Kevin Knauss: Health, History, Travel, Insurance
Posts related to how California MAGI Medi-Cal works, especially with Covered California, enrollment, termination, household income.
Throughout the past year of enrolling individuals and families into the Covered California health plans, Certified Insurance Agents were in the dark when it came to Medi-Cal. The Department of Health Care Services held a webinar on July 31st to review of the essential basics of the Medi-Cal program. Even if you only review the […]
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.
Through casual conversation and on various Internet forums numerous agents and brokers have mentioned they arent getting paid commissions for business they submitted through Covered California. Is there a crisis of commissions not being paid to Certified Insurance Agents? Without reliable data from the agent community it is hard to tell if the missing commissions […]
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.
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.
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.
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.
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.
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.
