Kevin Knauss: Health, History, Travel, Insurance
Posts related to the definition of household or tax household for the purposes of the tax credit subsidy through Covered California or Medi-Cal, family members
There are many good reasons to include qualifying adults such as parents and stepparents within a Covered California household. There can also be unintended consequences such as making the entire household eligible for Medi-Cal and ineligible for the Covered California subsidies. The best approach is to understand all of the IRS rules regarding a qualifying relative and how the inclusion of the parent or stepparent will modify the eligibility of the household for the subsidies and Medi-Cal.
The Change Log Table shows that Sacramento County Medi-Cal returned the client’s household size to 2 and added the deceased spouse back into the household. The only notification the client received that Medi-Cal had meddled with her account was when she received a notice from Kaiser informing the client that her coverage had been terminated.
Several clients have contacted me regarding eligibility determination forms they have received from Medi-Cal, even though some or all of the family members have a Covered California plan with the tax credit subsidy. Even if the household information on the forms is wrong, Covered California consumers should supply the necessary information to their county Medi-Cal office or risk losing their private health plans altogether. Medi-Cal has effectively taken over the functions of Covered California if the family had been in Medi-Cal or if they still have children covered by Medi-Cal.
There are a variety of reasons why a household member needs to be removed from a family’s Covered California account. In some unfortunate instances a family member has died. Other times a young adult ages-off the plan or a spouse gains other coverage such as Medicare.
The Department of Health Care Services (DHCS) has developed a Medi-Cal household size flow chart. The DHCS Guide for Calculating MAGI Medi-Cal Individual Household Size was originally developed to help county eligibility workers ascertain the actual household size under the new Affordable Care Act (ACA) rules. The newly expanded Medi-Cal eligibility under the ACA revolves around on IRS definitions for tax dependents and non-filer rules. Because families can be so diverse and the rules regarding what constitutes a tax family so complicated, the flow chart for determining household size was created.
One of the confusing aspects of the Affordable Care Act is the interchangeable tax terms people use when defining a household. The federal and state exchanges use the terms children or dependents when describing members of a household. The IRS uses the more accurate, but confusing terminology, of personal exemptions as the true test for […]
Individuals and families who have enrolled in health plans through Healthcare.gov, or a state exchange like Covered California face new challenges as they report income and household changes. Families reporting changes to household size and income may also be triggering changes to their health plan. These changes may result in the entire family becoming eligible for Medicaid, being shifted into a different Enhanced Silver plan or losing the Advance Premium Tax Credit all together.
One of the biggest questions regarding eligibility for premium assistance or discounts under the new Affordable Care Act is what type of income must the applicant count? The Covered California CalHEERS enrollment website will have a drop down menu to prompt households on the type of income they should be entering for eligibility.
