Kevin Knauss: Health, History, Travel, Insurance
Posts related to eligibility for health care programs based on household income such as Covered California, Medi-Cal, Medicare usually based on federal poverty levels.
Covered California has updated the CalHEERS income section of the individual and family plan application to accommodate partial year employment. This was accomplished with the insertion of simple date fields. Now, instead of the annualized income from a job a client has left, the employment can just have a start and end date. Changes to […]
Medi-Cal was one of the biggest mysteries during open enrollment in the new ACA health plans. Even though Covered California advertised a “no wrong door” approach to signing up for health insurance, when a client had to go through the Medi-Cal door, not even Covered California could tell them what to expect. Finally, seven months into the expanded Medi-Cal program, the Department of Health Care Services has finally put together a presentation that goes over the various parts of Medi-Cal and how the system works.
The Covered California CalHEERS online enrollment system continues to be upgraded to fix problems and accommodate household changes, but Certified Insurance Agents (CIA) are rarely notified of the updates. As CIAs helped enroll 40% of Covered California’s households and continue to update their clients changes through the system, agents deserve to be provided regular updates […]
The Affordable Care Act (ACA) allows for Special Enrollment Periods for individuals and families to purchase a health plan through the federal or a state exchange when there is a loss of coverage from a qualifying such as a change in employment. There has been confusion over how to characterize the previous month’s employment wages […]
Different interpretations of monthly verses annual income estimates on the part of Covered California and county Medi-Cal administrators have the potential to leave many Californians who are drawing unemployment benefits without any health insurance. At least one person has been denied the ability to purchase a private health plan with ACA tax credits while being simultaneously excluded enrollment in the ACA expanded Medi-Cal health plan. The conflicting interpretations can leave many people ineligible for either ACA tax credits or Medi-Cal.
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.
I will happily attend any public enrollment event and assist anyone applying either for Medi-Cal or a health plan with or without premium assistance. However, hence forth, I will not attend any event where Certified Agents are allowed to discriminate against people based on their income and Medi-Cal eligibility. Further, if anyone is refused assistance from an agent because they might be Medi-Cal, please do us all a favor and report that agent to Covered California. Income discrimination practiced by Certified Agents needs to stop.
Under the Affordable Care Act, individual and family plans (IFPs) will have coverage benefits very much like an employer sponsored small group plan. Another way in which the new IFP plans will mirror a group plan are enrollment restrictions. Individuals and families will only be able to enroll into the new IFP plans outside of open enrollment if there is a “qualifying event”.
While most people are thrilled with the ability to get affordable health insurance through Covered California, others are trying to avoid the premium free health insurance being offered. Specifically, some families and individuals are trying to figure out how to avoid having either their children or their family automatically enrolled in Medi-Cal. Inflating the income of the household is one way side step automatic enrollment in Medi-Cal health plans.
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.
