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 MAGI – Income. 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).
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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
-
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).
Disability Benefits 101 – Excellent explanation!
Los Angeles ONLINE Enrollment –
Contact Information for other counties
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)
#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
- 10 Essential Health Benefits
- Our Webpage on Medi & Denti Cal Benefits
- 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
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
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 *
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
ObamaCare – Expansion to 138% of FPL
Utilizing Medi-Cal Expansion to Increase Health-Care Access
VIDEO
Assembly Bill 1 ** Senate.bill.1.
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.
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(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.
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- § 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.
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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
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.
- 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.
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- Denial of benefits and possible criminal charges if you don't report changes in income!
- Visit our webpage on how to report changes
Federal Poverty Level &
Program Chart
Medi-Cal? Covered CA Subsidies? Enhanced Silver?
Child, Other FAQ and Main Medi-Cal Pages
Request for Verification CW 2200
- Aged and Disabled Federal Poverty Level Program
- Pregnant Women – Medi-Cal Eligibility – Breast & Cervical Cancer
- Release or kicked out Medi-Cal get Covered CA
Hospital Presumptive Eligibility
https://files.medi-cal.ca.gov/pubsdoco/presumptive_eligibility/HPE_landing.aspx
7 comments on “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.
Current address xxxx lakeport, CA 95453
Thank you for your help.
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
https://individuals.healthreformquotes.com/covered-ca-tax-credits-subsidies-aptc/report-a-change/proof-income-accepted-documents/
President Trump said Insurance was very complicated and no one knew that it was, he should have asked me.
https://www.cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html
I guess dealing with Covered CA and doing Medi Cal with no compensation requires advanced degrees. I don’t believe in calling anyone on the phone…
4 comments on “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 for Los Angeles 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?
comments-title”>6 comments on “Monthly or Annual Income Qualification for Medi Cal”
I am single, and unemployed.
In January 2021, I made over $100k from a stock sale.
For the rest of the year, I will make around $1,200/mo.
Question:
Is it my annual income or my current monthly income ($1,200/mo) that determines Medi-Cal eligibility?
My annual income will be large because of the stock sale in January 2021.
However, my current monthly income is low.
Am I eligible for Medi-Cal?
That’s what our webpage and citations say. I’m not an authorized Medi Cal agent, nor am I compensated to help people with Medi-Cal. So, just enroll online here.
Check back around April 14, when we have all the information on ARPA COVID Stimulus... things might change?
Did you want to look at Long Term Care, Life Insurance, Medicare, etc?
FAQ’s on Premium Subsidy & Projected Income
I am not getting APTC, and will get PTC next year, at tax time,
does it matter what I make monthly; in other words, if one month I make under $1,833, is that relevant?
***I understand how confusing it is, especially when Covered CA asks so many questions about monthly income. The point is when you file your taxes, what goes on line 37* Magi Income.
Although, Medi-Cal wants to write everyone and their calculations are based on monthly.
only the annual sum is important.
***Right. See MAGI Definition
monthly under 1833 for the month.
***Please talk to me in the bottom line MAGI income for the end of the year. I don’t know how many are in your household. Now I have to multiply 12 x $1,833 = $21,996 if you have a household of 2 it’s borderline, but you are right, that would put you in Medi-Cal.
Should we make it a point to have at least that much monthly income for the remainder of the year?
***The monthly amounts are all hocus – pocus with smoke and mirrors. What counts is the annual. Please use our quote engine and see what happens with your income on an annual basis. Some people at Medi Cal might disagree.
Did you want to look at getting Enhanced Silver – Cost Sharing Reductions?
Do you sell health insurance not run through covered california?
***Yes. Get quotes here. If you want the subsidy though, you must have Covered CA. Click here for instructions on how to appoint us as your agent, no extra charge. Did you like our answer better than calling Covered CA?
income from the IRA – Annuity,
***Line 15 A of the 1040
Are you saying that I would drop into Medical [Medi-Cal] if the monthly income dropped below $1,833 for the next month or even four months, despite the fact that the annual quota has already been surpassed.
