Covered California has developed a reprieve from immediate reporting to SAWS in the event of an error on the application that triggers Medi-Cal eligibility. The one-day delay in reporting the eligibility results to Medi-Cal is outlined in the CalHEERS 19.7 release scheduled to be implement on July 22, 2019.
California MAGI Medi-Cal
Posts related to how California MAGI Medi-Cal works, especially with Covered California, enrollment, termination, household income.
The brochure also outlines the rights and responsibilities of the Medi-Cal beneficiary. Eligibility determinations, either enrollment or termination, can be appealed. myMedi-Cal discusses the time periods for the appeals and the right to a State Fair Hearing.
The HIPP program pays the medical insurance premiums, coinsurance, deductibles, and other cost-sharing obligations for the individual. The annual cost of the premiums and member cost-sharing is compared to the estimated cost of an equivalent set of Medi-Cal services. Outlined in in an ACWD Letter 09-02, DHCS uses a specific formula to determine the cost-effective nature of the private insurance over Medi-Cal FFS.
The benchmark 100% federal poverty level income for a single adult increased 3% from $12,140 in 2018 to $12,490 for 2019. The all important Covered California premium tax credit eligibility income (138% of the FPL) for a single adult increased from $16,754 for 2018 to $17,237 in 2019. This means a single adult now has to have an annual Modified Adjusted Gross Income (MAGI) of $17,237 to be eligible for Covered California if they apply for health insurance in 2019.
You must apply for the Medicare Savings Program through your local Medi-Cal county office. You apply for the Social Security Extra Help program directly with Social Security. If you are determined eligible for the Medicare Savings Program you will be considered a Dual Eligible: eligible for both Medicare and Medi-Cal. Your eligibility can change throughout the year based on income but is usually re-evaluated on a yearly basis. Whenever you eligibility changes, you are eligible for a Special Enrollment Period to change or enter into different Medicare Advantage or Medicare Prescription Drug Plans.
The $1 increase in wages per hour between 2018 and 2019 is an 8% increase. The FPL has been increasing approximately 1% every year. But if we assume the FPL increases 2% that would put the new Medi-Cal monthly income level at $1,425. The increased minimum wage for 2019 still makes the individual working 30 hours per week ineligible for MAGI Medi-Cal.
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.
When your son or daughter is earning money from a job, but still living at home, it can be a bit confusing when applying for health insurance through Covered California. When do you count your child’s income for Medi-Cal or Covered California? Should your child have their own health plan? Do they file their own taxes? Are they still going to school?
If you have to move out of your county because of the wildfires you may be entitled to a Special Enrollment Period. California is broken into 19 different rating regions. Los Angeles County is actually two regions, 15 and 16. If you move to a different region, you have a qualifying event for a Special Enrollment Period IF you already have health insurance.
Upon review, the consumer was now listed as an American Indian or Alaska Native, there was no selection for current health insurance or Medicare enrollment, and the application showed a higher income than we had estimated for 2019. This is not the first time I have seen individuals and whole families being flipped into American Indian or Alaska Native designation. As mentioned earlier, Covered California seems to automatically erase the current health plan information during the renewal. But this was not a renewal, just a correction to Medi-Cal eligibility.