Many parents are receiving notices from their local county Medi-Cal offices that their children are now pending Medi-Cal for 2023. The same parents are wondering why their children are in a Covered California plan for 2022, but suddenly the children are being moved to Medi-Cal. The simple answer is the household income is too low.
Medi-Cal Income Limits Increase Every Year
Every year the income amount for dependents 18 years old and younger eligible for Medi-Cal increases. The income amount is based on the federal poverty level. If the household income is under 266 percent of the federal poverty level, all children are eligible for Medi-Cal. Covered California sends the household members eligible for Medi-Cal over to the respective county for the county to begin the enrollment process.
Many people do not update their income every year. While the income stays static, the threshold for Medi-Cal creeps up. The 2022 federal poverty levels are being applied for the 2023 Covered California subsidy and Medi-Cal eligibility. Many families are being caught by surprise that their current income is too low to maintain subsidies for their children.
Important To Review Household Income Estimate
For example, a family of 4 had an estimated household income of $71,000 for 2022 Covered California. All 4 household members, 2 adults and 2 children, were eligible for a private health plan with subsidies through Covered California. For 2023, the 266 percent income level for children’s Medi-Cal, for a family of 4, increased to $73,815. Covered California just rolls over the previous year’s income into 2023.
The family income at $71,000 for 2023 means the children are now Medi-Cal eligible. Covered California applies a passive renewal strategy. At the beginning of November, households who had not renewed their Covered California enrollments were passively renewed using their existing income estimate. If the income estimate was below 266 percent of the federal poverty level, Covered California applied a Pending Medi-Cal designation and the information was sent to the county.
Increasing Income Will Remove Pending Medi-Cal
Increasing the income estimate before 2023 to an amount over 266 percent of the federal poverty level will remove the Pending Medi-Cal designation. However, some county Medi-Cal offices seem to be more aggressive at pursuing Medi-Cal enrollment. Even if you raise your income estimate to satisfy the Covered California enrollment system, that does not mean the county will be satisfied. You may still have to communicate with the county Medi-Cal office that your income has increased and your children are not eligible for Medi-Cal.
