Covered California Medi-Cal Verification

The enrollment of individuals and families under the expanded Medicaid provisions of the ACA is not a slam dunk with either the mailing in of an application or clicking “enroll” on a website. A variety of documents will usually need to be sent to complete the enrollment at the county level. Not submitting the verification documents could ultimately delay enrollment for people who desperately need the insurance.

Medi-Cal Verification process is a mystery

The game plan at Covered California is that families applying for health insurance will either be routed to private health insurance with premium assistance or, if their forecasted income is below the expanded federal poverty line, the application is transferred to the respective county that the applicant resides in for enrollment into Medi-Cal. With absolutely no training on how California’s Medicaid system, known as Medi-Cal, actually works, most agents and possibly Certified Enrollment Counselors are clueless as to the enrollment process. Update: newly released chart on how each state will attempt to verify Medicaid eligibility from State Reforum: State Medicaid and CHIP Eligibility Verification Plans

Where do you live?

It is my understanding that there is no more asset test (How many cars do you own? How big is your bank account?) for qualification for Medi-Cal. However, there still is a residency requirement along with immigration and income verification. The county health and human services office will have to document and verify that the applicant’s lives in the county are lawful/eligible immigrants and their current income level. Residency Verification: whether applying online or with a paper application, Covered California will always need to verify residency for Medi-Cal because it goes by county. Always submit some sort of proof of residency such as a car registration or utility bill.

Confusing Covered California paper application

The Covered California paper application states on page 18 that if the applicant wants to be considered for Medi-Cal, they (Covered California or the county is not specified) will contact the applicant to get property and asset information. Well, I thought that property and assets were no longer part of the eligibility test? This is just a sample of the confusion that surrounds the Medi-Cal system where getting real information is like solving the mystery of Stonehenge. And when we are working with homeless folks, the staid and formal rules just don’t work.

Getting through the bureaucratic tunnel

The online application through the Covered California website automatically puts the applicant into a Medi-Cal path when the income is below the threshold. At the end of the online application the applicants are instructed to upload residency and income verification. The applicant is not instructed that someone will contact them and there is no mention of assets or property. It’s all a little confusing. We need to help Medi-Cal eligible families traverse the dark tunnel of bureaucracy so they can safely exit with health insurance at the other end.

Are counties ready for the flood of Medi-Cal applications?

Frankly, I can see most counties being overwhelmed with Medi-Cal applications and being swamped with trying to contact people for verification documents. This is where agents and certified enrollment Counselors need to be proactive and collect, copy, scan, upload and/or mail the documents to Covered California for the client. If at all possible, the applicant needs to send all requested documents.

Don’t expect a call anytime soon

As of November 15th, six weeks after the start of open enrollment, neither Covered California nor any county official has contact any of my clients requesting verification documents. I’m instructing my clients to make copies of the necessary documents and mail them to Covered California with a cover letter which includes their case and application number. Those two identifiers can be found in the upper left hand corner of the screen after logging into the Covered California website.

Mail to:

Covered California, P.O. Box 989725, West Sacramento, CA 95798-9725

January 1, 2014 or 2015?

With luck, those verification documents will find their way to the right application and county. For some Californians, if we send the documents with a paper application, upload scanned docs, or mail them to Covered California, they might get Medi-Cal by December for a January health insurance start date.

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Agents need to help families get through the dark bureaucratic tunnel to Medi-Cal insurance.
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  • puzzledinla

    Re providing additional verifications for property etc, the form clearly states this is only needed to be considered for additional Medi-Cal programs such as disabled assistance or help for seniors.

    • Kevin Knauss

      True, Medi-Cal is a huge program and encompasses several different areas. But if someone qualifies for Medi-Cal health, they might need those other services as well.