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.
Caution! There are known data miss-match issues between SAWS and Covered California CalHEERS software. When a consumer is released from Medi-Cal it is necessary to scrub the application and look for missing or inaccurate data and conditions. The missing data could prevent the individual or family from getting the subsidy. It could be as simple as the application no longer indicating that the consumer will file taxes. This is simply fixed by checking Yes, the consumer will file taxes. Both Covered California and Medi-Cal are working to resolve this issue.
For the family of a small business owner, the reduction of the MAGI because of the 20% deduction could drop any dependents under 18 years old into Medi-Cal. A family of four earning $70,000 makes all the household members eligible the tax credit subsidy through Covered California. If the family reduces their income by the 20% deduction, the new income is $56,000. That is below 266% of the federal poverty level for a family of four and all dependents 18 and younger are then deemed eligible for Medi-Cal.
The Medi-Cal representatives also confirm that erroneous information can pop into Covered California applications after an individual or family has been terminated from Medi-Cal. Once a person is deemed no longer eligible for Medi-Cal, the SAWS Soft Pause is released and the individual and family can then enroll in a Covered California plan with the tax credit subsidy. Unfortunately, the data on the Covered California can be missing or in accurate from what was originally entered.
Because Peter did not have health insurance in the last 60 days, he technically doesn’t qualify to enroll in a health plan in California. But when Peter moves out to California, his job has not started and he has no monthly income, he is just living off of his savings until the job starts in early summer. Because Peter has no monthly income, he qualifies for MAGI Medi-Cal.