***No, not at all. It’s all annual MAGI. This monthly is for people who want subsidies and can’t figure out the annual amount they will put on line 37* Medi-Cal does want to write everyone and not let them out.
You said the annual income is what matters,
***Right. But please do not quote me. I only read the official IRS publications, namely publication 974 and Covered CA bulletins.
but the part I described above and your response confused me. Are you saying that the annual is what matters as long as you make a minimum of 1833 for each month of the year?
***Yes. Please, forget the monthly amount. It’s just crap for those who can’t figure out what their MAGI* incomewill be on line 37.
How about appointing us as your agent so that we can get paid to help you. Sure, Covered CA says find free help, but it’s not free. It’s slave labor until I get appointed. There is no extra cost to you.
Since you are not taking the advance premium tax credit and if I understand you correctly, are not taking it in advance next year, just put that down and you shouldn’t have to enter an income amount.
***Please use our quote and subsidy calculator. You will note, it only asks for annual income.
****
As I understand it, insurance sign up starts in November.
***Right, now it’s October for a January effective date.
I have not gotten a subsidy this year, because my projected income is above 63k.
***That’s what the chart shows for a household of two, but it’s best to get a complementary quote and subsidy calculation.
I did not want to drop into medicare [Medi-Cal] if I made less than $1,833 in a month).
***MAGI Income is ANNUAL – what shows on line 37 of your 1040.
MAGI Income – Medi-Cal Qualification?
However, I definitely do not want APTC. [Advance Premium Tax Credit]
***That’s what the brochures on the above right and on this page talk about. Take the credit now or later? If your income drops below $34k you may qualify for Enhanced Silver Cost Sharing Reductions.
If I renew for CC in November and I indicate that I don’t want APTC, would I still have to provide a breakdown of projected income, along with documentation?
***No, note the new rule I just found that says Covered CA – the Exchanges MUST vette everyone who asks for Premium Credits. (42 U.S. Code § 18081 * CFR § 155.320)
When you asked if I would give up the subsidy, did you mean APTC, or do you mean the PTC that one gets as a refund on taxes.
***You have to stay in Covered CA to get either subsidy.
Does one have to fill out the financial part of the [Covered CA] application for next year in order to get the PTC on the tax refund following the benefit year?
***Yes, as Covered CA must vette everyone under 42 U.S. Code § 18081 * CFR § 155.320
Again, I have heard different opinions on this.
***That’s because very few people actually read the CFR’s, actual IRS documents and the documents don’t always refer to the other relevant rules, codes & laws. Check our main page on take it (APTC or PTC) now or later.
I was temporarily laid off on March 30.
My income is low and I might be eligible for Medi-cal.
Could you look into it for me, please.
*******************
We had a question just like this a week ago. Please click on the following link, review that and if you have any further questions, ask on the relevant page.
https://ccrules.healthreformquotes.com/how-to-report-a-change/#comment-12752
If you want us to put in into Medi Cal, where we don’t get paid to help you, we will do that, as you’ve been a client. Please send us a “clear” email as to what your income is, and what you want us to report to Covered CA, under penalty of perjury.
https://generallaw.steveshorr.com/criminal-law/perjury-what-is-the-definition/
Don’t forget, unemployment is taxable.
https://taxcredits.healthreformquotes.com/magi-modified-adjusted-gross-income-line-37/magi-faqs/sdi-state-disability-benefits-taxable/unemployment-compensation/
The Feds have a bill pending to pay 100%!
As, you’ll see on the Q & A for the other similar question, once you get into Medi Cal, it’s very difficult to get out.
I’m a real estate agent and my income fluctuates. So, I read the above, but didn’t click on the links – citations. Are you sure the law says monthly?
Monthly vs. Annual income: MAGI Medi-Cal rules allow counties to base eligibility on monthly rather than annual income. If an applicant provides both monthly and annual income, counties are instructed to divide the annual income by 12, compare it to the monthly amount also provided, and use the lower of the two amounts Western Poverty Law
if the individual’s current monthly income is lower than the projected annual income divided by 12, counties should enter the current monthly income.dhcs
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
46 comments on “MAGI Income – FAQ’s – Conical”
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?
