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:

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.

#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  

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

FAQ’s on Start Date

Covered CA Start Date – Conditional Eligibility 

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.

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 CAResponse By Email (Argelia) (09/08/2016 11:56 AM)

FAQ’s on Monthly Income

 

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

Medi-Cal Confirmation - As soon as you apply through Covered CA!!!

Covered CA says wait to hear from Medi-Cal

Covered CA says wait to hear from Medi-Cal

Eligibility Window & Where to click

Eligibility Window & Where to click

Medi Cal Contact Information

#Email  Addresses & Phone #'s: 

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

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

Medi Cal Contact Information

#Email  Addresses & Phone #'s: 

Ombudsman

  • Ombudsman Webpage
    • Phone: 1-888-452-8609
    • Email:   [email protected]ca.gov 
      • 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

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

#CFR – Code of Federal Regulations

Open the FAQ's below
Full CFR Regulations Medi Cal Eligibility

#CFR – Code of Federal Regulations

45 CFR 155.305 Eligibility Standards

 

 

ONLINE Enrollment in Medi-Cal
How to VIDEO

benefits Cal

 

#BenefitsCal is a one-stop-shop to apply for...

Covered CA Certified Agent

#Covered CA Certified Agent  

No extra charge for complementary assistance 

I'm in Sonia

 

Much more on Medi Cal

 

 

******************************************

Western Poverty Law - Insurance for Low Income

Advocate Guide to Medi Cal 

advocate guide to Medi Cal

Nolo Social Security, Medicare, Medi Cal & Government Pensions

nolo social security government pensions

 

FAQ’s “C-CHIP County Children’s Health Initiative Program”

  • I am a (the?) legal guardian of my Great Granddaughter.  She receives benefits from Social Sec. since her Mother is deceased. I need to get her covered with health insurance, but I don’t know were to apply. Every time I try, They ask for my information I’m on Medicare and I don’t want to change it. I’m 70 years old.  Can you please help ?.
    • First – Enter yours and your great granddaughters information here and get a quote. What is their your family MAGI income?  Does your great granddaughter live with you?  Are you taking the deduction for her on your tax return? See the household definition chart.  Once I know yours and their income, I would be able to tell you if you go Medi Cal, it’s a function of Income, see chart, where I don’t get paid to help you or Covered CA where if I’m lucky, I get minimum wage. They are asking for your information, as their qualification for Medi Cal or Covered CA is a function of Household income.  You will still stay on Medicare!  Here’s the ONLINE application  Medi Cal.
  • MY TWO CHILDREN ARE eligible FOR C CHIP PROGRAM, BUT I AM UNABLE TO GET THROUGH TO GET THEM REGISTERED IN THE PROGRAM.  I WAS NOT ABLE TO SPEAK TO ANYONE THat MAde SENSE. COVERED CAL. TOLD ME TO TALK TO CCHIP, CCHIP TOLD ME TO TALK TO COVERED CA. PLEASE HELP!
    • We don’t get paid to help people enroll in Medi-Cal, so this would be pro-bono for us.  Please appoint us as your Covered CA agent – Instructions – or just call them and have us appointed. My guess is, that you don’t have your ducks in a row, to show the proper income levels. What have you filed?  How about going ONLINE and completing the paperwork?
  • 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
  • What is ​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 C​alAIM​
      • 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 *
  • why doesn’t medi-cal really help? So long on #hold, so much wasted time?

Effective Date? Temporary Instant ID Card”

  • I have dropped my coverage from Blue Shield since my income this year has been $0. I haven’t worked since I was laid off last year.  I want to move over to medi-cal but I can’t get an application started on account that LA County has me on “pending” for medi-cal. I have been ‘pending’ for a year and a half.  I haven’t lived in Los Angeles for a year now. I’m up in Lake County and there medi-cal office says they can’t do anything until LA drops my medi-cal application– that I never put in.  Do you know who I need to get a hold of in order to resolve this?
    • Try the instructions on our Los Angeles Medi Cal webpage
      https://medi-cal.healthreformquotes.com/contact-info/enroll-online-los-angeles/
    • Try the contact people and departments on this page
    • https://medi-cal.healthreformquotes.com/contact-info/
    • You might also try going into your Covered CA account and changing your address or call Covered CA 1 800 300 1506
      As an agent, I’m not excited about doing all the extra work, as there is no compensation to assist with Medi Cal.
  • I have tried to change my address 4 times online and have talked to a covered California Representative 3 times and the medi-cal rep of Lake County once without change.  I don’t understand why this would be made so difficult.
    • I sent you a video and a screen shot that I completed the change of address and income for you.
  • Covered CA wants proof of income
  • President Trump said Insurance was very complicated and no one knew that it was, he should have asked me.  VIDEO
  • Steve’s educational background
  • Learn more about Conditional Eligibility

44 comments on “Medi-Cal – MAGI Income Eligibility Criteria

  1. https://www.dhcs.ca.gov/CalAIM/Pages/calaim.aspx

    ​California Advancing and​ Innovating Medi-Cal (CalAIM) 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 C​alAIM​
    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.

  2. 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?

