Covered California and ACA related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the ACA and Covered California knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Low Income Exemptions and Medi-Cal

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Question: People can be exempt from the (individual mandate) penalty if they have income below the tax filing threshold. But why people would want to be exempted but not just go into Medi-Cal and get full benefit?

Answer: Right. It doesn’t make sense to pass up free health care insurance, yet many people do. Many thousands of legal California residents who are currently eligible for Medi-Cal do not sign-up. I most cases it’s because the powers that be have not been able to get the message to them. Covered California has committed enormous outreach resources to get to these people in the next few months.


Yes I agree if the estate is going to take from beneficiaries after a person aged 55 receiving medi cal dies it is definitely not free. I am struggling with this myself. If one is not insured then we will be taxed on our tax returns.

The biggest unfair thing if you qualify for government subsidies under you don’t have to pay that back.

The public needs to know this and it needs to be fixed.

I disagree - it does make sense in some instances to pass on “free” health insurance because it isn’t really free. Any adult 55 or over in California who gets Medi-Cal will be subject to estate recovery for any benefits paid, even the capitation payments for those in a managed care organization. So it isn’t free - it’s actually debt you’re accruing - if the state is going to take it from your heirs after you’re gone.

Medicaid coverage in certain states can be established for specific kinds of patients, at the discretion of the individual state, using only basic information to establish likely eligibility for the program. It is my understanding that patients will receive one-time coverage for the month of service and the next month; to continue in the Medicaid program, the patient would have to submit a completed application and be approved according to State rules. The State will defined who will be qualified to do these presumptive screenings. Will there be something similar for Medi-Cal starting in October? If so how will it work.

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