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Medi Cal Explained

 Medi Cal  based on income below 138% of Federal Poverty Level

Earning too much for Medi-Cal??? Get Covered CA Quote here

Medi Cal Qualification under MAGI Income 

Ask us a Question? FAQ's?

Child & Sibling Pages

[sibling-pages]

 

What’s on this page?

Instant Term Life Insurance Quotes

Trump Big Beautiful Bill Changes

 

Need Medicaid? Then Get a Job

The deepest cuts to health care spending come from a proposed Medicaid work requirement, which is expected to end coverage for millions of enrollees who do not meet new employment or reporting standards.

In 40 states and Washington, D.C., all of which have expanded Medicaid under the Affordable Care Act, some Medicaid enrollees will have to regularly file paperwork proving that they are working, volunteering, or attending school at least 80 hours a month, or that they qualify for an exemption, such as caring for a young child. The new requirement will start as early as January 2027.

The bill’s requirement doesn’t apply to people in the 10 largely GOP-led states that have not expanded Medicaid to nondisabled adults.

Health researchers say the policy will have little impact on employment. Most working-age Medicaid enrollees who don’t receive disability benefits already work or are looking for work, or are unable to do so because they have a disability, attend school, or care for a family member, according to KFF, a health information nonprofit that includes KFF Health News.

State experiments with work requirements have been plagued with administrative issues, such as eligible enrollees’ losing coverage over paperwork problems, and budget overruns. Georgia’s work requirement, which officially launched in July 2023, has cost more than $90 million, with only $26 million of that spent on health benefits, according to the Georgia Budget & Policy Institute, a nonpartisan research organization.

“The hidden costs are astronomical,” said Chima Ndumele, a professor at the Yale School of Public Health.      Kff News *

Eligibility 

Undocumented,  Illegal, Lawful Presence

 

  • Visit our webpage on Lawful Presence for Covered CA
  • A year after granting Medi-Cal access to low-income immigrants without legal status, Gov. Gavin Newsom is proposing to freeze enrollment of new recipients and charge premiums in a move expected to save the state more than $5 billion.

    • Under Newsom’s proposal announced today, Medi-Cal — the state’s health insurance program for low-income people and those with disabilities — beginning in 2026 would no longer accept new enrollees 19 and older who lack permanent legal status.

    •  

      The 1.6 million immigrants already signed up would not lose their Medi-Cal coverage, and children could still enroll.

      • All undocumented Californians would still be covered for emergency medical and pregnancy care — so-called “limited scope”  share of cost  coverage that is paid for with federal dollars. But those who don’t enroll before January 2026 would be uncovered for other medical expenses, such as prescription drugs and doctor’s visits.  Learn More >>>  Cal Matters. org

  • all income-eligible Californians may qualify for full-scope Medi-Cal regardless of immigration status.  January 2024  ILRE *  DHCS *
  • AB 133  7/27/2021  Under AB 133, approximately 235,000 Californians aged 50 years and older are newly eligible for Medi-Cal, including preventive services, long-term care and In-Home Supportive Services.
  • Age 26 through 49  Read More  DHCA.CA.Gov *
  • In 2019, California became the first state to extend Medi-Cal coverage to all eligible undocumented young adults up to the age of 26 and with today’s expansion, the state has the most inclusive health coverage for low-income persons in the country.
  • AB 133 also extends the Medi-Cal postpartum care period from 60 days to 12 months without requiring a mental health diagnosis, including for eligible undocumented Californians.  Gov.CA.Gov *

 

 

Benefits

Medical

Dental

#Denti Cal Beneficiary Handbook 2023  

denti cal handbook

Medi Cal Vision Coverage

 

#My Medi-Cal 
How to get the Health Care
You Need
24 pages

Smart Phones - try turning sideways to view pdf better
My medi cal explanation of medi cal

 

Get much more detail on Medi Cal

Improvements?

