Kevin Knauss: Health, History, Travel, Insurance
Posts related to California's Medi-Cal program, specifically MAGI based, income eligibility, enrollment, costs, children, Covered California.
I find it amusing that the strategy to kill off government funded and managed health insurance for people may be the very illustration and demonstration of how single payer can work. The added benefit is a nod to the fact that, if included, volunteer work or family care work is treated as equally valuable as a wage earning job for eligibility for Medicaid. This is an acknowledgement that people volunteering in our communities plays an important role in the maintenance of the community fabric.
I don’t mind enrolling people into Medi-Cal. I’m a one-person operation and I enjoy chatting with people. But I have to draw the line with people who insist on me answering a million questions and then failing to give me the appropriate information to complete their Covered California Medi-Cal eligibility application. I also will not knowingly participate in any misrepresentation or fraud so a person can either be enrolled in Medi-Cal or be determined eligible for the tax credits through Covered California.
Finally, some folks are considering just enrolling in Medi-Cal because they are eligible. They have very little or no income to report on their taxes because they are living off of savings, interest, and dividends. Here again, Medi-Cal would be used as a containment strategy to an unexpected accident or illness. Medi-Cal is typically a HMO plan which requires a Primary Care Physician to make referrals to specialists, order tests, or imaging.
One of my clients received a letter from Covered California notifying her that her monthly premium would jump from $63.64 to $993.45 per month. The letter casually stated that the premium increase was 147.2%. The client is a household of two people one eligible for Covered California and the spouse is on Medicare. When I went through the renewal procedure on the updated Covered California website, I had to re-confirm that the spouse was on Medicare. The final eligibility results were that the Medicare spouse could select a plan at the full premium amount while the primary applicant could select a plan with the monthly subsidies.
If Bribes are a legitimate source of income for Medi-Cal why not for Covered California I thought? When I checked the 2016 Covered California Countable Sources of Income table, Bribes was suspiciously missing from the list. Why is Covered California hiding this significant source of income for many politicians from their consumers?
One of the first changes consumers and agents will notice is under the information for household members. For the question of Sex (which should be gender), in addition to Male and Female, the drop down box will include Transgender: Male to Female and Transgender: Female to Male. While selecting the Sex is required, the Covered California application does not alert the consumer to the fact that rates are not based on gender AND you cannot be denied health insurance or receive a higher rate because you are transgender.
When a union goes on strike it can be difficult for union members and those trade members associated with the union to keep paying their health insurance premiums with either reduced or no income. There are options to maintaining health insurance if you know the rules of the health insurance game. These rules revolve around Special Enrollment Periods with the qualifying event of loss of coverage.
Millions of people have been enrolled into expanded Medi-Cal through Covered California based solely on their lack of income. Thousands of those same Medi-Cal beneficiaries went on to get jobs or other insurance and forgot to report this to their county Medi-Cal eligibility department. Many of these people fear they will have to repay Medi-Cal for the months they were really ineligible for the no cost health insurance. Do you have to repay Medi-Cal after your income increases and you were no longer eligible? The short answer is usually not.
The Department of Health Care Services has updated their Estate Recovery Program page to reflect the new rules ushered in with the passage of SB 833 in 2016. There had been some confusion as to who was actually subject to new Estate Recovery rules. Essentially, it all hinges on when the Medi-Cal beneficiary dies.
The Western Center On Law & Poverty has put together a comprehensive guide to the Medicaid program in California known as Medi-Cal. Published in March 2016, there are bound to be changes to many of Medi-Cal’s programs, conditions, and eligibility in 2017. Titled Getting and Keeping Health Coverage for Low-Income Californians: A Guide for Advocates is 375 pages long and covers many topics from eligibility, citizenship, enrollment, re-determination, and the variety of programs Medi-Cal offers such as Children’s Health Insurance Program, Medi-Cal Access Program (MCAP) for pregnant women.