    REPLY

    See our webpage on Capital Gains and Carry Over Losses

  3. Medi-Cal is California’s Medicaid program, which provides health insurance to individuals and families who earn low incomes, including 40% of the state’s children, half of Californians with disabilities, and over a million seniors. In total, the program covers more than 12 million people, or nearly one in three Californians.

    Medi-Cal also covers a large number of working Californians, many of whom became eligible for the program because of the Affordable Care Act’s Medicaid expansion. Working Californians may be one of the least recognized or understood populations served by the program. In a 2018 poll, 42% of Californians said that they believed that most working-age adults without a disability enrolled in Medi-Cal are unemployed. Twenty percent said they didn’t know. This report combines key findings from survey data with insights from 19 in-depth interviews with enrollees to paint a more accurate and complete picture of working Californians who rely on Medi-Cal, why they came to enroll in the program, and the role it plays in their lives.

    The report is accompanied by video stories from a few working Californians who participated in the in-depth interviews

    https://www.chcf.org/publication/working-californians-enrolled-medi-cal-stories/

  4. My family is receiving medi-cal in California due to low income.

    If I sell my house, will that disqualify me for medi-cal for that year only or will it disqualify me longer?

  5. I am on Medi-Cal ( CA medicaid) as an “expansion adult” qualified based on MAGI.

    I am turning 65 next week so supposedly my MAGI eligibility ends right then but I haven’t received any “dis-enrollment” or “recertification” notices.

    So I wonder how that works and for how long I am “safe”… That would affect when I want my medicare to start.

    • Hi Steve,

      Confusion about MAGI Medi-Cal.

      For those young adults who are healthy, not pregnant but have no income goes into the MAGI Medi-cal file.

      Although the asset test is said to be no longer required, why do case workers still ask for bank statements and questions about personal assets?

      Are they confused?

  6. Hi Steve,

    I have a Medi-Cal question you might be able to answer or point me in the right direction.

    My wife and I have an adult son with various medical problems. He’s on Medi-Cal since his MAGI is below the limit because he can work only part-time due to his health. So he can’t support himself alone.

    He lives with us and we feed him.

    However, he files his own income taxes, meaning we don’t have him on our return as a dependent.

    Nonetheless, is our financial support somehow jeopardizing his Medi-Cal eligibility?

    Thank you for being generous with your time and knowledge.

    • I’m not familiar with Medi Cal benefits, simply because a parent passed away.

      Please advise what program that is.

      If you only have private documents from Medi Cal or Social Security so stating, please send that to me privately at [email protected]

      If what you mean is, the income for you and the child is below 266% of Federal Poverty Level Chart or $45k for a family of two, then the child would qualify for Medi Cal. Family of 3 $57k.

      Family Size basically goes by whose on the tax return. For Covered CA and I presume Medi Cal, married persons must file jointly.

      So, please respond anonymously with yours and your “fiances” income and I’ll look at the charts for you…

  7. I have too much money in my bank account assets to qualify for Medi-Cal, but I don’t make enough to qualify for Covered CA subsidies. What can I do?

    • There is no longer an asset test for Medi Cal. You need to earn at least $17k to get subsidies with Covered CA. Click here to enroll in Medi Cal in Los Angeles County https://medi-cal.healthreformquotes.com/medi-cal-introduction/enroll-online-los-angeles/ I don’t get paid to help you enroll or to answer questions.

      https://wclp.org/wp-content/uploads/2016/06/Western_Center_2016_Health_Care_Eligibility_Guide_Full_rev.1.pdf#page=4

      H. Assets or Resources

      In an effort to simplify program rules, the MAGI methodology does not consider assets or resources other than income. Thus applications for MAGI Medi-Cal, MCAP, and Covered California do not have any questions about bank accounts, homes, cars, property, etc.

      On the other hand, most non-MAGI programs that count income still have limits on what resources an individual may have besides income to qualify for MediCal. However, like everything else with the non-MAGI programs, the rules vary by program.

      For example,

      the Medicare Savings Programs (QMB, SLMB, etc.) have a countable resource limit of $4,000 for an individual and $6,000 for a married couple, while

      the 250% Working Disabled Program has a resource limit of $2,000 for an individual and $3,000 for a couple.

      In general, non-MAGI programs that do not count income, such as the program for Former Foster Youth or the Minor Consent program, do not look at resources either.

  8. Thanks Steve – much appreciated. Two more questions regarding your answer:
    At 55 can medical seek premiums from an estate that I am a beneficiary?
    Are interest or dividends that are received within a ira considered untaxable intrest/dividends, and therefore added to MAGI?

    • I don’t think Medi-Cal would have a lien of what you inherit. Their lien would be on what remains in your estate when G-d forbid, you pass away.

      On my estate recovery page I’ve done say 20 hours of research putting together the links and information. I’m not an attorney, so I suggest you contact one or read through all the links and brochures that I’ve thought were good enough to make it to my website.