Trump, whatever less coverage

Cal Aim

2025  Possible Increases or decreases in Funding and Coverage

 

  • How Trump Administration Cuts Could Hurt Medi-Cal
    Federal funds cover more than 60% of California’s low-income health insurance plan. Losing even part of that money could result in cutbacks on care for kids or state tax hikes.   Read more *
  • California OKs $2.8B to close Medicaid funding gap after expanding immigrant coverage  Read More *
  • A fifth of Americans are on Medicaid. Some of them have no idea.
    Programs with consumer-friendly names and private insurance company involvement add to the confusion.  Read More *
  • Defending Medi Cal in 2025  CHCF  *
  • Medi-Cal Waivers and State Plan Amendments  Chcf * 

IHSS  Cal AIM   Waivers 

 

  • This series of short explainers outlines the overlaps and gaps between three Medi-Cal Home and Community-Based Services programs and CalAIM Community Supports. The three explainers focus on:
    • Assisted Living Waiver
      Home and Community-Based Alternatives Waiver
      California Community Transitions    Read More * 
  •  

 

FAQ’s

When does coverage #start?

 

  • I applied for Medi-Cal but have not received any information from the county

Documentation Required during

Covered CA 90 Day  #Conditional Eligibility 

A 90 day conditional eligibility notice  means that you get coverage for 90 days even though Covered CA hasn’t verified that you qualify.  As long as you send the proofs that are being asked for, everything is fine!  There is NOTHING to worry about!  Just comply.  If you have trouble with compliance, email us.

Clients need to submit valid documentation for one or more of the following reasons:

You  can upload, fax, send to their Certified Agent or mail their documentation. More than one document may be required.

View our Conditional Eligibility Quick Guide * or Job Aid for more information on the notice and to view a list of acceptable Verification Documentation.

Look for this sentence in the letter that you get from Covered CA.

We need your proof within 90 days. If we get a response and you prove your citizenship by the due date above, you will keep your insurance through Covered California.

Here’s the biggest lesson I learned in one year of law school.  Read everything 3 times and when you think you understand it, read it again.

conditional eligibilty

Resources & Links

Immediate & Retroactive Medi Cal Coverage

more proofs

 

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 *

 

DHCS – Medi Cal Website 

Pending Applicants

  • For those who applied and
    • are likely [: having a high probability of occurring or being true : very probable –  rain is likely today Webster * ]
    • eligible, [qualified to participate or be chosen  –   eligible to retire Webster * ]
      • See our webpage on mandate for Government to write in plain English.

        • Contra proferentem is a rule of contract interpretation that states an ambiguous contract term should be construed against the drafter of the contract. The term contra proferentem is derived from a Latin phrase meaning “against the offeror.”

          Contra proferentem has become increasingly important with the rise of contracts of adhesion. Contracts of adhesion involve pre-written contracts which are offered on a strict take-it or leave-it basis, leaving no opportunity for a party to bargain over specific contractual terms. Because the party does not have an opportunity to negotiate, they may reasonably interpret a term in a different manner than the contract offeror intended. Contra proferentem exists to place the burden of ambiguity on the party most capable of mitigating that ambiguity – the person who wrote it.

          The doctrine of contra proferentem is also especially important in the field of insurance law due to the generalized nature of many of its terms. For example, it may be unclear if a policy that covers “water damage” will cover damage caused by a rainstorm induced mudslide. The doctrine of contra proferentem encouraged insurance providers to create enumerated lists of events that are excluded under a given policy, ultimately increasing clarity for insurance purchasers.  Source  Cornell Law *

    • 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.    Source DHCS.CA.Gov *

Western Poverty Law

An applicant can receive Medi-Cal coverage (and payment for Medi-Cal covered benefits received) for up to three calendar months preceding the month of application if they would have been eligible for Medi-Cal during those months. 148

Applicants can apply for retroactive Medi-Cal on the Medi-Cal application or after applying for Medi-Cal or CalWORKs by indicating the request on the application or by separate written request.149

Retroactive Medi-Cal can be requested for up to one year after the date of application150 so if there are outstanding bills, the Medi-Cal member should submit them to Medi-Cal for reimbursement or ask the provider to bill Medi-Cal.

Footnotes

147. Welf. & Inst. Code §§ 14017.7,   14017.8. Note that an individual is only sent a BIC if one has not been issued to that person previously. If the person was previously assigned a BIC, it is re-activated. If the beneficiary needs to request a new card, they can contact the county.  Additionally, beneficiaries can request a paper BIC from the county so they do not have to wait for the plastic card to arrive in the mail if they have an urgent need.
148. Welf. & Inst. Code §§ 14019, 14019.6; 22 CCR § 50197; MEDIL 14-27 (May 15, 2014),
149. 22 CCR § 50148(a)(2).  150. 22 CCR § 50148(b).  Source Western Poverty Law  Page 5.211 *

 

Email from at Chief at Medi Cal

Hello Mr.

