Kevin Knauss: Health, History, Travel, Insurance
Posts related to California's Medi-Cal program, specifically MAGI based, income eligibility, enrollment, costs, children, Covered California.
Your children could be flipped into Medi-Cal if you return to Covered California without having properly terminated Medi-Cal earlier. On numerous occasions, children were flipped from Covered California to Medi-Cal, even if the stated estimated income was high enough to make everyone eligible for the subsidies.
The Public Health Emergency (PHE) conditions state that no one will be terminated from Medi-Cal unless they move out of state. Of course, individuals can report a change to their situation, such as gaining employer sponsored health insurance, and seek a termination from Medi-Cal.
Consumers transitioned to Covered California do not have to keep the lowest cost Silver plan they have been enrolled into. You can select a lower or higher metal tier plan (Bronze, Gold, or Platinum.) You can select a different health plan that may support your doctors. For example, you may have been enrolled in a Kaiser Silver plan, but your doctors are affiliated a different medical group; you can change the plan selection.
Does my Medi-Cal insurance cover my abortion? Yes. Is my private insurer required to cover my abortion? Yes for most people. California law is clear that abortion care is basic health care, and most insurance plans must cover basic health care services. This requirement does not apply to employers that provide “self-funded” health care coverage or grandfathered plans.
The higher asset limit applies to non-exempt assets. Generally, assets exempt from the calculation are an individual’s house as a primary residence, one car, burial plot, up to $1,500 in a burial expense account, furniture, and other household and personal items. What has stymied many people from being eligible for some Non-MAGI Medi-Cal programs are the non-exempt assets such as savings accounts, stocks, bonds, or other assets that could be liquidated to pay for health care services.
Currently, there are 14.5 million Californians in some sort of Medi-Cal health care program. This represents a 16 percent increase since March 2020, largely attributed to continuous coverage requirements of the PHE. Based on Medi-Cal outreach mailings that had a 12 percent return rate, undeliverable, DHCS estimates that upwards of 2 million people could lose their Medi-Cal coverage due to loss of contact.
Santa Barbara County sent a letter saying the couple did not qualify for Medi-Cal. They then received a letter from Covered California stating that they no longer qualified for any subsidy. When I accessed the couple’s Covered California account, all of their income information had been erased. When I looked at the transaction history on the Covered California account, Santa Barbara County Medi-Cal office had accessed the account and submitted changes.
In addition to the above exemptions, Estate Recovery can be waived if substantial hardship exists for the surviving family members. Estate Recovery is targeted at the assets of the deceased beneficiary. If the deceased Medi-Cal beneficiary owns nothing when they die, nothing will be owed. The State will never force children to move to force the sale of a home to satisfy Estate Recovery.
When you receive an inheritance of money, that cash is an asset, no different than a savings account. The inheritance is not counted as monthly income. It is generally considered a one-time lump sum distribution. Consequently, an inheritance of money should not impact your MAGI Medi-Cal eligibility.
L.A. Care’s systemic failure to timely process prior authorizations for health care services delayed members’ access to medically necessary health care services and had a detrimental impact on its members. Examples of member harm caused by authorization delays include a cancer patient’s health deteriorating, a plan member suffering extreme pain for over two weeks, and another cancer patient given a prognosis of six to nine months to live who disenrolled from L.A. Care because of treatment delays.
