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Medi-Cal vs Covered CA subsidies

Transfering  from  Medi-Cal to Covered CA?
Correcting MAGI Income?

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What is a Medi Cal   #Soft Pause

Soft pause is basically a waiting period or hold, while Medi Cal does an investigation to see if you’re eligible for Medi Cal.  Medi Cal appears to have priority over Covered CA.  Learn more >>>

 

SAWS Soft Pause Removal

Currently, the Soft Pause feature of SAWS protects consumers from losing MAGI-based Medi-Cal eligibility when personal circumstances change.  The soft pause allows the county to run eligibility determinations for other programs while keeping the beneficiary on a MAGI aid code.  This generally happens when a MAGI beneficiary becomes eligible for APTCs Covered CA Tax Subsidy, premium-based Medi-Cal, or limited scope/restricted/pregnancy-related Medi-Cal, or if the beneficiary becomes ineligible for MAGI Medi-Cal.

The county worker must screen the beneficiary for Non-MAGI programs (See our other Medi Cal Webpages) before removing the soft pause or before sending the case for APTC (subsidies) evaluation.  If the individual is eligible for Non-MAGI Medi-Cal, the county can remove the soft pause to place the beneficiary into an appropriate aid code.  The same 90-day cure period applies to restore a beneficiary to a proper non-MAGI aid code if the individual did not respond to the Non-MAGI evaluation request.

County workers have the ability to remove the soft pause directly.  If an individual has been determined eligible for APTCs, the county worker can help the beneficiary complete plan enrollment in CalHEERS after removing the soft pause.

In the past, when Medi-Cal kicks you out for making too much $$$, they don’t enroll you in Covered CA! Insure Me Kevin.com *   Get a quote and subsidy calculation here and we can help you.  No extra charge!   Now they will under SB 260

 

#Hints on fighting with Medi-Cal to get released and go back to Covered CA

Relevant Codes & Regulations

Misc

We don’t get paid on Medi-Cal…  pay us a tutoring consulting fee?

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#My Medi-Cal 
How to get the Health Care
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My medi cal explanation of medi cal

Why Medi Cal seems aggressive to increase enrollments?

FAQ’s 

How to Voluntarily Get out of Medi-Cal and Go to Covered CA
if you reported the #wrong Income

 

Steve’s NEW May 2021 VIDEO Clearing Up Confusion in Covered CA & Medi Cal Accounts
& Pdf explanation

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Videos by Steve Shorr

Covered CA states that this is the correct process:

    • The county will process the voluntary discontinuance request.
    • The system will end-date the consumer’s Medi-Cal eligibility and re-run eligibility**. (Your income will still show as within Medi-Cal limits, so the system will determine the consumer not eligible to financial help through Covered California.)
    • You  will be found eligible to Covered California programs. (If your corrected income makes you eligible to financial help through Covered California, that financial help eligibility will now show.)
      • **Note: These changes would be moving forward, meaning that if you  were  deemed Medi-Cal eligible, even in error, correcting the application and restoring eligibility for Covered California would be prospective (for a future effective date) only.

 

How brokers can help consumers who have been found Medi-Cal eligible after incorrectly entering their income

  • If you were moved into the Medi-Cal income threshold by mistake (i.e., because you reported incorrect income) you must update your  case after the voluntary discontinuance is processed in order to return to Covered California enrollment and be evaluated for financial assistance eligibility.
    • Covered CA Report a change 
    • Please see two sample scenarios and next steps below for a current Covered California consumer who incorrectly reported their income, entering a number within the Medi-Cal limits, and was found eligible to Medi-Cal:
    • If the consumer’s case has been placed into Carry-Forward status and the County has not begun processing the referral*, the consumer or their delegated enroller can update the application within CalHEERS to correct the entered income and remove the consumer’s Medi-Cal eligibility. Enrollers can identify cases in Carry-Forward status by the multiple program eligibilities that show in the Household Eligibility Results Summary page of the application:
      • *Note: Since the county will have received the referral, they may still attempt to process the referral at a later date even after the consumer’s income is corrected within the application. If the consumer receives a request from their county for information, they should comply with the county request or request voluntary discontinuance at that time. If they do not, the income correction made in the application may be reverted by the county, placing the consumer back into the Medi-Cal income threshold.
  • Covered CA Tool Kits 