Have you been asked to Redetermine?
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.)
See our web pages on
accepted proofs of income
https://individuals.healthreformquotes.com/covered-ca-tax-credits-subsidies-aptc/report-a-change/proof-income-accepted-documents/
Then scroll down and get more details on:
Bank Statement Review
Self employed Health Insurance Deduction
Home Office Deduction
Computing Subsidies and Health Insurance Deduction
Premium Subsidy reconciliation – it’s not what you made in 2019, it’s what do you expect to make in 2020!
Be sure to report changes in income within 10 days.
There might be criminal penalties if you don’t!
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.
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?
Usually no. Learn More @ Insure Me Kevin.com
Can I get Medi-Cal if I get unemployment?
Qualifying for MAGI Medi-Cal a function of the number of people in your family – tax return and your expected MAGI income for the current tax year.
Please use our
complementary subsidy, premium and benefits calculator
and then we can help you better.
Medi-Cal has year around enrollment.
Please review the special enrollment qualifications.
There used to be temporary plans and Mr. Mip, which is minimum essential coverage and covers pre-existing conditions.
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
Here’s the link to Enroll in Medicare https://medicare.healthreformquotes.com/sign-medicare/
Once you get Medicare A & B we can set you up with a Medicare Advantage Plan with Blue Shield, AARP or Blue Cross. Most of these plans have ZERO premium and all include Part D Rx.
You can pay your Part B Hospital premium of $135 from Medicare from your Social Security check.
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.
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.
I 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.
Kentucky Gets exemptions so that they can require Medicaid recipients to work
http://www.modernhealthcare.com/article/20180112/NEWS/180119945
La times
http://enewspaper.latimes.com/infinity/latimes/default.aspx?pubid=50435180-e58e-48b5-8e0c-236bf740270e
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.
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/
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?
See the rules about low income subsidy and selling a home for reference.
See our page on Capital Gains and the sale of a home
Being as MAGI Medi Cal is based on monthly earnings, it looks like you only would be in Covered CA for a month, if that’s what you want.
Get Covered CA quotes here.
Did you need life insurance to protect your family?
President Trump – No one except Steve Shorr knew how complicated Insurance was
https://youtu.be/b_8UFNQqk7k
Penalties for Part B even if you had Covered CA…
https://cahealthadvocates.org/equitable-relief-waiver-of-part-b-penalties-ends-sept-30-apply-now/
https://medicare.healthreformquotes.com/seminar/part-b/part-b-doctor-visits-late-enrollment-penalty/covered-ca-waiver-part-b-penalty/
Here’s a graph about waiting too long to enroll in Medicare Part B.
Publication 11036
BUT, per your redetermination page https://medi-cal.healthreformquotes.com/redetermination/
and https://www.law.cornell.edu/cfr/text/42/435.916
Once you are renewed by Medi-Cal it’s good for a year!
Yes, but besides the mandate to report changes, the periodic renewal mentions this:
(d) Agency action on information about changes.
(1) Consistent with the requirements of § 435.952 of this part, the agency must promptly redetermine eligibility between regular renewals of eligibility described in paragraphs (b) and (c) of this section whenever it receives information about a change in a beneficiary’s circumstances that may affect eligibility.
Yeah, but Medi Cal already knows my date of birth, so nothing has changed!
You’re going beyond our pay grade. We are not lawyers.
When to report a change in circumstances to Medicaid?
If the Medicaid recipient does nothing, they are breaking the law. A change in circumstance is also for minor but important life events such as change of address. If you don’t let SSA know, then they can’t communicate with you, which will cause a whole host of potential problems.
If the Medicaid recipient does nothing after a significant change in circumstances (such as coming into new money), Medicaid will eventually find out (likely from the IRS) or as part of a random audit and they may kick the Medicaid recipient out of the program and demand retroactive reimbursement for benefits paid while the person was no longer qualified. https://www.elderneedslaw.com/blog/change-in-circumstance
https://www.cbpp.org/health/medicaid-compliance-with-eligibility-requirements
Did you report that you would be eligible for Medicare?
