Children in the counties of San Mateo, San Francisco and Santa Clara may get booted off their parent’s Covered California plan and forced into Medi-Cal because of higher income guidelines in these Bay Area counties.
Covered California sent out a notice that some children in the Bay Area will be deemed Medi-Cal eligible and will be taken off their parent’s health plan as of April 1, 2016. The expanded Medi-Cal kids’ option only applies to the Bay Area counties of San Mateo, San Francisco, and Santa Clara. Because these counties have a higher cost-of-living, they have higher income eligibility for the Medi-Cal kids program. Whereas most families have their children dropped in Medi-Cal if their Modified Adjusted Gross Income is below 266% of the federal poverty line (FPL), in these Bay Area counties children qualify for Medi-Cal with a household income of 322% of the FPL.
Medi-Cal to boot children off of parent’s health plans
Unlike the Covered California automatic enrollment of children into Medi-Cal if the household income is below 266% of the FPL, children in households with income between 266% and 322% are having their premium assistance stripped from the parents. This is because if you qualify for minimum essential coverage from a government program you are not entitled to the premium assistance of Advance Premium Tax Credits to lower your monthly health insurance bill. Essentially, Medi-Cal in the counties of San Mateo, San Francisco, and Santa Clara will be holding some children for ransom. The two options for the parents are to allow your child to enter an over-burdened Medi-Cal system to receive care or to pay the full premium rate for their children’s health insurance either through Covered California or with an off-exchange plan.
(I certainly hope the irony is not lost on anyone that a government run program and regulations meant to help families is penalizing them if they don’t enter the Medi-Cal system.)
Covered California notice
2016 County Children’s Health Initiative Program (CCHIP) Quick Guide for Certified Enrollers
Background
County Children’s Health Initiative Program (CCHIP) is an existing health insurance program that offers affordable and comprehensive medical, dental, and vision insurance for children age 0-19 who qualify. CCHIP is only available in three counties: San Mateo, San Francisco, and Santa Clara.
Children eligible for CCHIP are not eligible for premium assistance with a Covered California plan and must enroll in the CCHIP program in their county or choose to enroll in an unsubsidized Covered California plan. Eligibility into the CCHIP program is 266-322 Federal Poverty Level (FPL).
During the week of February 15, DHCS sent a notice to existing Covered California consumers who have been deemed eligible for CCHIP.
Consumers should contact CCHIP to confirm their wish to either participate in the program or to opt for a Covered California plan without premium assistance. The non-eligible CCHIP Covered California consumers will remain enrolled in their Covered California plan with their current premium assistance amount.
Talking Points
- Advise impacted consumers their children are now eligible for CCHIP
- The child’s Covered California plan with premium assistance will end on March 31
- The child will be enrolled in an unsubsidized Covered California plan starting on April 1, unless the consumer selects CCHIP coverage
- Advise the consumer to contact the CCHIP program for additional information on program benefits or to enroll in CCHIP
If a consumer does not want to call CCHIP, they can call the Covered California Service Center after March 15, after our system has implemented CCHIP and we have an up-to-date record of eligibility and enrollment.
CCHP Contact Information:
San Francisco County: San Francisco Health Kids
(415) 615-5700, P.O. Box 194327, San Francisco, CA 94119
In-Person Assistance:
Monday-Friday, 8:00 am to 5:30 pm
7 Spring Street, San Francisco, CA 94104
San Mateo County: San Mateo County Health Coverage Unit
Children’s Health Initiative
(650) 616-2002, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080,
Santa Clara County: Children’s Health Initiative
(888) 244-5222, (408) 808-6180, 770 S Bascom Avenue, San Jose, CA 95128,
Children enrolled in unsubsidized health plans
The Covered California enrollment system has never had the ability to have different members of a family in both a subsidized plan and one with premium assistance. It will be interesting to see what sort of programing magic Covered California implements to split families apart in the system. It also raises all kinds of questions about the family members left on original health plan with premium assistance. Will the children kicked off their parent’s plan still be included in the household size? By reducing the number of children in a household, the income of the remaining family members may be greater than 400% of the FPL and no longer eligible for premium assistance.
Working to expand Bay Area Medi-Cal since 2014
Medi-Cal has been scheming about how to corral these Bay Area children since 2014. In an October 2014 memo bureaucrats with the Department of Health Care Services outlined their strategies for implementing the higher income threshold in the Covered California system. Specifically, Covered California was to be an accomplice in migrating children from their parent’s plan into Medi-Cal.
CalHEERS [Covered California] will identify eligible children in the three CCHIP counties and provide data extract files to each CCHIP counties to notify families to enroll eligible children into the local program.
Increasing the family burden even more
The expanded County Children’s Health Insurance Program (C-CHIP) has been around for years. Parents could always apply to have their children covered by C-CHIP if their household income was between 266% and 322% of the FPL and they lived in San Mateo, San Francisco, or Santa Clara counties. But yanking kids off their parent’s health insurance plan and either forcing the parents to pay the full premium or subjecting their children to Medi-Cal is a public relations failure.
Enroll off exchange
If you are a parent whose child is being booted off your health plan and you have decided not to have the child or children placed into Medi-Cal, consider enrolling them in a health plan off-exchange. Because the child is losing the premium assistance, that is a qualifying event for enrollment in a health plan not offered through Covered California. If you purchase a health plan through Covered California, the health insurance pays Covered California $13.95 every month per person enrolled. Since it was Covered California who supplied your income data to Medi-Cal, there are strong philosophical reasons not to support the operations of Covered California.
C-CHIP files for download
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