Federal Poverty Level &
Program Chart

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

Possible reasons why Medi-Cal likes to get as #many people enrolled as possible

  • Medi-Cal takes control of the MAGI Income Process!
  • Income – Federal Poverty Level can put families into Medi-Cal
    • More people might wind up in Medi-Cal, due to updates in FPL for 2015 – InsureMeKevin Blog
  • One solution, if you can come up with the premium, (Free Quote)  would be to forgo subsidies, tax credits and get a regular private plan direct – through us with an Insurance Company, based on Special Enrollment of Loss of Minimum Essential Coverage.
    • Another solution – is to use the hints from  InsureMeKevin.com and get Medi-Cal to change – adjust your income, so that you qualify for Covered CA.
  • Here’s an excerpt of an email I rec’d 1.7.2015.
    • Hello Steve,
    • Thank you for contacting Covered California™ I apologize for the delay in getting back to you.
    • Unfortunately, the county office Medi-Cal did an audit on this application on 1/2/2015 and they completed an income change and the income is now showing zero. The county overrides Covered CA and the clients will have to contact there local Medi-Cal office and have Medi-Cal update there correct income then you can do a Report A Change and put the income back in for this family and the application will allow you to put the insurance plan back in. If Medi-Cal does not get updated with the family correct income they will keep auditing this application and changing the income back.
    • You also have access to the Transaction History on the Summary page for this application and when see System that is the county auditing the application.
    • Excerpt 3.27.2015
  • It is best for your clients to reach out to a county eligibility worker to correct the state and county systems. Correcting the Covered California application will only do just that, and when the county reviews their information again and the clients information does not match what is on file the state and county systems they will override the Covered California application again. Please have your clients reach out to a county eligibility worker at their earliest convenience to update all their information household members, income, tax information etc. Once the county system has been update then you can log into this application from your agent account and click on Report a Change and correct the income. If the income is above Medi-Cal limits the application will allow to choose a Covered California plan.
    • Covered CA unable to allow kids to opt out of Medi-Cal even when parents are willing to pay unsubsidized premium –
    • Learn More ==> CA Healthline 4.7.2016.   Opposing View Point about Agents being Greedy  Insure Me Kevin.com
  • Carry Forward Status (CFS) 
    • CalHEERS will automatically place all eligible and conditionally eligible APTC/CSR/CCP individuals into CFS when a redetermination of eligibility results in “eligible”, “conditionally eligible” or “pending” for MAGI Medi-Cal program eligibility. CFS is designed to ensure that the transitioning individual will continue in their Covered California QHP coverage until the resident county completes the individual’s full Medi-Cal determination. DHCS 17-07   *  Cal Heers Job Aid 9.2016  *  FAQ for Enrollers assisting Medi Cal Enrollment  

