With the release of the federal poverty levels for 2023, Covered California has revised their income table. The changes that go into effect April 1st in the Covered California application system reflect the higher federal poverty income levels as they pertain to Medi-Cal programs.
Higher Medi-Cal/Covered California Income Amounts effective April 1, 2023
The income columns that have been updated to reflect the higher federal poverty levels are 138%, 213%, 266%, and 322%. All those income columns, based on household size, correspond to Medi-Cal eligibility for adults, Medi-Cal for Pregnant Women, Medi-Cal for Children, and Medi-Cal Assess Program and CCHIP for children in counties in San Francisco, San Mateo, and Santa Clara counties. The other income columns that are not tied to Medi-Cal eligibility remain unchanged from the 2023 open enrollment period.
Changes Made To Covered California Account Could Trigger Medi-Cal
Consumers applying to Covered California in for health insurance in April will be screened on the revised income table. However, any current Covered California member who submits a change to their Covered California account, such as a change of address, will have the revised applied to the household for eligibility determination
For example, a single adult with an estimated annual income of $19,000 when they applied to Covered California in December 2022 was eligible for a private plan with the subsidies. If they report a change to their email address in April will have their $19,000 income compared to the revised income chart. Since the income of 138% FPL for Medi-Cal eligibility has increased from $18,755 (2022) to $20,121 (2023), they would most likely be determined eligible for Medi-Cal.
Similarly, a 2-person household (parent and child) entered Covered California with an income of $37,000 for 2023. Both parent and child were eligible for a private plan with the subsidies. If they report a change after April, the child would be determined eligible for Medi-Cal. The Medi-Cal eligibility would be triggered because the 266% FPL column increase from $36,150 (2022) to $38,783 (2023). Any household income under 266% FPL qualifies children 18 years old and younger eligible for Medi-Cal.
Covered California screens for Medi-Cal eligibility based on the applicants monthly income. Even if your income is set increase the following month, the monthly income in which you apply will be used to determine Medi-Cal eligibility. If a household member is determined to be potentially eligible for Medi-Cal, Covered California sends the information over to the member’s county for review. Once Medi-Cal eligibility is triggered, no changes can be made in the Covered California application to reverse the determination. Only Medi-Cal can update the application at that point.