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Will college students flood Covered California Medi-Cal health plans?

California is facing the prospect of adding 1.4 million people1 to its Medi-Cal rolls because of the expanded eligibility for the Medicaid program under the Affordable Care Act. Children, individuals, and families will automatically be placed into a Medi-Cal HMO health plan category when they apply for health insurance through Covered California and their income is below certain federal poverty level guidelines.

No tax credits if Medi-Cal eligible

Once a person is deemed eligible for Medi-Cal, they are not eligible for premium assistance. If the individual or family wants discounted or no cost health insurance they must accept Medi-Cal. They always have the option of purchasing a private health plan through Covered California at full market price.

California Department of Managed Health Care Model Notice for insurers

Medi-Cal is changing to 

Free or low-cost health insurance is available through Medi-Cal. Medi-Cal is California’s health care program for people with low incomes. You can get Medi-Cal if:

Your income is low; and

Your eligibility is based on your income. It is not based on how much money you have saved or if you own your own home. You do not have to be on public assistance to qualify for Medi-Cal. You can apply for Medi-Cal anytime.

You are a U.S. citizen, U.S. national or lawfully present in the U.S.

Will college students flood into Medi-Cal?

We can be fairly certain that the big push to enroll college students into new ACA health plans will result in a large portion of the students channeled into Medi-Cal plans. It is estimated that are 480,000 young adults age 19-29 that will be eligible for Medi-Cal2. If we assume a full-time student is able to work 20 hours per week, that monthly wage still puts them below the 138% of the federal poverty line ($15,865) and automatic Medi-Cal.

20 hours x $10.50 = $210.00 per week x 4 weeks = $840.00 x 12 months = $10,080.00 per year

It may be an allusion that young invincibles are necessary to make the ACA a success when so many will not be enrolled in private health insurance but state subsidized Medicaid programs. Nonetheless, Covered California and state universities will be making a concerted effort to get college students to sign up for the new health plans.

Medi-Cal is turning into big money maker

Of course, Medi-Cal is administered on the county level and many of the health plans are run by private companies. Many insurance companies see the expanded Medi-Cal enrollment program as a real money maker (see- Aetna finds profit opportunity in Medicaid under ACA and Wellpoint to acquire Medicaid administrator). Even if the monthly reimbursement might not be equal to market rate premiums, the government usually pays promptly relieving the company of chasing down people who don’t pay their monthly premiums in the individual market. The big fat icing on the cake is that young college kids aren’t sick and don’t get sick. So relative to the entire Medicaid population, insurance companies will make money from the young adult Medi-Cal members.

Medi-Cal has all the new ACA benefits

The good news is that all the Medi-Cal HMO plans will be equivalent to health plans through Covered California or outside the exchange. They will all include the 10 essential health benefits, preventive office visits at no charge, contraceptives and low or no copayments for most services. The downside is that the members will have to designate a primary care physician and only use the network of providers associated with the health plan.

A really tight provider network

Many of the networks will not be as large as health plans offered through Covered California carriers. Medi-Cal providers receive lower reimbursements for services than those negotiated by private health insurance companies. The reduced payment schedule, which is under pressure to be cut even more, has led many physicians to scale back the number of Medi-Cal members they see or exit the program as a provider all together. Consequently, wait times for office visits and services may grow longer as more low income California residents are funneled into Medi-Cal health plans.

Each county administers the Medi-Cal health plans through their Health and Human Services Department. The HMO plans bid to offer their health plans to the various counties. Some counties will have multiple plan to choose from while other counties will only have one plan

October Update

From all the news reports thousands college students who are not taken as a dependent on their parents taxes have successfully enrolled in a county based Medi-Cal HMO plan with no problems at all. However, I have heard reports that San Diego County has been very aggressive with college students trying to determine if they truly have an income below 138% of the Federal Poverty Line. Tactics include numerous letters demanding letter of income and parental assistance and phone calls to verify income. San Diego County even denied one woman Medi-Cal after Covered California determined she was eligible. I’d be interested in hearing if anyone else has been challenged by their county over their Medi-Cal eligibility.

