Kevin Knauss: Health, History, Travel, Insurance
Posts related to California's Medi-Cal program, specifically MAGI based, income eligibility, enrollment, costs, children, Covered California.
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.
For a single adult, the monthly Medi-Cal income was $1,482. In 2022, the monthly income will increase to $1,564. In other words, an adult can earn up to $1,564 per month and still qualify for no cost Medi-Cal. MAGI Medi-Cal annual amounts for a single adult increased to $18,755, from $17,775 in 2021, for a single adult.
The Department of Health Care Services (DHCS), the agency that manages the county based Medi-Cal system, has worked, and struggled, to efficiently determine MAGI Medi-Cal eligibility from the income section of the Covered California application. In a February 19, 2021, All County Welfare Directors letter, No. 21-04, DHCS outlined some of the changes to Modified Adjusted Gross Income (MAGI) calculations for MAGI Medi-Cal eligibility determinations.
The new law requires Covered California to automatically enroll individuals who have been terminated from Medi-Cal into the lowest cost Silver plan in the person’s region. The automatic enrollment is meant to prevent a gap from when an individual or family is terminated from Medi-Cal to when they enroll in a new health plan.
Individuals and families who enrolled in health insurance through Covered California for plan year 2021 were determined eligible for any federal or California premium assistance based on 2020 FPL numbers. Even if the new FPLs are higher than the estimated income, the enrollment and subsidies will continue. However, if you make change to your application during the year, the new FPLs will apply and could trigger Medi-Cal eligibility.
California policy states that Disaster and Emergency assistance payments received from federal, state, or local government agencies is exempt from both Modified Adjusted Gross Income (MAGI) and non-MAGI Medi-Cal programs. Consequently, county Welfare Directors have been directed to disregard the LWA when making income eligibility determinations. However, for Covered California, the LWA money is counted as taxable income for eligibility and calculation of the monthly Advance Premium Tax Credit subsidy (federal) and the California Premium subsidy.
