CFR – Code of Federal Regulations

45 CFR 155.305 Eligibility Standards

 

 

 

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71 comments on “Eligibility Criteria for Medi-Cal – MAGI Income

  1. FAQ’s from Updated Webpage

    Gaurav says:
    May 20, 2020 at 5:32 pm

    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.
    https://californiahealthline.org/news/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?

    Steve Shorr says:
    May 20, 2020 at 6:48 pm

    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.

    Gaurav says:
    May 20, 2020 at 7:05 pm

    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?

    Steve Shorr says:
    May 20, 2020 at 9:24 pm

    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 a list of plans that Health Net writes by county. Santa Clara shows up for PPO.

    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.

    Steve Shorr says:
    May 20, 2020 at 9:27 p

    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.

    Steve Shorr says:
    May 20, 2020 at 9:33 pm

    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.

    Steve Shorr says:
    May 20, 2020 at 9:40 pm

    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

  2. 46 comments on “MAGI Income – FAQ’s – Conical”

    1. Anonymous says:

      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?

        •  

    2. Anonymous says:

      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.)

      •  

    3. Anonymous says:

      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.

      •  

    4. Anonymous says:

      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?

      •  

    5. Anonymous says:

      Can I get Medi-Cal if I get  unemployment?

      •  

    6. Anonymous says:

      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.

        Here’s my research:

        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.

        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

        •  

    7. Anonymous says:

      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.

      •  

    8. G. says:

      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.

      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.

      •  

      •  

    9. JANICE D says:

      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.

       

  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. 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

  9. 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

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