSS In Home Supportive Services
- Direct Phone # for Medi Cal 866.613.3777 (Anthem Blue Cross?)
Ombudsman
- Ombudsman Webpage
- Phone: 1-888-452-8609
- Email: [email protected]
- The Office of Ombudsman cannot approve/terminate/reinstate Medi-Cal eligibility; alter aid codes, change/update addresses, change/update name or initiate inter-county transfers.
Complex Questions Assistance
- Health Consumer Alliance at 1-888-804-3536.
- Disability Rights California at 1-800-776-5746.
- Covered CA Facebook Page
- HICAP – Health Insurance Counseling & Advocacy Program
- CA Health Care Advocates – 1-800-434-0222 Volunteer counselors can help you understand your specific rights and health care options
- Medi Cal Consulting Services
- National Center on Law & Elder Rights - Case Consultation for Professionals
- VITA Volunteers Income Tax Assistance
- Medi Cal - Technical Comprehensive Reference Materials
- Our webpage on education, research & tutoring for a fee
- aging.ca.gov/Medicare_& Medi Cal Counseling
- Elder Care locator
Medi-Cal for All Children program
SB 75 Eligibility and [email protected]
Medi Cal - #County Office Lookup
See our Main Webpage on Medi Cal contact information
I applied for Medi-Cal but have not received any information from the county
When does coverage #start?
Medi-Cal will pay medical bills for 3 months prior to acceptance into medi-cal, but one must ask for retroactive coverage Western Poverty Law Center Page 5.211. * Excerpt of email from [email protected]
Note that you can get immediate confirmation of provisional Medi-Cal enrollment when you apply direct or through an agent – at no additional charge on Covered CA’s website. If you scroll down on the eligibility page and find it.
Other ways to get immediate medical care while waiting for your ID cards.
What should I do?
NEW information on Medi-Cal’s website for Pending Applications & Newly Enrolled
What if Medi-Cal took hold of my file, but say I don’t qualify, is there a lapse in coverage?
Will Covered CA backdate coverage?
If you have already applied, you do not need to apply again. Medi-Cal is processing your application as quickly as possible. Due to the large number of Medi-Cal applications received, processing is taking longer than expected, and proof of certain information is required in order to complete each application. Covered CA.com *
Pending Applicants
For those who applied and are likely eligible, but are waiting for their application to be finalized, there are ways you can get immediate care while you wait:
- You can go to a hospital for emergencies. The Hospital Presumptive Eligibility (PE) program provides adults, pregnant individuals, children, and former foster care enrollees with temporary, no cost Medi-Cal benefits for up to two months. In order to receive Hospital PE benefits, you must complete a simplified application online during a hospital stay. You will be notified immediately of your eligibility determination.
- You can visit your local county human services office. You can use your information to confirm your Medi-Cal eligibility and get a temporary identification card. This will allow you to get services until your enrollment is complete.
- Pregnant individuals can get temporary Medi-Cal coverage from certain Medi-Cal providers and clinics.
- Children can get temporary Medi-Cal coverage provided by enrolled Medi-Cal providers and clinics that see children.
Once your Medi-Cal eligibility is confirmed, the health coverage is effective beginning the first day of the month when you applied.
If you would like more information or to check the status of your application, please contact your county human services agency.
Covered CA Website Guidance
Medi-Cal Confirmation – Often As soon as you apply through Covered CA!!! ID card printing confirmed via email 4.23.2021
Direct with Medi Cal is faster
Covered CA says wait to hear from Medi-Cal
Eligibility Window & Where to click
Medi Cal Contact Information
- Medi Cal Contact Sheet
- [email protected] regarding general Medi-Cal eligibility. If the question contains specific details the county or the district office that handles your case must answer.
- Medi-Cal Member & Provider helpline, at (800) 541-5555.
- California Department of Health Care Services 1-844-253-0883
- [email protected]
- medi-cal201[email protected] Ms. Leslie Benson
- IHSS In Home Supportive Services
- Direct Phone # for Medi Cal 866.613.3777 (Anthem Blue Cross?)
