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California MAGI Medi-Cal

Posts related to how California MAGI Medi-Cal works, especially with Covered California, enrollment, termination, household income.

 

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Expanded Medi-Cal costs $611 per member per month

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Medi-Cal health insurance premiums paid to managed care health plans or Health Maintenance Organizations (HMOs) is a sizeable sum of money. The California Department of Health Care Services estimates the average monthly cost for each Medi-Cal beneficiary is $611. Expanded Medicaid, where families earning less than 138% of the federal poverty line are automatically enrolled in Medi-Cal through Covered California, encompasses a population who is often healthier and use fewer health care services than beneficiaries who qualified under the original Medi-Cal rules.

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Medi-Cal adult dental is back

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As of May 1, 2014, limited dental services will be included for adults, 21 years and older, that are on Medi-Cal. Adult dental Medi-Cal services were removed during the California budget crisis in 2009. Some counties may require adults to enroll in a dental manage care plan while others will offer a Fee-For-Service program. The Denti-Cal adult services will be the same whether they are obtained through a plan or through a Denti-Cal participating dentist or clinic. The challenge for adults in rural counties will be finding a dentist that accepts Denti-Cal.

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Covered California annual income estimate prevents Medi-Cal enrollment

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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.

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How income and household changes might affect ACA health plans

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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.

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Medicare sanctions CalOptima’s OneCare Special Needs Plan

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Orange County Health Authority’s CalOptima OneCare Medicare Advantage plan was served a notice of immediate sanctions by the Centers for Medicare and Medicaid Services (CMS) on January 24, 2014. The immediate sanctions mean that CalOptima can’t market or enroll new members into their OneCare Special Needs Plan until the sanctions are lifted. CMS cited “widespread and systemic failures impacting CalOptima’s enrollees’ ability to access health care services and prescription medications” as a summary for issuing immediate sanctions.

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Will Covered California Medi-Cal claw back payments?

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With more working Americans eligible for expanded Medicaid health insurance there is also a growing fear that some government agency will want to seize a recipient’s assets to pay for the health care expenses. Fortunately, the expanded Medicaid, Medi-Cal in California, works under slightly different rules and provides some protection against “claw back” of assets to satisfy health care debt. However, one age group may be subject to Medi-Cal estate recovery rules under expanded Medicaid.

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How do I find a Medi-Cal Doctor?

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Now that you, your children or your entire family are now enrolled in Medi-Cal, the next challenge is finding a doctor. Virtually all of the Medi-Cal plans will be HMOs (Health Maintenance Organizations) where you will have to select a primary care physician (PCP). Your PCP will be your initial contact point for referrals to other health care services he or she may not be able to perform in their office.

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ACA is splitting families apart

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The Affordable Care Act is failing families on two major issues that need immediate resolution. The employer sponsored health insurance regulation has left many spouses without affordable coverage and household income limits are placing children in Medicaid programs. Together, these two ACA regulations are unfairly fracturing the health insurance coverage for many families and need immediate changes.

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Covered California Medi-Cal Verification

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The enrollment of individuals and families under the expanded Medicaid provisions of the ACA is not a slam dunk with either the mailing in of an application or clicking “enroll” on a website. A variety of documents will usually need to be sent to complete the enrollment at the county level. Not submitting the verification documents could ultimately delay enrollment for people who desperately need the insurance.

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Will college students flood Covered California Medi-Cal health plans?

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We can be fairly certain that the big push to enroll college students into new ACA health plans will result in a large portion of the students channeled into Medi-Cal plans. It is estimated that are 480,000 young adults age 19-29 that will be eligible for Medi-Cal2. If we assume a full-time student is able to work 20 hours per week, that monthly wage still puts them below the 138% of the federal poverty line ($15,865) and automatic Medi-Cal.

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