Guidance offered by Covered California to Certified Insurance Agents assisting consumers with enrollment into MAGI Medi-Cal
On or about August 17, 2016, a departing CalOptima employee downloaded data, which included protected health information, to an unencrypted USB flash drive. Shortly after, the departing employee returned the USB flash drive to CalOptima. While we are still investigating the contents of the flash drive, we do not believe the information was shared.
People who turn 65 and may have been receiving a hefty subsidy through Covered California to reduce their health insurance premium can be shocked at the costs of enrolling in Medicare. However, there are a variety of resources to assist Medicare beneficiaries to lower their health insurance and health care costs. Assistance from both Social Security and Medi-Cal may be an option for some Medicare beneficiaries depending on their household income.
Beginning in August, 2016, Covered California will send a notice to those consumers approaching or are over their 65th birthday who may be eligible for Medicare. The notice advises them that they may no longer be eligible for Advanced Premium Tax Credit or Covered California coverage. If the consumer receives the notice, it will be displayed in the online application (CalHEERS).
Covered California will be performing an update to their online application that will allow undocumented children to become eligible for full-scope Medi-Cal benefits on May 16, 2016. Children under 19 years of age and whose household income is below 266% of the federal poverty level will not have to verify their immigration status. They will not have to provide proof of citizenship, lawful presence, or proof of immigration status in order to become eligible for Medi-Cal.
When a woman completes an Application for Coverage with Covered California and checks the box to indicate she is pregnant, she should be given the option to stay on a Covered California plan. Instead, the system is moving some women in low-income ranges to Medi-Cal.
Covered California has updated their income table for qualifying for either the premium assistance or Medi-Cal. The new income amounts reflect the modest increase to the federal poverty levels (FPL) which is the foundation for premium assistance. The new income amounts only apply to individuals and families who will apply for health insurance through Covered California for 2016. Households who renewed their coverage in 2015 or enrolled during open enrollment for 2016 are not affected by the higher income levels in most situations.
Covered California has updated their online application for 2016 open enrollment to automatically determine the eligibility of former foster youth and pregnancy coverage for Medi-Cal programs. In previous online versions the applicant was directed to the respective program for more information and final eligibility determination. In many situations the new Covered California enrollment website will help place the individual directly into the program they are eligible for.
The purpose of this letter is to provide counties with guidance regarding fluctuating or self-employment income, and the use of projected annual income when transmitting income to the California Healthcare Eligibility, Enrollment and Retention System (CalHEERS) to calculate MAGI. Self-employment or fluctuating income may include income received from self-employment, partnerships, s-corporations, royalties, estates, trusts and real estate rentals.
Recognizing that we need both access and affordability, today we issued a notice to all 50 state Medicaid directors and sent letters to the CEOs of several drug manufacturers about providing access to therapy for Hepatitis C patients. Our notice to state Medicaid directors reminds states of their obligation to provide access to these promising therapies (consistent with section 1927 of the Social Security Act) based on the medical evidence, and that they have tools available to manage their costs. Our letter to manufacturers asks them to provide us with information on pricing arrangements and asks them for ideas to support the provision of these lifesaving medications to Medicaid programs at sustainable prices.