Where a primary source of confusion starts to creep into the preliminary eligibility determination for either Medi-Cal or Covered California hinges on when the new FPL amounts are considered for eligibility. This is where the rules concerning determining eligibility are not necessarily aligned between Medi-Cal and Covered California. The rules put forth by the ACA govern how Covered California applies the FPL amounts for determining eligibility for the Premium Tax Credit subsidy, which are slightly different than Medi-Cal. The Department of Health Care Services, the agency that administers Medi-Cal, must abide by older federal rules for eligibility determinations.
The federal Department of Health and Human Services has published the 2015 federal poverty line (FPL) which includes a modest increase over the 2014 FPL. The FPL is used by Marketplace exchanges like Covered California to determine when an individual or family is eligible for either Medicaid, Medi-Cal in California, or tax credits to purchase […]