FAQ’s 

 
  • I’ve been on medi-cal and recently qualified for Social Security Disability [SSDI?] and receive approx.$800 a month.
    • They [Social Security] also gave me a check for the time I should have already had it, which was for $25,000.
    • My mother passed away and left me her bank account. I think from what I have read that this won’t disqualify me from Social Security Disability because I didn’t earn the money through working. That’s great.
    • The problem is Medi-Cal. I don’t know how to approach it because I know I will need it, I’m unable to work, and in the Bay Area $800 is nothing now that I will have to pay $2000 a month in rent, that is what the inheritance was going to help me with.
    • What can I do to avoid being penalized by medi-cal? I’m afraid to tell them anything because I’m afraid they will say I owe them $$$$$. I was going to try to cancel or drop meds-cal for the time being because that money won’t carry me for too long.
  • Assets are no longer counted for MAGI Medi Cal.
  • my x wife just got approved for social security under widows benefits and gets $1,400 a month, $16,800/year.   she also has an adult disabled child who gets $585 SSA [SSI?] , $7,020 from the deceased parent as well, the child also works and get $300 every two weeks $7,800/year she only makes $5 hour she has down syndrome.
    • My question is they are cancelling the medi cal because she makes $8 to much it seems like the should both get medi cal to me
    • The child on SSI, shouldn’t have a problem staying on Medi Cal, regardless of income as long as he stays on SSI
      .
    • Under Health Care Reform, one can get subsidies and enhanced silver – cost sharing reductions once their income reaches 138% of federal poverty level.
    • With subsidies and the extra help with enhanced silver, you might not notice much difference… Click here for quotes
    • Here’s more explanation of how much Social Security Counts towards MAGI income – line 37…
    • You might also check into household definition and tax filing so as to not have to count the child’s income
      .
  • I want to make sure the Alameda County Board of Supervisors understands how their policies have screwed me and my children out of continuous medical coverage.   Is this needless county-induced interruption in coverage something you have seen elsewhere?  Or is it isolated to Alameda County?
  • Answer I’ve sent your comment to Medi Cal [email protected] and to the Board of Directors @ Covered CA [email protected]   Contact Info for Alameda Board of Supervisors
  • Please fill out the form…
    • First, let’s read the letter. The main points are:
    • Covered CA and Medi-Cal review your income and family size to see what program and subsidy level one qualifies for.
    • Here’s an income chart and here’s our free quote and subsidy calculator.
    • Thus for a single person one needs to have expected 2016 MAGI income of at least $16,245 to get Silver 94. Less that than one qualifies for no cost Medi-Cal.
    • Next the letter says to check out your www.CoveredCA.com account.
    • Gosh, things are WORSE than my friendly competitors have stated!!! Someone, NOT me, went into your account and changed the income from $20k to ZERO and FORGED my name. I will be reporting this to Covered CA, Dept. of Insurance, Department of Managed Health Care and the Los Angeles Police Department. I will send you the documentation in a private email.
    • So, please send me any, all and whatever proof you have that your estimated 2016 MAGI income will be over $17k ASAP.
    • Some of the confusion seems to be the documentation you sent Covered CA prior to appointing me as your agent. Did Covered CA send you a request for proof of income? I can’t find that in the Agent Portal.
      .
  • I am on unemployment till April. I thought that was considered income.   I started my own business and the way it’s going, I will start making money in April. I’m leasing properties and won’t make money till the properties are leased- which will be April.  Please advise?
    • Answer Unemployment Insurance Information is at edd.ca.gov The maximum weekly benefit appears to be $1k, that would certainly be enough. I’m not sure how long one can collect unemployment. Here’s their publication # 1275, which probably has it. I don’t get paid to handle unemployment…
    • Please send me the documentation of your unemployment and not just tell me about it. Also, the amount you are getting. How much do you expect to earn in your business? Please check the Unemployment Website and see if you can even collect unemployment as you are working, leasing properties. I do not want to be involved in any tax issues.
    • Here’s a list of Covered CA Accepted Income Documents<a href=”https://www.irs.gov/pub/irs-pdf/p525.pdf” target=”_blank” rel=”nofollow”>IRS publication # 525 page 27 shows that unemployment does count towards income on your 1040.
  • I was confused because I thought your previous email meant that showing proof of income via unemployment would put me back at Medi-cal. I just brought up the leasing thing because I thought you were asking for proof that I would start making money from my own business after unemployment. I’m not making any money or doing work that’s bringing income while I’m receiving unemployment, but I have been seeking employment per Unemployment guidelines.
    • I’ve attached proof of income from unemployment. Let me know if there’s anything else you need.
  • Answer The question is, will your 2016 income be more or less than $17k. What proof do you have that you will be making that kind of money from your business in April?
    • Thanks for sending your unemployment documentation showing $2k/month. I will upload that to Covered CA and see what happens.
    • If I can’t fix it there, then I suggest you contact your County Eligibility Worker – Los Angeles or file an appeal.
    • I went into your Covered CA account, corrected the income. I got a automated reply that Covered CA will review and let you know if you qualify for Special Enrollment. I don’t know how? They didn’t allow me to upload the proof of your unemployment income. I will email Agent Support at Covered CA and send you a private copy.
    • It’s 566 every pay period (every 2 weeks), so that’s roughly over 1k per month (your previous email said 2k per month I think, just wanted to correct that).
  • I don’t really have proof of income for my business. The properties that I will rent are currently vacant. New tenants are expected to move in May, so I’ll start receiving income from that just luckily after the time unemployment runs out. Sorry I don’t have any documentation to prove this for the future.
    • Answer In that case, all you are showing is $12k in MAGI income and that’s below 138% of Federal Poverty Level or the $17k shown on the income chart. So, it’s Medi-Cal or you can have a private plan direct with the insurance company, without subsidies or enhanced silver benefits. I will send you a new quote privately. Website visitors can get a quote with and without subsidies, here.