Covered California Medi-Cal health plans by county

California Medi-Cal Health Plans, November 1, 2013
County – Plans
Alameda
Alameda Alliance for Health 
Anthem Blue Cross Partnership Plan
Alpine
Anthem Blue Cross Partnership Plan
California Health & Wellness
Amador
Anthem Blue Cross Partnership Plan
California Health & Wellness
Butte
Anthem Blue Cross Partnership Plan
California Health & Wellness
Calaveras
Anthem Blue Cross Partnership Plan
California Health & Wellness
Colusa
Anthem Blue Cross Partnership Plan
California Health & Wellness
Contra Costa
Anthem Blue Cross Partnership Plan
Contra Costa Health Plan
Del Norte
Partnership Health Plan of California
El Dorado
Anthem Blue Cross Partnership Plan
California Health & Wellness
Fresno
Anthem Blue Cross Partnership Plan
CalViva Health    
Glenn
Anthem Blue Cross Partnership Plan
California Health & Wellness
Humbolt
Partnership Health Plan of California
Imperial
California Health & Wellness
Molina Healthcare of California Partner Plan, Inc.
Inyo
Anthem Blue Cross Partnership Plan
California Health & Wellness
Kern
Health Net Community Solutions, Inc.
Kern Family Health Care
Kings
Anthem Blue Cross Partnership Plan
CalViva Health   
Lake
Partnership Health Plan of California
Lassen
Partnership Health Plan of California
Los Angeles
Positive Healthcare
Health Net Community Solutions, Inc.    
L. A. Care Health Plan
Madera
Anthem Blue Cross Partnership Plan
CalViva Health   
Marin
Partnership Health Plan of California     
Mariposa
Anthem Blue Cross Partnership Plan
California Health & Wellness
Mendocino
Partnership Health Plan of California        
Merced
Central California Alliance for Health 
Modoc
Partnership Health Plan of California
Mono
Anthem Blue Cross Partnership Plan
California Health & Wellness
Monterey
Central California Alliance for Health      
Napa
Partnership Health Plan of California    
Nevada
Anthem Blue Cross Partnership Plan
California Health & Wellness
Orange
CalOptima    
Placer
Anthem Blue Cross Partnership Plan
California Health & Wellness
Plumas
Anthem Blue Cross Partnership Plan
California Health & Wellness
Riverside
Inland Empire Health Plan
Molina Healthcare of California Partner Plan, Inc.
Sacramento
Anthem Blue Cross Partnership Plan  
Health Net Community Solutions, Inc.
Kaiser Permanente
Molina Healthcare of California Partner Plan, Inc.
San Benito
Anthem Blue Cross Partnership Plan
San Bernardino
Inland Empire Health Plan
Molina Healthcare of California Partner Plan, Inc.
San Diego
Care 1st Partner Plan, LLC
Community Health Group Partnership Plan 
Health Net Community Solutions, Inc.
Kaiser Permanente
Molina Healthcare of California Partner Plan, Inc.
San Francisco
Anthem Blue Cross Partnership Plan
Family Mosaic Project  (No Website)
San Francisco Health Plan
San Joaquin
Health Net Community Solutions, Inc.  
Health Plan of San Joaquin   
San Luis Obispo
CenCal Health   
San Mateo
Health Plan of San Mateo     
Santa Barbara
CenCal Health    
Santa Clara
Anthem Blue Cross Partnership Plan
On Lok Lifeways
Santa Clara Family Health Plan
Santa Cruz
Central California Alliance for Health    
Shasta
Partnership Health Plan of California
Sierra
Anthem Blue Cross Partnership Plan
California Health & Wellness
Siskiyou
Partnership Health Plan of California
Solano
Partnership Health Plan of California     
Sonoma
Partnership Health Plan of California        
Stanislaus
Health Net Community Solutions, Inc.  
Health Plan of San Joaquin  
Sutter
Anthem Blue Cross Partnership Plan
California Health & Wellness
Tehama
Anthem Blue Cross Partnership Plan
California Health & Wellness
Trinity
Partnership Health Plan of California
Tulare
Anthem Blue Cross Partnership Plan      
Health Net Community Solutions, Inc.
Tuolumne
Anthem Blue Cross Partnership Plan
California Health & Wellness
Ventura
Gold Coast Health Plan
Yolo
Partnership Health Plan of California   
Yuba
Anthem Blue Cross Partnership Plan
California Health & Wellness
*Health plans are from the DHMC website and may change
**Anthem Blue Cross link was not working as of
November 2, 2013. It might work in the future.

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1,2 CalSIM version 1.8 Statewide Data Book 2014 – 2019, UCLA Center for Health Policy Research and UC Berkeley Labor Center.

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With poverty level income, most college students will be Medi-Cal eligible under the ACA.