For many individuals, families and their children that were award a Medi-Cal health plan based on their estimated Modified Adjusted Gross Income reported through the Covered California application, it can be a daunting task to report a change of income to Medi-Cal. As we have all learned, once Covered California hands of the enrollment to the Medi-Cal all changes to the household income must be reported and verified by Medi-Cal.
Medi-Cal is separate from Covered California
Two important bits of information are that
- Medi-Cal eligibility is based on the Monthly household income and the tax credits to subsidize private health insurance through Covered California are based on the Estimated Annual household income.
- Medi-Cal enrollment is county specific. Each of California’s 58 counties handles Medi-Cal eligibility and enrollment.
Reporting income change to Medi-Cal can be difficult
This means you have to be able to submit proof of your monthly income to your local county social services department that handles Medi-Cal before you can escape its grasp and enroll in a private health plan with tax credits from Covered California. Secondly, even though all the counties use many standard forms from the Department of Health Care Services, they may also have their own county specific forms for reporting changes to the household and income.
If you have what Covered California considers a mixed household, some members in private plans with tax credits and other members enrolled in Medi-Cal, you should first report a change of income in the Covered California system. This will adjust the Advance Premium Tax Credit (APTC) for household members receiving the monthly tax subsidy to lower the monthly health insurance premium. (A typical mixed household has the parents or guardians receiving the APTC and the children enrolled in Medi-Cal if the household income is below 266% of the federal poverty line).
Covered California and Medi-Cal don’t talk to one another
The Covered California CalHEERS program for enrollment is separate from the Medi-Cal SAWS program that keeps track of enrolled individuals and families in Medi-Cal health plans. While county Medi-Cal eligibility workers can view the Covered California information, Covered California can’t view or interact with the SAWS program. There does not seem to be a trigger or prompt to have the local county Medi-Cal administrators view any updated income information in the Covered California system.
Call county first
Individuals and families enrolled in Medi-Cal who wishes to report a change to income should first attempt to call their local county social services department for instructions. (List of county Medi-Cal departments http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx). Another good step is to register with MyBenefitsCalWin which is also an online entry portal for applying for Medi-Cal at the county level. A change of income reported in the MyBenefitsCalWin may be picked up an implemented by some counties. But you will still need to submit proof of the income change to county. That’s where calling the county to see if they have specific form for reporting an income change is helpful. Some counties default to the MyBenefitsCalWin webpage as a resource while others have county specific websites. Check your for your county at http://www.benefitscal.org/
Forms to report a change of income to Medi-Cal
There are also two forms that should be accepted to report a change of income. (Download each below). The first is the Mid-Year Medi-Cal Status Report and the other is the Medi-Cal Annual Redetermination Form. Some counties will send out the mid-year status report to capture updates that Medi-Cal members forgot to report. The redetermination form is sent out on the anniversary of the enrollment into Medi-Cal. There may be questions on both forms that are not applicable to individuals and families that are in the MAGI Medi-Cal or expanded Medi-Cal program. The MAGI (Modified Adjusted Gross Income) Medi-Cal is the ACA expanded Medicaid insurance in California and is based solely on the household’s income. Non-MAGI Medi-Cal are programs where income AND assets may be used to determine eligibility such as if a person resides in a skilled nursing facility.
Proof of income
Regardless of which form you submit to report a change of income you will need to send verification of the income change. Proof of income can come from a variety of sources including bank statements, pay stubs, receipts, tax forms, etc. The MyBenefitsCalWin website has a list of accepted proof of income documents that are accepted.
- Dated check stubs for the last 30 days
- Statement from your employer
- Copy of last year’s tax return
- Bank statement showing direct deposit
- A current benefit check
- Copies of child support checks
- Alimony checks
- Award letter
MAGI Medi-Cal requires no asset test
But remember, if you are in MAGI Medi-Cal, you don’t have to submit information from Other Resources, which are assets, such as life insurance policies, savings account information, stock, bonds, etc. You are reporting income that is taxable and that you will report on your taxes. If you receive interest and dividends from investments that are taxable, you will report that as income, but not the actual principal or investment amount.