Trying to get out of Medi-Cal and go to Covered CA?
How to Voluntarily Get out of Medi-Cal and Go to Covered CA
if you reported the wrong Income
Links mentioned in the Video
- Income Chart – Line 11 1040 Covered CA MAGI
Here’s the May 20, 2020 Covered CA bulletin on how to do this. Please Note that Medi-Cal & Covered CA have different definitions of the $600/week PUC Pandemic Unemployment Compensation and if it counts as MAGI Income!
Covered CA states that this is the correct process:
If your case has already transferred to the county, you must:
- The county will process the voluntary discontinuance request.
- The system will end-date the consumer’s Medi-Cal eligibility and re-run eligibility**. (Your income will still show as within Medi-Cal limits, so the system will determine the consumer not eligible to financial help through Covered California.)
- You must log into their portal to report a change, now correctly reporting their income.
- You will be found eligible to Covered California programs. (If your corrected income makes you eligible to financial help through Covered California, that financial help eligibility will now show.)
**Note: These changes would be moving forward, meaning that if you were deemed Medi-Cal eligible, even in error, correcting the application and restoring eligibility for Covered California would be prospective (for a future effective date) only.
How brokers can help consumers who have been found Medi-Cal eligible after incorrectly entering their income
If you were moved into the Medi-Cal income threshold by mistake (i.e., because you reported incorrect income) you must update your case after the voluntary discontinuance is processed in order to return to Covered California enrollment and be evaluated for financial assistance eligibility.
Please see two sample scenarios and next steps below for a current Covered California consumer who incorrectly reported their income, entering a number within the Medi-Cal limits, and was found eligible to Medi-Cal:
- If the consumer’s case has been placed into Carry-Forward status and the County has not begun processing the referral*, the consumer or their delegated enroller can update the application within CalHEERS to correct the entered income and remove the consumer’s Medi-Cal eligibility. Enrollers can identify cases in Carry-Forward status by the multiple program eligibilities that show in the Household Eligibility Results Summary page of the application:
*Note: Since the county will have received the referral, they may still attempt to process the referral at a later date even after the consumer’s income is corrected within the application. If the consumer receives a request from their county for information, they should comply with the county request or request voluntary discontinuance at that time. If they do not, the income correction made in the application may be reverted by the county, placing the consumer back into the Medi-Cal income threshold.
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We've developed the Medi-Cal portion of our website, as many of our Covered CA clients unfortunately end up here, if their income drops below 133% of FPL, Federal Poverty Level, see the income chart.
We do not get a nickel, for this site or for helping people enroll in Medi-Cal, nor answering complex questions. When you have other questions or need coverage, take a look at our other websites:
Currently, the Soft Pause feature of SAWS protects consumers from losing MAGI-based Medi-Cal eligibility when personal circumstances change. The soft pause allows the county to run eligibility determinations for other programs while keeping the beneficiary on a MAGI aid code. This generally happens when a MAGI beneficiary becomes eligible for APTCs, premium-based Medi-Cal, or limited scope/restricted/pregnancy-related Medi-Cal, or if the beneficiary becomes ineligible for MAGI Medi-Cal.
The county worker must screen the beneficiary for Non-MAGI programs before removing the soft pause or before sending the case for APTC evaluation. If the individual is eligible for Non-MAGI Medi-Cal, the county can remove the soft pause to place the beneficiary into an appropriate aid code. The same 90-day cure period applies to restore a beneficiary to a proper non-MAGI aid code if the individual did not respond to the Non-MAGI evaluation request.
County workers have the ability to remove the soft pause directly. If an individual has been determined eligible for APTCs, the county worker can help the beneficiary complete plan enrollment in CalHEERS after removing the soft pause.
DHCS ACWDL 17-35 (October 5, 2017)
Possible reasons why Medi-Cal likes to get as many people enrolled as possible
Medi-Cal takes control of the MAGI Income Process!
Covered CA subsidies cost more than Medi-Cal. The CBO’s latest projections from earlier this year show government paying out an average of $6,300 annually for every subsidized enrollee in fiscal 2018. It estimates that number will rise to nearly $12,500 in 2028. In contrast, Medicaid spends $4,230 per non-disabled adult, set to inflate at 5.2% annually to just over $7,000 per person in 2028. Modern Health Care 8.8.2018 *
More people might wind up in Medi-Cal, due to updates in FPL for 2015 – InsureMeKevin Blog
One solution, if you can come up with the premium, (Free Quote) would be to forgo subsidies, tax credits and get a regular private plan direct – through us with an Insurance Company, based on Special Enrollment of Loss of Minimum Essential Coverage.
Another solution – is to use the hints from InsureMeKevin.com and get Medi-Cal to change – adjust your income, so that you qualify for Covered CA.
Here’s an excerpt of an email I rec’d 1.7.2015.