Western Poverty 6.226
Age: Expansion Adults must be at least 19 years old and under age 65
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.
https://wclp.org/wp-content/uploads/2016/06/Western_Center_2016_Health_Care_Eligibility_Guide_Full_rev.1.pdf#page=50
23. 42 U.S.C. § 1396a(a)(10)(A)(i)(VIII); 42 C.F.R. § 435.119(b)(1); Welf. & Inst. Code § 14005.60(a); MEDIL 13-12 (Sep. 16, 2013) at p. 6,
24. Welf. & Inst. Code § 14005.37(d)
Aged & Disabled?
https://medi-cal.healthreformquotes.com/eligibility/aged-and-disabled/
Covered CA agrees with that on children who turn 26. They can stay on the plan till the end of the year.
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.
We are not aware of any Medicare provision that allows one on MAGI Medi-Cal to delay enrollment. In fact, there are Part B penalties if you don’t enroll on time.
If you have to pay for Part A Hospital and don’t sign up on time, there is a penalty.
You are MANDATED to inform Medi-Cal of any changes to eligibility within 10 days. Medi-Cal might get VERY pissed, if you don’t
Welfare & Institutions Code 14005.37. (h) Beneficiaries shall be required to report any change in circumstances that may affect their eligibility within 10 calendar days following the date the change occurred. See Also Western Poverty Guide page 6.226
BUT, per your redetermination page https://medi-cal.healthreformquotes.com/redetermination/
and https://www.law.cornell.edu/cfr/text/42/435.916
Once you are renewed by Medi-Cal it’s good for a year!
Yes, but besides the mandate to report changes, the periodic renewal mentions this:
(d) Agency action on information about changes.
(1) Consistent with the requirements of § 435.952 of this part, the agency must promptly redetermine eligibility between regular renewals of eligibility described in paragraphs (b) and (c) of this section whenever it receives information about a change in a beneficiary’s circumstances that may affect eligibility.
Yeah, but Medi Cal already knows my date of birth, so nothing has changed!
You’re going beyond our pay grade. We are not lawyers.
When to report a change in circumstances to Medicaid?
If the Medicaid recipient does nothing, they are breaking the law. A change in circumstance is also for minor but important life events such as change of address. If you don’t let SSA know, then they can’t communicate with you, which will cause a whole host of potential problems.
If the Medicaid recipient does nothing after a significant change in circumstances (such as coming into new money), Medicaid will eventually find out (likely from the IRS) or as part of a random audit and they may kick the Medicaid recipient out of the program and demand retroactive reimbursement for benefits paid while the person was no longer qualified. https://www.elderneedslaw.com/blog/change-in-circumstance
https://www.cbpp.org/health/medicaid-compliance-with-eligibility-requirements
Did you report that you would be eligible for Medicare?
Western Poverty 6.226
Age: Expansion Adults must be at least 19 years old and under age 65
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.
https://wclp.org/wp-content/uploads/2016/06/Western_Center_2016_Health_Care_Eligibility_Guide_Full_rev.1.pdf#page=50
23. 42 U.S.C. § 1396a(a)(10)(A)(i)(VIII); 42 C.F.R. § 435.119(b)(1); Welf. & Inst. Code § 14005.60(a); MEDIL 13-12 (Sep. 16, 2013) at p. 6,
24. Welf. & Inst. Code § 14005.37(d)
Aged & Disabled?
https://medi-cal.healthreformquotes.com/eligibility/aged-and-disabled/
Covered CA agrees with that on children who turn 26. They can stay on the plan till the end of the year.
Here’s a graph about waiting too long to enroll in Medicare Part B.
Publication 11036
Penalties for Part B even if you had Covered CA…
https://cahealthadvocates.org/equitable-relief-waiver-of-part-b-penalties-ends-sept-30-apply-now/
https://medicare.healthreformquotes.com/seminar/part-b/part-b-doctor-visits-late-enrollment-penalty/covered-ca-waiver-part-b-penalty/
Reply from Medi-Cal!!!
