If you have to move out of your county because of the wildfires you may be entitled to a Special Enrollment Period. California is broken into 19 different rating regions. Los Angeles County is actually two regions, 15 and 16. If you move to a different region, you have a qualifying event for a Special Enrollment Period IF you already have health insurance.
Upon review, the consumer was now listed as an American Indian or Alaska Native, there was no selection for current health insurance or Medicare enrollment, and the application showed a higher income than we had estimated for 2019. This is not the first time I have seen individuals and whole families being flipped into American Indian or Alaska Native designation. As mentioned earlier, Covered California seems to automatically erase the current health plan information during the renewal. But this was not a renewal, just a correction to Medi-Cal eligibility.
The proposed rule is complicated and has many conditions and exclusions. Because of this complexity, many individuals and families with lawful permanent status, and enrolled in Covered California, or who have children enrolled in Medi-Cal, are fearful as being labeled as a Public Charge. Covered California has sought to allay the fears of people who might be affected by the proposed rule that their participation in Covered California and monthly premium tax credit subsidy they receive will not adversely impact their status.
Caution! There are known data miss-match issues between SAWS and Covered California CalHEERS software. When a consumer is released from Medi-Cal it is necessary to scrub the application and look for missing or inaccurate data and conditions. The missing data could prevent the individual or family from getting the subsidy. It could be as simple as the application no longer indicating that the consumer will file taxes. This is simply fixed by checking Yes, the consumer will file taxes. Both Covered California and Medi-Cal are working to resolve this issue.
The Medi-Cal representatives also confirm that erroneous information can pop into Covered California applications after an individual or family has been terminated from Medi-Cal. Once a person is deemed no longer eligible for Medi-Cal, the SAWS Soft Pause is released and the individual and family can then enroll in a Covered California plan with the tax credit subsidy. Unfortunately, the data on the Covered California can be missing or in accurate from what was originally entered.
Because Peter did not have health insurance in the last 60 days, he technically doesn’t qualify to enroll in a health plan in California. But when Peter moves out to California, his job has not started and he has no monthly income, he is just living off of his savings until the job starts in early summer. Because Peter has no monthly income, he qualifies for MAGI Medi-Cal.
The 2018 guidelines reflect the 2.1 percent price increase between calendar years 2016 and 2017. After this inflation adjustment, the guidelines are rounded and adjusted to standardize the differences between family and household sizes. Included with this informational bulletin is the 2018 Dual Eligible Standards chart that displays the new standards for the Medicare Savings Program categories.
The question no one can answer for me is if the expanded Medi-Cal HMO capitation rates have been decreasing because there are more healthy people in the Medi-Cal pool? Or are there other factors that are driving down the rates. There must be good money in Medi-Cal as Aetna, Blue Shield, and United Healthcare have all been approved to offer Medi-Cal HMO plans alongside other private health insurance companies such as Anthem Blue Cross, Health Net, Kaiser, and Molina.
For a single adult applying through Covered California, the monthly income must be greater than 138% of the Federal Poverty Level ($1,397 monthly, $16,754 annually) in order to qualify for private health insurance with the premium tax credit subsidy. If the individual or household is below 138% of the FPL, they will be deemed eligible for Medi-Cal.
A significant drop in household income does not qualify you to apply to Covered California for the tax credit subsidy to lower your monthly health insurance premium. If you are already in Covered California, you can report a change of income and then select a different health plan.