Kevin Knauss: Health, History, Travel, Insurance
Posts related to California's Medi-Cal program, specifically MAGI based, income eligibility, enrollment, costs, children, Covered California.
The Medi-Cal HMO plans are very similar to private health insurance plans. The plans have member ID cards, a provider network, and a drug formulary. One of the biggest complaints I hear is that the Medi-Cal HMO plans have few primary care providers and specialists that are accepting new patients. I also hear the same complaint from my clients in private health plans.
If Medi-Cal makes any changes to your account through Covered California, and you have family members who are in a private health plan through Covered California, you need to finalize the new plan. In the above scenario, an additional subsidy was applied to lower the health insurance premium.
ABLE account beneficiaries can contribute their own income or property to their ABLE account. A beneficiary may transfer countable property to their ABLE account to spenddown excess property.
When the Covered California system is in the renewal mode, changes to your household will affect enrollment and subsidies for 2020. If you need to make changes for 2019, you will want to go through the Report A Change function on the home page.
The requirement to repay cost of Medicaid and CHIP benefits pertains only to a sponsor who has signed a Form I-864 Affidavit of Support or a Form I-864A Contract. The state agency may not seek repayment from the sponsored immigrant.
Covered California has developed a reprieve from immediate reporting to SAWS in the event of an error on the application that triggers Medi-Cal eligibility. The one-day delay in reporting the eligibility results to Medi-Cal is outlined in the CalHEERS 19.7 release scheduled to be implement on July 22, 2019.
The brochure also outlines the rights and responsibilities of the Medi-Cal beneficiary. Eligibility determinations, either enrollment or termination, can be appealed. myMedi-Cal discusses the time periods for the appeals and the right to a State Fair Hearing.
Until Covered California fixed the glitch, all women who reported they were pregnant were channeled into the Full Scope Medi-Cal for Pregnant Women program and had their Covered California health plans automatically terminated. This was a nightmare for many families as it completely disrupted their plans for the OBGYN they wanted to see and where they wanted to have their baby delivered.
The HIPP program pays the medical insurance premiums, coinsurance, deductibles, and other cost-sharing obligations for the individual. The annual cost of the premiums and member cost-sharing is compared to the estimated cost of an equivalent set of Medi-Cal services. Outlined in in an ACWD Letter 09-02, DHCS uses a specific formula to determine the cost-effective nature of the private insurance over Medi-Cal FFS.
The benchmark 100% federal poverty level income for a single adult increased 3% from $12,140 in 2018 to $12,490 for 2019. The all important Covered California premium tax credit eligibility income (138% of the FPL) for a single adult increased from $16,754 for 2018 to $17,237 in 2019. This means a single adult now has to have an annual Modified Adjusted Gross Income (MAGI) of $17,237 to be eligible for Covered California if they apply for health insurance in 2019.