Our website is #MUCH more than just
Pro Bono helping you with Medi-Cal

We've developed the Medi-Cal portion of our website, as many of our Covered CA clients unfortunately end up here, if their income drops below 138% of FPL, Federal Poverty Level

We do not get a nickel, for this site or for helping people enroll in Medi-Cal, nor answering complex questions.  When you have other questions or need coverage, take a look at   our other websites:

Sample Notification Letters

#Sample Notification Letters

 

Medi-Cal Notice that you are losing coverage

Medi-Cal Notice that you are losing coverage

Larger View – Key Points – notice of action

Larger View - Key Points - notice of action

Notice of Action – No More Medi-Cal
Notice of Action - No More Medi-Cal

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Automatic Transfer to Covered CA

SB 260 #Hurtado

Automatic health care coverage enrollment.
 
The Medi-Cal program,…  allows qualified low-income individuals to receive health care services.  Covered California, [no extra charge to use a Certified Broker/Agent] facilitates the enrollment of qualified individuals and qualified small employers in qualified health plans as required under the federal Patient Protection and Affordable Care Act. …
 
Covered CA  beginning no later than July 1, 2021, must enroll an individual in the lowest cost silver plan [metal level chart] or another plan, as specified, upon receiving the individual’s electronic account from an insurance affordability program. This bill would require enrollment to occur before coverage through the insurance affordability program is terminated, and would prohibit the premium due date from being sooner than the last day of the first month of enrollment. The bill would require the Exchange to provide an individual who is automatically enrolled in the lowest cost silver plan with a notice that includes specified information, including the individual’s right to select another available plan or to not enroll in the plan.
 
Existing law requires a health care service plan providing individual or group health care coverage or a health insurer to notify an enrollee, subscriber, policyholder, or certificate holder who ceases to be enrolled in coverage that the individual may be eligible for coverage through the Exchange or Medi-Cal.
 
This bill would require a health care service plan providing individual or group health care coverage or a health insurer to notify an enrollee, subscriber, policyholder, or certificate holder that the health care service plan or health insurer will provide the individual’s contact information to the Exchange if the individual ceases to be enrolled in coverage, and to include a notice that includes specified information, including advising individuals to consider their options carefully if they are eligible for enrollment in the Medicare Program.
 
The bill would allow an individual to opt out of that transfer of information, and would require a health care service plan or health insurer to transfer the information of an individual who ceased to be enrolled in coverage and who did not opt out to Covered CA  beginning January 1, 2021, in a manner prescribed by Covered CA. Because the bill would expand the scope of a crime with respect to health care service plans, the bill would impose a state-mandated local program.  SB260  Hurtado  *
 

More Reference Material on when you no longer qualify for Medi-Cal

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FAQ’s  

  • What if I start earning too much #money 
  • MAGI Income – Modified Adjusted Gross Income Line 11 + Social Security* for Medi-Cal.    
  • How do I go from Medi-Cal to Covered CA?  How long do I have to get new coverage?
  • Do I get subsidies?
    • Most Likely!!!  Click here for a  complementary quote and subsidy calculation
    • So, just like President Obama said, your net premium might only be $50/month.  Plus, enhanced Silver 94, very low co-pays & deductibles.
  • Will Steve Shorr Insurance help me at no additional charge?
  • What if I don’t have a Release – Notice of Action?
    • Medi-Cal is supposed to send you a notice of action   FAQ’s .  If not, contact your Social Worker and get one   Scroll down for a sample letter.  I do grant they they don’t give you a lot of time to get new coverage.  Note also that loss of coverage qualifies you for a special enrollment period and you don’t have to wait for Open Enrollment, nor are you subject to the rule about having to enroll by the 15th to get coverage by the first.
    • Use our complementary subsidy and quote engine
    • to see how your income, household size, etc qualifies you for subsidies in Covered CA.
    • There is no charge for us to help you.  If you already have a Covered CA account, here’s how to appoint us as your agent.
Learn about Medi Cal Redetermination

All our plans are Guaranteed Issue with No Pre X Clause
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Medi-Cal vs Covered CA subsidies  Modern Health Care * 

Medi-Cal vs Covered CA subsidies

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