Medi-Cal under ObamaCare/ACA is now a lot easier to qualify for!
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.
- Assets are no longer counted!
- 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).
Disability Benefits 101 – Excellent explanation!
Medi-Cal Eligibility Procedures Manual
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)
- Medi Cal Explained CHCF
- Historical Guide 2006 CHCF 174 pages
- CalAIM 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.
- 10 Essential Health Benefits
- Our Webpage on Medi & Denti Cal Benefits
- Western Poverty Law - Exact Legal Rules on Coverage for Low Income Californian's
Our Webpage on
I applied for Medi-Cal but have not received any information from the county
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
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
See our contact page for Medi-Cal.
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 *
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
Covered CA says wait to hear from Medi-Cal
Eligibility Window & Where to click
CFR – Code of Federal Regulations
- § 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 –
(2) Is under age 19;
(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
- § 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.
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#Report changes as they happen - within 30 days!
10 days for Medi Cal
Our webpage on ARPA & Unemployment Benefits - Silver 94
- 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.
- Our opinion & short cut * 6 pages of questions - way too complicated, easy to mess it up, lose subsidies and/or go into Medi-Cal - Just give the bottom line in MAGI Household 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?
- Visit our webpage on how to report changes
Child, Other FAQ and Main Medi-Cal Pages
- Aged and Disabled Federal Poverty Level Program
- IHSS In Home Supportive Services
- Part B Medicare Premium paid by Medi Cal – Part D Rx?
- Share of Cost – Medically Needy – What is it?
- SSI – Supplemental Security Benefits – Automatic Medi Cal – SSDI
- Pregnant Women – Medi-Cal Eligibility – Breast & Cervical Cancer
- Transitions from Medi-Cal to get Covered CA