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.
California MAGI Medi-Cal
Posts related to how California MAGI Medi-Cal works, especially with Covered California, enrollment, termination, household income.
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.
2018 FPL guidelines are updated for Medi-Cal determinations only and will not affect eligibility for Covered California consumers. The Covered California 2017 levels are used for the 2018 benefit year.
The 2018 guidelines reflect the 2.1 percent price increase between calendar years 2016 and 2017. After this inflation adjustment, the guidelines are rounded and adjusted to standardize the differences between family and household sizes. Included with this informational bulletin is the 2018 Dual Eligible Standards chart that displays the new standards for the Medicare Savings Program categories.
The question no one can answer for me is if the expanded Medi-Cal HMO capitation rates have been decreasing because there are more healthy people in the Medi-Cal pool? Or are there other factors that are driving down the rates. There must be good money in Medi-Cal as Aetna, Blue Shield, and United Healthcare have all been approved to offer Medi-Cal HMO plans alongside other private health insurance companies such as Anthem Blue Cross, Health Net, Kaiser, and Molina.
For a single adult applying through Covered California, the monthly income must be greater than 138% of the Federal Poverty Level ($1,397 monthly, $16,754 annually) in order to qualify for private health insurance with the premium tax credit subsidy. If the individual or household is below 138% of the FPL, they will be deemed eligible for Medi-Cal.
A significant drop in household income does not qualify you to apply to Covered California for the tax credit subsidy to lower your monthly health insurance premium. If you are already in Covered California, you can report a change of income and then select a different health plan.
Perhaps the most difficult part of the Covered California application for the consumer is creating a password. The rules are very strict and have not always been adequately explained. Covered California has included more information to help consumers create a password when they have to reset it. The biggest complaint after the password has been rejected is that the system tells the consumer that the pass word cannot contain a dictionary word. You would be amazed at how many two letter combinations actually are words found in a dictionary. Hint: don’t put two letters together when creating a password. Always have letters separated by a number or special character.