The Western Center On Law & Poverty has put together a comprehensive guide to the Medicaid program in California known as Medi-Cal. Published in March 2016, there are bound to be changes to many of Medi-Cal’s programs, conditions, and eligibility in 2017. Titled Getting and Keeping Health Coverage for Low-Income Californians: A Guide for Advocates is 375 pages long and covers many topics from eligibility, citizenship, enrollment, re-determination, and the variety of programs Medi-Cal offers such as Children’s Health Insurance Program, Medi-Cal Access Program (MCAP) for pregnant women.
Like a mugger coming out of the shadows, San Diego County Medi-Cal worker(s) mugged a family enrolled in Covered California and stole their health insurance for 2107. The attack was unprovoked as the couple had not been in Medi-Cal and don’t have any children in Medi-Cal. However, Covered California reported the family to San Diego County because the family fit the profile of a household who they think aren’t smart enough to estimate their own income for 2017.
Several clients have contacted me regarding eligibility determination forms they have received from Medi-Cal, even though some or all of the family members have a Covered California plan with the tax credit subsidy. Even if the household information on the forms is wrong, Covered California consumers should supply the necessary information to their county Medi-Cal office or risk losing their private health plans altogether. Medi-Cal has effectively taken over the functions of Covered California if the family had been in Medi-Cal or if they still have children covered by Medi-Cal.
Consumers logging into their Covered California accounts hoping to renewal their health insurance may find they have lost their subsidy. Instead of the reduced premium amount they are used to paying, Covered California displays that are not receiving the tax credit subsidy and must pay the full premium amount. A common denominator for consumers who have lost their subsidy is that they had been on Medi-Cal in 2016, but later in the year qualified for Covered California and the Advance Premium Tax Credits to lower their monthly health insurance bill. The transfer of critical application information from Medi-Cal to Covered California is missing, triggering a loss of the subsidy.
One Orange County Medi-Cal eligibility worker not only made his necessary changes to the consumer’s account, he also corrupted some information within the Covered California enrollment system. Because Medi-Cal puts a soft pause on the consumer’s account when one of the household members is eligible for Medi-Cal, only the county Medi-Cal worker can correct the wrong mailing address they created and reverse the Covered California consumer’s negative declaration of interest in subsidized health insurance.
The implementation of Obamacare requires it to be administered by a variety of federal, state, and local government bureaucracies. Many consumers have been caught in a swirl of seemingly conflicting and utterly confusing rules, advice, and government forms. This cauldron of Obamacare confusion is particularly acute among individuals over 55 years old who are subject to California’s Medi-Cal Estate Recovery program. The anxiety instilled in this population is compounded by conflicting IRS 1095 forms that seem to open the door to a large tax bill for the repayment of the premium subsidies they received during the year.
Covered California will strip the health insurance subsidy from consumers who have not filed their federal taxes beginning on May 16, 2016. Word of the non-tax filer ineligibility for the Obamacare tax credits was released in a summary of updates to the Covered California online application software known as CalHEERS. The release notes for the CalHEERS 16.4 update state that enhancements to the application will include a way for consumers to attest that they have filed their taxes.
Medi-Cal advocate Beth Capell smeared the reputation of all health insurance agents by insinuating that agents enroll Medi-Cal eligible children in private plans just for the commissions they derive from those enrollments. Ms. Capell is assuming, incorrectly, that all health agents put money above the best interest of their clients. It’s unclear where Ms. Capell’s animus towards health agents springs from when thousands of agents have assisted tens of thousands of families with enrollment in Covered California and Medi-Cal health plans.
Two years after the launch of Covered California and expanded Medi-Cal, California’s Department of Health Care Services and each of California’s fifty-eight counties, that individually administer Medi-Cal managed health plans for eligible residents, are still grappling with numerous questions regarding eligibility, enrollment, and the integration with the Covered California application.
On March 7 Covered California updated their online enrollment program with adjustments to how changes to income are calculated, plus new required fields for attestations from former foster youth. The Covered California CalHEERS program was also updated with new federal poverty level (FPL) incomes. A significant update will affect children in San Mateo, San Francisco, and Santa Clara counties where the higher household income of 322% of the FPL makes more children 18 years and younger in those counties eligible for Medi-Cal.