Thank you for contacting Covered California™ I apologize for the delay in getting back to you.
Unfortunately, the county office Medi-Cal did an audit on this application on 1/2/2015 and they completed an income change and the income is now showing zero. The county overrides Covered CA and the clients will have to contact there local Medi-Cal office and have Medi-Cal update there correct income then you can do a Report A Change and put the income back in for this family and the application will allow you to put the insurance plan back in. If Medi-Cal does not get updated with the family correct income they will keep auditing this application and changing the income back.
You also have access to the Transaction History on the Summary page for this application and when see System that is the county auditing the application.
It is best for your clients to reach out to a county eligibility worker to correct the state and county systems. Correcting the Covered California application will only do just that, and when the county reviews their information again and the clients information does not match what is on file the state and county systems they will override the Covered California application again. Please have your clients reach out to a county eligibility worker at their earliest convenience to update all their information household members, income, tax information etc. Once the county system has been update then you can log into this application from your agent account and click on Report a Change and correct the income. If the income is above Medi-Cal limits the application will allow to choose a Covered California plan.
Covered CA unable to allow kids to opt out of Medi-Cal even when parents are willing to pay unsubsidized premium –
Carry Forward Status (CFS)
CalHEERS will automatically place all eligible and conditionally eligible APTC/CSR/CCP individuals into CFS when a redetermination of eligibility results in “eligible”, “conditionally eligible” or “pending” for MAGI Medi-Cal program eligibility. CFS is designed to ensure that the transitioning individual will continue in their Covered California QHP coverage until the resident county completes the individual’s full Medi-Cal determination. DHCS 17-07 * Cal Heers Job Aid 9.2016 * FAQ for Enrollers assisting Medi Cal Enrollment
Hints are fighting with Medi-Cal to get released and go back to Covered CA
With all the alligators in the swamp and at best getting paid $58 to sign someone up for Medi-Cal I never noticed the hearing rights available.
So, get your proofs of income (Covered CA Accepted Documents) together and ask for a hearing (form). Better yet, just send the proofs and hopefully Medi-Cal will fix the problem on their own.
Relevant Codes & Regulations
42 CFR 435.118 Qualifications for Infants and children under age 19
42 CFR 435.110 If you get AFDC they you get Medi-Cal
W & I Code 10850 Records
and 10950 Hearings
We don’t get paid on Medi-Cal… pay us a consulting fee?
Excerpt of email from DHCA
Thank you for contacting the Department of Health Care Services (DHCS).
We are prohibited by law from sharing Protected Health Information (PHI), and Personal Confidential Information (PCI).
Please refer the consumer to the Medi-Cal Now In-Box at [email protected] and we will be happy to assist them with any Medi-Cal issues they may have.
Protected Health Information (PHI) is individually identifiable health information that describes the past, present, or future physical or mental health or the condition of an individual. PHI includes information about the health care services an individual has received or will receive and information about payment for health care services provided in the past, present, or future. Personal confidential information (PCI) is information that is not public which identifies or describes an individual including names, home addresses, home telephone numbers, Social Security Numbers, medical or employment histories, personnel records, licensing records or workers’ compensation. Thank you for allowing DHCS to serve you. Email dated 6.5.2017 10:43 AM
Try Covered CA's Facebook Page https://www.facebook.com/CoveredCA/
Medi-Cal vs Covered CA subsidies Modern Health Care *
- 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
See sample letters below.
How long do I have to get new coverage?
Do I get subsidies?
Most Likely!!! Click here for a
So, just like President Obama said, your net premium might only be $50/month. Plus, enhanced Silver 94, very low co-pays & deductibles.
Will Steve Shorr Insurance help me at no additional charge?
Yes, but you must get a quote first and either have a release from Medi-Cal, like shown below or contact your Social Worker and get one. If you already have a Covered CA account, you must appoint us as your agent. After you get your quote, we can discuss your options by appointment.
What if I don’t have a Release – Notice of Action?
Medi-Cal is supposed to send you a notice of action FAQ’s . If not, contact your Social Worker and get one Scroll down for a sample letter. I do grant they they don’t give you a lot of time to get new coverage. Note also that loss of coverage qualifies you for a special enrollment period and you don’t have to wait for Open Enrollment, nor are you subject to the rule about having to enroll by the 15th to get coverage by the first.
to see how your income, household size, etc qualifies you for subsidies in Covered CA.
There is no charge for us to help you. If you already have a Covered CA account, here’s how to appoint us as your agent.
More Reference Material on when you no longer qualify for Medi-Cal
Reporting a Change and Notices of Action
notice of action FAQ’s
Transitioning Covered California cases to Medi-Cal
Policies and Procedures for Annual Renewal and Change in Circumstance Redeterminations and Discontinuance from Medi-Cal
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