Ombudsman
- Ombudsman Webpage
- Phone: 1-888-452-8609
- Email: [email protected]
- The Office of Ombudsman cannot approve/terminate/reinstate Medi-Cal eligibility; alter aid codes, change/update addresses, change/update name or initiate inter-county transfers.
Complex Questions Assistance
- Health Consumer Alliance at 1-888-804-3536.
- Disability Rights California at 1-800-776-5746.
- Covered CA Facebook Page
- HICAP – Health Insurance Counseling & Advocacy Program
- CA Health Care Advocates – 1-800-434-0222 Volunteer counselors can help you understand your specific rights and health care options
- Medi Cal Consulting Services
- National Center on Law & Elder Rights - Case Consultation for Professionals
- VITA Volunteers Income Tax Assistance
- Medi Cal - Technical Comprehensive Reference Materials
- Our webpage on education, research & tutoring for a fee
- aging.ca.gov/Medicare_& Medi Cal Counseling
- Elder Care locator
Medi-Cal for All Children program
SB 75 Eligibility and [email protected]
Medi Cal - #County Office Lookup
See our Main Webpage on Medi Cal contact information
Open the FAQ's below
Full CFR Regulations Medi Cal Eligibility
#CFR – Code of Federal Regulations
45 CFR 155.305 Eligibility Standards
- § 155.300 — Definitions and general standards for eligibility determinations.
- § 155.302 — Options for conducting eligibility determinations.
- § 155.305 — Eligibility standards.
-
(c) Eligibility for Medicaid. The Exchange must determine an applicant eligible for Medicaid if he or she meets the non-financial eligibility criteria for Medicaid for populations whose eligibility is based on MAGI-based income, as certified by the Medicaid agency in accordance with 42 CFR 435.1200(b)(2), has a household income, as defined in42 CFR 435.603(d), that is at or below the applicable Medicaid MAGI-based income standard as defined in 42 CFR 435.911(b)(1) and –
(1) Is a pregnant woman, as defined in the Medicaid State Plan in accordance with 42 CFR 435.4;
(2) Is under age 19;
(3) Is a parent or caretaker relative of a dependent child, as defined in the Medicaid State plan in accordance with42 CFR 435.4; or
(4) Is not described in paragraph (c)(1), (2), or (3) of this section, is under age 65 and is not entitled to or enrolled for benefits under part A of title XVIII of the Social Security Act, or enrolled for benefits under part B of title XVIII of the Social Security Act.
-
- § 155.310 — Eligibility process.
- § 155.315 — Verification process related to eligibility for enrollment in a QHP through the Exchange.
- § 155.320 — Verification process related to eligibility for insurance affordability programs.
- § 155.330 — Eligibility redetermination during a benefit year.
- § 155.335 — Annual eligibility redetermination.
- § 155.340 — Administration of advance payments of the premium tax credit and cost-sharing reductions.
- § 155.345 — Coordination with Medicaid, CHIP, the Basic Health Program, and the Pre-existing Condition Insurance Plan.
- § 155.350 — Special eligibility standards and process for Indians.
- § 155.355 — Right to appeal.
- SUBPART A — General Provisions. (§§ 155.10 – 155.20)
- SUBPART B — General Standards Related to the Establishment of an Exchange (§§ 155.100 – 155.170)
- SUBPART C — General Functions of an Exchange (§§ 155.200 – 155.285)
- SUBPART D — Exchange Functions in the Individual Market: Eligibility Determinations for Exchange Participation and Insurance Affordability Programs (§§ 155.300 – 155.355)
- SUBPART E — Exchange Functions in the Individual Market: Enrollment in Qualified Health Plans (§§ 155.400 – 155.430)
- SUBPART F — Appeals of Eligibility Determinations for Exchange Participation and Insurance Affordability Programs (§§ 155.500 – 155.555)
- SUBPART G — Exchange Functions in the Individual Market: Eligibility Determinations for Exemptions (§§ 155.600 – 155.635)
- SUBPART H — Exchange Functions: Small Business Health Options Program (SHOP) (§§ 155.700 – 155.740)
- SUBPART I — J [Reserved]
- SUBPART K — Exchange Functions: Certification of Qualified Health Plans (§§ 155.1000 – 155.1080)
- SUBPART L — [Reserved]
- SUBPART M — Oversight and Program Integrity Standards for State Exchanges (§§ 155.1200 – 155.1210)
- SUBPART N — State Flexibility (§§ 155.1300 – 155.1328)
- SUBPART O — Quality Reporting Standards for Exchanges (§§ 155.1400 – 155.1405)
- § 435.900 — Scope.