Thank you for your email, and apologies for the delay in responding.

Due to the large number of Medi-Cal applications received through the Covered California website, it is taking longer than expected to verify all of the applications. Once an application is found likely eligible for Medi-Cal, it is sent to the applicant’s county of residence for processing. You and/or the applicant do not need to submit another application to the county if one has already been submitted. A tax penalty will NOT affect those who applied by the deadline and are waiting on an eligibility determination.

If the individuals you’re assisting would like more information about their applications and eligibility statuses, you or they can contact the applicant’s county human services agency

Please remember that in the event of an emergency where medical care is needed, individuals should call 9-1-1 or go to their nearest hospital. Medi-Cal will cover costs associated with services rendered while their application is pending.

Thank you for your patience.

Crystal Crystal M. Haswell,
Chief Outreach and Enrollment Unit
Medi-Cal Eligibility Division California Department of Health Care Services

 

Emails Rec’d from actual client

6.2.2023

 

Hi Steve,

Thanks for all the work you have put into this.  [redacted]  called the County level medi-cal this afternoon to ask about eligibility and inquiring about [redacted]  SSN. It was an hour wait but we got to talk to someone.

They confirmed that they have her correct SSN and that [redacted] is covered with temporary Medi-cal coverage until they finish processing her application. So that’s a relief. Once they’re done, we’ll get notified with whether she will be on medi-cal or a covered california plan.

We have case numbers and her temp medi-cal number so we can get updates if we don’t hear back. I think we are good to go regarding [redacted]’s  coverage. Thanks again for your help in this.

[redacted]

Ditto for what [my wife]  said!!
THANK YOU STEVE for all of you hard work!!!!
[redacted]

 

 

 

#Redetermination when Pandemic Ends

Medi-cal [Medicaid nationally] has not disenrolled anyone for say the past year and a half due to the COVID 19 pandemic.  When the pandemic emergency  is declared over it’s estimated that millions will lose coverage.  Those whose incomes are over 138% of Federal Poverty level can get Covered CA, FREE QUOTES.

Learn More ==>  Our webpage on Redetermination

Medi-Cal Managed Care HMO – Health Care Options 

#Pick your Plan

Here you can review and choose the HMO that you want to deliver your Medi-Cal health Care.

Medi Cal Provider HMO Selection Website

learn choose enroll medi cal plans

Learn more:

Health Insurance unfortunately is very complicated

President Trump February 27, 2017

Trump  Make America Healthy Again

  • The Supreme Court has determined that health insurance plans under the Affordable Care Act (ACA), also known as Obamacare, must continue to fully cover preventative services, including cancer screenings, HIV prevention medication, and mental health counseling, without co-pays or deductibles.  Forbes * 
  • Nearly half of the U.S. population is pre-diabetic or has type-2 diabetes. Every month, diabetes causes 13,000 new amputations, 5,000 new cases of kidney failure and up to 2,000 new cases of blindness in our country. In 1960, approximately 13 percent of American adults were obese. Now, more than 40 percent of Americans are obese, and more than 70 percent are either obese or overweight.
  • Even more shockingly, one-quarter of our teenagers today are pre-diabetic or have type-2 diabetes, and obesity is the leading medical reason that 71 percent of young Americans are disqualified from military service.  Learn More >>> The Hill 