      IRA interest is also tax exempt until you withdrawn the money. I’m not a CPA and don’t know your full situation. Learn More ===> IRS Publication 590

  9. I’m a 45 year old male who is single and on medi-cal. I have a Roth worth $11,000 and a car. My earnings this year will be $20,000 approximately. If I contribute $5,000 to a traditional IRA this year to bring my MAGI to below 138% of the poverty level, will I be able to requalify for Medi-cal?

    • Assets are no longer a factor in MAGI based Medi-Cal qualification. An IRA deduction on line 32 of your 1040 would lower line 37 which is the basis of MAGI income, as most taxpayers don’t have foreign income, social security or tax exempt interest to add back in.

      Please be sure to double check with competent tax counsel, the answer appears to be yes.

      On the other hand, you are nearing age 55 at which point, the Medi-Cal premiums can be deducted from your estate.

      Is there any way you can look for a better job or take another part time job to get your earnings up?

      Send us a private email, we can help you set up your IRA.

      • Using the link in the upper right-hand corner and getting a free quote and subsidy calculation you may find that covered California with subsidies will look very appealing

      • Thanks Steve – much appreciated. Two more questions regarding your answer:

        At 55 can medical seek premiums from an estate that I am a beneficiary?
        Are interest or dividends that are received within a ira considered untaxable intrest/dividends, and therefore added to MAGI?

        • I don’t think Medi-Cal would have a lien of what you inherit. Their lien would be on what remains in your estate when G-d forbid, you pass away.

          On my estate recovery page I’ve done say 20 hours of research putting together the links and information. I’m not an attorney, so I suggest you contact one or read through all the links and brochures that I’ve thought were good enough to make it to my website.

          IRA interest is also tax exempt until you withdrawn the money. I’m not a CPA and don’t know your full situation. Learn More ===> IRS Publication 590

  10. This is a lady who was in a major car accident. Her Father called and we set her up with coverage through Covered CA where I did get a measly commission. She flat out accused me of fraud, lack of integrity, criminal motive, etc. for not putting her into no premium Medi-Cal! Thus, we don’t do coverage for competent adults through 3rd parties. Yes, it’s a quandary, as she wasn’t competent at the time.

    Hello Mr. Shorr,

    I wanted to tell you I’ve two modes of resolution now for the dilemma I’d been fighting w/BS thru Covered CA. First and this was my initial thought I should have just done on the outset was dispute the charge with my bank. They gave BS what they were owed and returned my overpayment to me immediately as I’d proof I no longer had need for their service and was being enrolled in Medi-cal. It took about ten minutes and I already have my money back.

    After spending twenty days and three hours on the phone (mostly holding or educating inexperienced employees) the resolution Blue Shield sought was simply finalizing enrollment in Medi-cal. The Medi-cal Ombudsman had told me to bring my issue back to the county and ask for a hearing and all this run around and I threatened them with a lawsuit so they called me somewhat immediately at least ten times. I’d not answered any of the calls as the caller ID was blocked and so I’d not answered the phone. I couldn’t figure out who’d be so rude to call and not leave a message so many times that I finally answered the call mostly as I wasn’t on another call. Every other time they’d called I was already on with one agency or another getting nowhere. The unknown caller was the actual Ombudsman who said they couldn’t help me and again said to file for a hearing at the county. Then she’d noted I’d not enrolled in Medi-cal yet and I told her in response I’d had no time. She said well let me at least do that for you. I chose the same Medi-cal program as my son and immediately everything fell into place. A letter was issued to Blue Shield with correct ending and beginning dates (that would initiate a refund if appropriate) and I’d met the 20 Sept deadline so I wasn’t just thrown into an unknown plan. All that was required to activate the refund. It’s likely that tomorrow on the deadline it would have also been “magically” solved yet I likely would not have known why if the Ombudsman had not told me all that completing enrollment would entail and not realizing herself that she’d issued the statement to Blue Shield that they’d been awaiting and I’d asked for… It’s almost too crazy to believe…

    There are so many gaps in these systems and so many people who don’t understand what they’re supposed to do or what they are doing yet their actions often lead to success unknowingly and it must happen often enough that I’m rare if not the only one who had to suffer for weeks all because I’d not had time to phone and select a plan out of all the horrible plans they offered as I was trying to gain a refund first and the clock kept ticking. I don’t really care what I choose as I’m going to keep paying to see my neurologist in cash and only want my medication to still be covered by insurance as it’s quite expensive.

    I realize you don’t wish to work in this area any longer yet it’s possible you may encounter this in a transitional phase. Please note if any of your customers had other insurance they must complete signup in every way to close out the current coverage that then initiated a number of automatically generated forms and communications. The same is true for people on Medi-cal who seek different insurance if they’re able to afford it. Someone must finish the entire enrollment process completely or Medi-cal won’t terminate itself even though a refund wouldn’t be an issue in that case. I won’t likely be needing nor receiving anything from Blue Shield as my bank paid for August and I’m enrolled retroactively so I owe them nothing for Sept. Amazing that no one knew this. Amazing that no one else asked me to complete enrollment given that the deadline is tomorrow. I was only made aware of it yesterday. Thought it might be of some value as this wasn’t a minor undertaking.

    Jennifer M

Leave a Reply to Jennifer M Cancel reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.