- General Methods of Administration
- Applications
- § 435.905 — Availability of program information.
- § 435.906 — Opportunity to apply.
- § 435.907 — Written application.
- § 435.908 — Assistance with application.
- § 435.909 — Automatic entitlement to Medicaid following a determination of eligibility under other programs.
- § 435.910 — Use of social security number.
- Determination of Medicaid Eligibility
- Redeterminations of Medicaid Eligibility
- § 435.916 — Periodic redeterminations of Medicaid eligibility.
- § 435.919 — Timely and adequate notice concerning adverse actions.
- § 435.920 — Verification of SSNs.
- Furnishing Medicaid
- Income and Eligibility Verification Requirements
Source:Sections 435.940 through 935.965 appear at 51 FR 7211, Feb. 28, 1986, unless otherwise noted.
- § 435.940 — Basis and scope.
- § 435.945 — General requirements.
- § 435.948 — Requesting information.
- § 435.949 — Verification of information through an electronic service.
- § 435.952 — Use of information.
- § 435.953 — Identifying items of information to use.
- § 435.955 — Additional requirements regarding information released by a Federal agency.
- § 435.956 — Verification of other non-financial information.
- § 435.960 — Standardized formats for furnishing and obtaining information to verifying income and eligibility.
- § 435.965 — Delay of effective date.
ONLINE Enrollment in Medi-Cal
How to VIDEO
#BenefitsCal is a one-stop-shop to apply for...
- Medi-Cal
- Medical Services
- CMSP (County Medical Services Program)
- GA/GR (General Assistance and General Relief )
- Cash Aid
- County Medical Services Program (CMSP),
- Food Assistance - Cal Fresh (formerly known as Food Stamps)
- How to use Eat Fresh.org VIDEO
- Cooking & Nutrition
- California Work Opportunity and Responsibility to Kids (CalWORKs) or check their other website
- Required Reporting
- Job Skills
- You Tube Channel Videos
#Covered CA Certified Agent
No extra charge for complementary assistance
- Appoint us as your broker
- VIDEO on ARPA Stimulus and more Covered CA Subsidies
- Set Consultation Meeting via Phone, Skype or Zoom
- Get Instant Health Quotes, Subsidy Calculation & Enroll
- Videos on how great agents are
- I'm in Sonia VIDEO
#Report changes as they happen - within 30 days! 10 CCR California Code of Regulations § 6496
10 days for Medi Cal 22 CCR § 50185
Our webpage on ARPA & Unemployment Benefits - Silver 94
IRS Form 5152 - Report Changes
- Our VIDEO on how to report changes to Covered CA
- Lost your job? How to keep your Health Insurance. Shelter at Home VIDEO
- References & Links
- Here's instructions, job aid, reporting change in income
- Our webpage on the exact definition of MAGI Income
- If you've appointed us - instructions - as your broker, no extra charge, we can do it for you.
- Voter Registration
- Task Guide Phone - Voter Registration
- Denial of benefits and possible criminal charges if you don't report changes in income!
- Fudging Income?
- Western Poverty Law on reporting changes
- How to cancel coverage.
- Visit our webpage on how to report changes
Medi-Cal and the Insurance Companies don’t pay agents, yet it’s just as time consuming and complex to help people with Medi Cal as a Covered CA or direct plan!
Here’s links on why Government workers are lazy:
stable-government-jobs-promote-laziness/
public-service-not-regular-job/
/why-government-workers-are-harder-to-motivate
my-lazy-summer-public-employee
confessions-overpaid-lazy-entitled-public-servant
Life+of+a+government+employee
how-federal-workers-became-new-welfare-queens
If you like waiting on hold with Covered CA – Stay there. If you would like to just send an email and I’ll take care of it, appoint me as your agent and I’ll see what I can do.
We’ll be in touch in the future if, as we hope, we can make enough money to get back on CC.