Consumers who moved from Medi-Cal to Covered California in 2016 may have had critical data lost, denying them the Covered California subsidy in 2017.
Consumers logging into their Covered California accounts hoping to renewal their health insurance may find they have lost their subsidy. Instead of the reduced premium amount they are used to paying, Covered California displays that are not receiving the tax credit subsidy and must pay the full premium amount. A common denominator for consumers who have lost their subsidy is that they had been on Medi-Cal in 2016, but later in the year qualified for Covered California and the Advance Premium Tax Credits to lower their monthly health insurance bill. The transfer of critical application information from Medi-Cal to Covered California is missing, triggering a loss of the subsidy.
Medi-Cal May Have Erased Important Information
When an individual or family applies through Covered California for health insurance, and is determined eligible for Medi-Cal, the statewide computer system that the county Medi-Cal offices use takes over the application information. Covered California has little to no access to the SAWS (Statewide Automated Welfare System) or the MEDS (Medi-Cal Eligibility Data System) computer software that Medi-Cal uses.
After a county eligibility worker determines that an individual or family is no longer eligible for Medi-Cal, the soft-pause on the Covered California account is released allowing the eligible household members to enroll in a health plan with the tax credit subsidy. Somewhere in the transfer of application information from Medi-Cal to Covered California, critical conditional responses to Obamacare subsidy questions are lost. When I say lost, I mean application questions that should have either a Yes or No response are left blank.
Loss of Covered California Subsidy from Missing Data
When a consumer applies for health insurance through Covered California they can’t move forward with the application until all of the necessary conditional responses are answered. For example, the question, “Does this person receive Medicare benefits?” must be marked with either a Yes or No. Until an answer is selected, the CalHEERS Covered California software program won’t let the applicant proceed.
Without a response to the Medicare question, the Covered California CalHEERS systems defaults to NO and the subsidy can be denied.
However, when a consumer application is released from Medi-Cal, many of these critical conditional question are marked neither Yes or No. The question is left blank. Without these critical responses, the CalHEERS systems can’t determine if the household is eligible for the monthly subsidy. In lieu of a response, CalHEERS defaults to No.
Consumers Must Agree to File Taxes
A condition of receiving the monthly tax credit subsidy is that the consumer agrees to file taxes and, if married, file a “married filing joint” tax return. But if there is no answer to the question, “Is this person planning to file taxes this year?” has no answer, then Covered California determines the applicant is not eligible for the tax credits. The consumer originally completed the application with all the answers selected. But on the applications I have seen that have been released by Medi-Cal, crucial responses such the tax filing status is missing.
Application information released from Medi-Cal back to Covered California may have missing responses to critical questions such are you planning to file taxes. If there is no response, then the consumer can’t get the Covered California subsidy.
Review and Scrub Covered California Application
If the consumer has completed the renewal process, and has not been awarded the monthly subsidy, they should go to the Actions box and select Report a Change to correct missing response for the 2017 subsidy.
If you go to renew your Covered California health plan for 2017, and the system does not award you any monthly subsidy, and you were in Medi-Cal in 2016, you need to scrub the application. In other words, you need to go through the complete application looking for missing responses. Covered California advised me not to use the Report a Change for 2016, but to select the Report a Change link in the Actions if the consumer has already started the renewal process.
Why Did You Make the Change?
After you have updated the application by correcting the responses that were erased by Medi-Cal, you will come to the Signature for Renewal page. On this page you must give a reason for why you made the change. You’ll notice that there is no Old Value because it was erased by Medi-Cal. Your responses to the conditional questions will be in the New Value column. The reasons from the drop down box are usually nonsensical. None of them apply. Covered California needs to add a Medi-Cal Mess Up reason to the drop down box. I have usually selected Other, or the least offensive reason for the change. I don’t think Covered California is checking the reasons for the change at this point. And if they do, I can point out that there was no Old Value to begin with indicating a massive failure on their part to even allow the application to go forward.
On the Signature for Renewal page, after the responses have been entered, the consumer will notice that there is no Old Value, these are the response that were erased by Medi-Cal.
Subsidy Amount Reinstated
Covered California needs to add the reason for the change to information of Medi-Cal Erased My Responses.
After I have scrubbed the applications where Medi-Cal erased the data, the subsidies have miraculously been restored. Now that the family has the subsidy restored, they can return to agonizing over the lack of reasonably priced health plans that have none of their providers are in-network. Oh the joy. There may be other reasons why Covered California has denied the Premium Tax Credit subsidy. Consumers need to make sure they have given consent for verification of their information if it has expired. Additionally, if Covered California can’t confirm that a consumer has filed their 2015 taxes, even if the tax payer has done so, they will need to attest that they have file their tax return.
Another reason why consumers may not be awarded the subsidy is that Covered California can’t verify the household has filed their last tax return. They need to attest that they have done so in order for the subsidy to be reinstated.