Kevin Knauss: Health, History, Travel, Insurance
Posts related to California's Medi-Cal program, specifically MAGI based, income eligibility, enrollment, costs, children, Covered California.
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.
Covered California sent out a notice that some children in the Bay Area will be deemed Medi-Cal eligible and will be taken off their parent’s health plan as of April 1, 2016. The expanded Medi-Cal kids’ option only applies to the Bay Area counties of San Mateo, San Francisco, and Santa Clara. Because these counties have a higher cost-of-living, they have higher income eligibility for the Medi-Cal kids program. Whereas most families have their children dropped in Medi-Cal if their Modified Adjusted Gross Income is below 266% of the federal poverty line (FPL), in these Bay Area counties children qualify for Medi-Cal with a household income of 322% of the FPL.
With the expansion of Medicaid in California a large number individuals and families are now enrolled in a Medi-Cal health plan. The expanded Medi-Cal managed health care plans must cover all the same benefits as private health insurance purchased through Covered California. There is no cost to the consumer in terms of monthly premium, deductible, coinsurance or copayments. However, enrollment in these plans does cost something and I’m often asked how much these plans cost the tax payer.
Medi-Cal county eligibility workers continue to tamper with the estimated income of Covered California consumers. The result of these unauthorized adjustments to household income is families continue to get dumped into Medi-Cal with no warning. Covered California continues to allow these anonymous bureaucrats to make unauthorized income adjustments with notification to the member. These nameless and faceless bureaucrats, making sometimes life and death decisions about a families’ health insurance, are the embodiment of government power run amok that scared so many opponents of Obamacare.
If a woman indicates on her Covered California individual and family plan account that she is pregnant, the application will be automatically screened for eligibility of certain Medi-Cal pregnancy programs. Some women have found that they are kicked off their private health plan with the premium assistance and relegated to the health care services only from Medi-Cal. This means they may not be able to see their regular OBGYN for pre-natal visits. However, you do not have to report your pregnancy to Covered California and risk being forced onto Medi-Cal.
The Department of Health Care Services (DHCS) has developed a Medi-Cal household size flow chart. The DHCS Guide for Calculating MAGI Medi-Cal Individual Household Size was originally developed to help county eligibility workers ascertain the actual household size under the new Affordable Care Act (ACA) rules. The newly expanded Medi-Cal eligibility under the ACA revolves around on IRS definitions for tax dependents and non-filer rules. Because families can be so diverse and the rules regarding what constitutes a tax family so complicated, the flow chart for determining household size was created.
Covered California Certified Insurance Agents assisted 429,365 individuals for possible enrollment into the expanded ACA Medi-Cal health insurance from January 1, 2014 through July 31st, 2015. The Medi-Cal assistance enrollment figure comes from a Public Records Act Request that I submitted in early October of 2015 to Covered California. As the $58 compensation to agents for Medi-Cal enrollments ceased over the summer I felt it was important to learn the level of agent involvement with funneling Californians in Medi-Cal health plans.