6 positions 

  • 1. Mr. Kennedy has prioritized addressing chronic disease, which accounts for over $1 trillion in annual U.S. healthcare costs. He has stated that President-elect Trump seeks "measurable impacts" to combat the chronic disease epidemic within two years — a goal that has drawn attention from healthcare leaders, some of whom have praised its ambition while noting potential challenges.
  • Mr. Kennedy identified chronic disease as a key priority before his nomination to lead HHS. "I'm going to urge President Trump on day one to do the same thing they did in COVID, which is to declare a national emergency, but not for infectious disease, but for chronic disease," Mr. Kennedy said in a Sept. 26 interview, about one month after he dropped out of the presidential race.
  • His vision extends beyond healthcare delivery to address broader contributors to chronic disease. Mr. Kennedy has criticized the influence of the pharmaceutical and food industries, linking issues like obesity and diabetes to ultra-processed foods, federal subsidies and dietary guidelines.
  • He has called for reforms targeting food additives, pesticides and environmental health risks, alongside overhauls of agencies like the CDC and FDA.
  • Health systems may find some common ground in Mr. Kennedy's focus on prevention and early intervention to reduce chronic disease burdens, which could align with some of their efforts to address social determinants of health. However, experts, including former CDC Director Tom Frieden, MD, caution against oversimplification. "There are some things that RFK Jr. gets right," Dr. Frieden told NPR. "We do have a chronic disease crisis in this country, but we need to avoid simplistic solutions and stick with the science."
    .
  • 2. He's called for an end to direct-to-consumer advertising for prescription drugs. Mr. Kennedy has criticized the advertising relationships between pharmaceutical companies and news outlets, arguing that pharmaceutical advertising influences editorial content and public discourse beyond its intended purpose of promoting products. When his campaign was active in early 2024, Mr. Kennedy said if elected he would issue an executive order on his first day in office to ban pharmaceutical advertising on television.
  • Direct-to-consumer advertising of prescription drugs surged after the FDA eased restrictions in 1997 and totaled nearly $10 billion in 2016. Proponents argue it educates consumers and empowers patient involvement, while critics warn it can misinform patients, drive inappropriate prescribing and inflate healthcare costs. Concerns also include promoting costly brand-name drugs over cheaper alternatives, straining patient-physician relationships.
    .
  • 3. He has expressed interest in redirecting Medicare spending toward promoting healthy behaviors rather than covering certain pharmaceuticals. Mr. Kennedy has been a vocal opponent of Medicare and Medicaid funding for GLP-1 drugs used for weight loss, arguing that these programs should instead prioritize covering gym memberships and healthier food options for enrollees.
  • "For half the price of Ozempic, we could purchase regeneratively raised, organic food for every American, three meals a day and a gym membership, for every obese American," Mr. Kennedy said during a Congressional roundtable in September, as reported by the Associated Press.
  • The Biden administration recently proposed broader coverage of GLP-1 and weight loss drugs for Americans with obesity, a move that could put Mr. Kennedy in a reactive position if he secures confirmation to lead HHS.
    .
  • 4. He is considering changes to the Medicare physician fee schedule. Mr. Kennedy and his advisers are considering an overhaul of Medicare's payment formula, four anonymous sources told The Washington Post in November. The move could mark a bid to shift the health system's incentives toward primary care and prevention.
  • The Medicare physician fee schedule was adopted in 1992, establishing a complex system of administrative pricing based on the resource inputs used in producing physician services. It influences not only Medicare payments, but also private insurance payment systems, which often mirror Medicare's methodologies.
  • Sources told The Post that discussions about the fee schedule are in their early stages and have involved a plan to review the thousands of billing codes that determine how much physicians get paid for performing procedures and services. These codes are integral to determining reimbursement rates and have faced criticism for historically favoring procedural and specialty care over primary care services. An overhaul could address these disparities and potentially reshape the economics of medical practice across the country.
    .
  • 5. He has raised controversial and widely challenged claims about vaccine safety for nearly 20 years. Mr. Kennedy's suspicion of vaccines dates back to at least 2005, when he published an article called "Deadly Immunity" in unusual publications for the topic: Rolling Stone magazine (print) and Salon (digital). The article claimed that thimerosal, eliminated in routine childhood vaccines in 2001, caused autism. The article was amended and corrected several times before, years later, Salon announced in 2011 that it was retracting "Deadly Immunity" in entirety. An explanation of that decision and the corrections made to Mr. Kennedy's article are detailed by Salon here.
  • More recently, Mr. Kennedy said in a 2023 podcast interview that, "There's no vaccine that is safe and effective." The nonprofit Mr. Kennedy was aligned with for nearly a decade, Children's Health Defense, has been a vocal critic of COVID-19 vaccines and public health mandates, with its claims frequently challenged by public health experts. The group has filed dozens of federal and state lawsuits since 2020, many challenging vaccines and public health mandates. Mr. Kennedy has been on leave from the group as its founder, chairman and chief litigation counsel since he announced his plans to run for president in April 2023.
  • When described as anti-vaccine, Mr. Kennedy has pushed back. Instead, he argues that he wants to improve the science of vaccine safety. "We're not going to take vaccines away from anybody," he told NPR in November. "We are going to make sure that Americans have good information. Right now the science on vaccine safety particularly has huge deficits in it, and we're going to make sure those scientific studies are done and that people can make informed choices about their vaccinations and their children's vaccinations."
    .
  • 6. He supports abortion rights up to the point of fetal viability, after which he favors restrictions. Mr. Kennedy believes abortion should be legal up to a point he describes as when the fetus becomes viable outside the womb, after which he supports restrictions. Mr. Kennedy clarified this position in a video released in June 2024, though he did not specify an exact number of weeks for viability. He acknowledged that his views on abortion have evolved over time as he continued to explore the issue. In May 2024, he had expressed support for a woman's right to choose an abortion at any stage of pregnancy, including full term.
  • Mr. Kennedy has also pointed to the importance of addressing economic factors in discussions about abortion and reproductive health. "We should be looking at why there are so many abortions in the first place," he said, emphasizing the need to understand the financial challenges and economic pressures that contribute to abortion rates among individuals and families.
  • Mr. Kennedy introduced a plan while running for president called "More Choices, More Life" that called for a subsidized daycare initiative aimed at making childcare more accessible. He said universal childcare has the capacity to add $1 trillion to the U.S. GDP. "And since economics is a major driver of abortion, this policy will do more to lower abortion rates than any coercive measure ever could," the website for the plan states.    Becker Hospital Review *