Dear Steve,
You can stay on Medi-Cal after the age of 65 years of age, even if your renewal happens before the age of 65 years old. If you have full Medi-Cal benefits, you pay no Medicare cost sharing.
The medical services must be covered by Medicare and Medi-Cal. share of coast before Medi-Cal pays for your medical expense.
Medi-Cal will only cover these costs and services if you use providers that accept Medi-Cal. … If you qualify for full Medi-Cal (Medi-Cal without a share of cost (SOC)), Medi-Cal will also cover your Medicare Part A and B deductibles and copayments, and pay your monthly Medicare Part B premium.
Let me suggest you review the Medicare webpage:
https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/part-a-part-b-sign-up-periods , and provide you with more information.
Thank you for allowing DHCS to serve you.
Timothy
Here’s our webpage on signing up for Medicare A & B
Can one trust what a Government Worker says?
President Trump – No one except Steve Shorr knew how complicated Insurance was
https://youtu.be/b_8UFNQqk7k
Medi-Cal has many other programs that you might qualify for. Like food stamps, nursing home, phones, etc. Medi-Cal has a wide range of social services. They are Social or Case workers.
See also our page on “bank statement review”
View more FAQ’s
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?
Medi-Cal has many other programs that you might qualify for. Like food stamps, nursing home, phones, etc. Medi-Cal has a wide range of social services. They are Social or Case workers.
See also our page on “bank statement review”
Paying for the living expenses of an individual you do not have a legal obligation to support. In addition to non-related parties, this also could apply to adult children. If you are paying for the room and board for a child you are no longer obligated to support, this may be a gift. http://www.troutcpa.com/blog/what-is-a-gift
Not all money transfers are gifts The IRS isn’t interested in the rental value of your child’s old bedroom, or the amount of food that disappears from your refrigerator.https://blog.taxact.com/gift-tax-supporting-adult-children/
Covered CA list of countable income
This question is really beyond my pay grade. Covered CA suggests you try VITA. I would think the question is beyond their pay grade too. Try your own CPA.
Do you need life insurance to make sure your son is supported if you are not here?
Thank you Steve, I will check these out.
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.
See our webpage on counting household size for someone filing their own tax return and not being claimed as a dependent elsewhere.
Let me see if providing room and board counts as gift income?
Paying for the living expenses of an individual you do not have a legal obligation to support. In addition to non-related parties, this also could apply to adult children. If you are paying for the room and board for a child you are no longer obligated to support, this may be a gift. http://www.troutcpa.com/blog/what-is-a-gift
Not all money transfers are gifts The IRS isn’t interested in the rental value of your child’s old bedroom, or the amount of food that disappears from your refrigerator.https://blog.taxact.com/gift-tax-supporting-adult-children/
Covered CA list of countable income
This question is really beyond my pay grade. Covered CA suggests you try VITA. I would think the question is beyond their pay grade too. Try your own CPA.
Do you need life insurance to make sure your son is supported if you are not here?
Thank you Steve, I will check these out.
Eligibility is determined by MAGI, but is there also a countable property limit?
See reply to virtually the same question below.
If I remarry, would my child lose his Medi Cal? The child qualified as my spouse passed away.
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…
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.
Medi-cal enrolled a lot of people that were not eligible
https://oig.hhs.gov/oas/reports/region9/91602023.pdf
http://www.latimes.com/business/la-fi-california-medicaid-expansion-20180326-story.html
Chip program. Children when whole family doesn’t qualify
https://www.medicaid.gov/chip/index.html
Work requirement?
Health-Care Standoff in Washington Raises Stakes of State-Level Fights – The Wall Street Journal
https://apple.news/AtAWUYW8YR4W_gdFNkFppdA
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
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
Plus the enhanced silver benefits also known as cost sharing reductions
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
Plus the enhanced silver benefits also known as cost sharing reductions
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
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
Check out this page on Medi Cal wanting precedence over Covered CA and how to remove a “soft pause.”
https://medi-cal.healthreformquotes.com/eligibility/magi-income-medi-cal-qualification/medi-cal-trumps-subsidized-plans/