Medi Cal Contact Information

 

 

  • Ombudsman Webpage
    • Phone: 1-888-452-8609
    • Email:   [email protected] 
      • The Office of Ombudsman cannot approve/terminate/reinstate Medi-Cal eligibility; alter aid codes, change/update addresses, change/update name or initiate inter-county transfers.

See our Main Webpage on Medi Cal contact information

Non MAGI Medi Cal

Medi Cal
out of state and  #emergency coverage?

 

  • CA Medi Cal – Out-of-state medical care is limited to the following:
    • (a) (1) When an emergency arises from accident, injury or illness; or
    • (2) Where the health of the individual would be endangered if care and services are postponed until it is feasible that he/she return to California; or
    • (3) Where the health of the individual would be endangered if he/she undertook travel to return to California; or
    • (4) When it is customary practice in border communities for residents to use medical resources in adjacent areas outside the State; or
    • (5) When an out-of-state treatment plan has been proposed by the beneficiary’s attending physician and the proposed plan has been received, reviewed and authorized by the Department before the services are provided; and the proposed treatment is not available from resources and facilities within the State.
  • (6) Prior authorization is required for all out-of-state services, except:
    • (A) Emergency services as defined in §51056.
      • “emergency services” means those services required for alleviation of severe pain, or immediate diagnosis and treatment of unforeseen medical conditions, which, if not immediately diagnosed and treated, would lead to disability or death.
    • (B) Services provided in border areas adjacent to California where it is customary practice for California residents to avail themselves of such services.  texas.gov/medicaid
    • Medi Cal Treatment Authorization Request
      • 540-1 (a) (5) When an out-of-state treatment plan has been proposed by the beneficiary’s attending physician and the proposed plan has been received, reviewed and authorized by the Department before the services are provided; and the proposed treatment is not available from resources and facilities within the State
  • Medi Cal only covers outside of CA for emergencies and very special circumstances.  Cornel Law *
  • Sources

#Explanation from Western Poverty Law

Chapter 2. MAGI Medi-Cal Programs

A. Constructing Households

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

Much more #detail on Medi Cal

 

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

Medi-Cal Confirmation - As soon as you apply through Covered CA!!!

Covered CA says wait to hear from Medi-Cal

Covered CA says wait to hear from Medi-Cal

Eligibility Window & Where to click

Eligibility Window & Where to click

Medi-Cal determines eligibility based on #monthly, not annual income. 

  • 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, as you reported it, as required by law, within 10 days, 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)

 

 

FAQ’s

Conditional & Temporary Coverage

  • What if Medi-Cal took hold of my file, but says I don’t qualify, is there a lapse in coverage? 
    Will Covered CA backdate coverage? 
  • Answer – you have conditional coverage while Medi Cal is investigating your application.  When Medi Cal disenrolls you, you are automatically enrolled under SB 260 into a Covered CA plan.  We can help you with that.  Just appoint us as your broker.  No extra charge.

Links & Resources

Report Changes Promptly 

#Report changes as they happen - within 30 days! 10 CCR California Code of Regulations § 6496

10 days for Medi Cal 22 CCR § 50185

Our webpage on ARPA & Unemployment Benefits - Silver 94 

report income changes

IRS Form 5152 - Report Changes

report changes as they happen

#VITA Volunteers Income Tax Assistance
 get your taxes done Free  

**********************************

CA Courts
#May I help you? 
Advise vs information

Covered CA Certified Agent

#Covered CA Certified Agent  

No extra charge for complementary assistance 

I'm in Sonia

 

MORE

Much more on Medi Cal

 

 

******************************************

Western Poverty Law - Insurance for Low Income

Advocate Guide to Medi Cal 

advocate guide to Medi Cal

Nolo Social Security, Medicare, Medi Cal & Government Pensions

nolo social security government pensions

 

  • Our Webpage on COVID 19

  • CA State Senator Steven Bradford 35th District 
  • His Webpage on COVID 19 Resources

  • BIC Benefits Identification Card

    Sample BIC Card

  • How to replace lost or stolen card?

Ask us a Question? FAQ's?

FAQ’s “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  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?
  • 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).

FAQ’s

  • How does Covered California work with Medi-Cal?
    • Covered California will act as a “one-stop shop” for health insurance. Through Covered California, you will be able to apply for Medi-Cal benefits electronically and receive a real-time eligibility results. You will also be able to report changes online and receive real-time customer support 24 hours a day. dhcs.gov More FAQ’s DHCS ♦ Insure Me Kevin.com
    • Disability Benefits 101 – Medi-Cal The Details
  • What is ​California Advancing and​ Innovating Medi-Cal (CalAIM)
    • Cal Aim is a long-term commitment to transform and strengthen Medi-Cal, offering Californians a more equitable, coordinated​, and person-centered approach to maximizing their health and life trajectory.​​​​
    • Goals of C​alAIM​
      • 1. Identify and manage comprehensive needs through whole person care approaches and social drivers of health.
      • 2. Improve quality outcomes, reduce health disparities, and transform the delivery system through value‑based initiatives, modernization, and payment reform.
      • 3. Make Medi-Cal a more consistent and seamless system for enrollees to navigate by reducing complexity and increasing flexibility. DHCS *
  • why doesn’t medi-cal really help? So long on #hold, so much wasted time?

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
    • Try the contact people and departments on this page
    • 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.
    • 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
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42 comments on “Medi-Cal – MAGI Income Eligibility Criteria”

  1. https://www.chcf.org/wp-content/uploads/2017/12/PDF-PhysicianParticipationMediCalEnrollmentBoom.pdf

    https://www.chcf.org/resource/medi-cal-seniors-policy-at-a-glance/#related-links-and-downloads

    https://www.cmadocs.org/newsroom/news/view/ArticleId/21480/Study-finds-fewer-California-physicians-accept-Medi-Cal-despite-a-surge-in-patients

    https://www.commonwealthfund.org/blog/2025/how-medicaid-state-directed-payments-support-critical-health-care-providers

    Reply

  2. If your carry over net operating loss (from prior years) is allowed to be taken into account, is it part of the Federal Modified Adjusted Gross Income number ) or does California specifically require you to take it out of the equation?

    REPLY

    See our webpage on Capital Gains and Carry Over Losses

    Reply

  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/

    Reply

  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?

    Reply

  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.

    Reply

    • 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?

      Reply

      • 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”

        Reply

  7. 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.

    Reply

    • 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?

      Reply

      • 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?

        Reply

    • 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…

      Reply

  10. 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?

    Reply

    • 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 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.

      Reply

  12. 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?

    Reply

    • 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

      Reply

  13. 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?

    Reply

    • 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.

      Reply

      • 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

        Reply

      • 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?

        Reply

        • 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

          Reply

  14. 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

    Reply

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