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Covered California and Obamacare 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 Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Parent on Covered California and Child on Medi-Cal

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Question: I recently attended a webinar on Covered California eligibility and they used an example where the mother was eligible for Covered California and the child was eligible for Medi-Cal. How is that even possible?

Answer: The eligibility upper limits for Medi-Cal are different for adults and children - for adults it’s 138% of Federal Poverty Level (FPL), for children it’s 250% FPL. So if the parents’ income is between 138% and 250% FPL, then you’ll get s split public / private eligibility as you described.


Candy …

If dependent children are eligible for coverage under the employer plan, there are two choices: 1) terminated coverage under CoveredCA after enrolling in the employer plan, or 2) continue coverage under CoveredCA, but terminate premium tax credits and pay the full premium for each child ($120-$180 each per month depending on the insurance company).

The PPACA does not allow for premium tax credits when a person is ELIGIBLE for employer-sponsored health insurance which is “affordable” for the employee (premium less than 9.56% [in 2015] of household MAGI).

In other words, if the cost of the employee-only health insurance is less than $95.60 per $1,000 of gross wages, regardless of the cost of dependent coverage, the taxpayer is not entitled to claim any of the premium tax credits for himself, his spouse, or his children. If he receives any tax credits for months during which he had coverage under the employer-sponsored plan, those will probably have to be repaid.

My son and his 2-children originally obtained CovCA cvg last year. Since then, he has HP coverage thru his new employer. Do the children remain on CovCA or is there another plan that is more suitable for them (ages 8 & 4)?

Phil is incorrect again on this. The 250% FPL value is for FAMILIES which were previously eligible for the Healthy Families program which has now been transitioned to Medi-Cal. The numbers I posted above are the correct eligibility values for children O-19, as tiered.

For Adults over age 19, and families, as of April 1, 2012, there are four bands of FPL eligibility: 135%, 185%, 200%, and 250%. There is no 138% band listed anywhere in the document discussing this topic released by California DHS on March 1, 2012 — the most current document posted on the DHS website.

As a result of Medi-Cal expansion in California, the Medi-Cal eligibility for children increased up to 250% FPL and are newly eligible with incomes up to $138 FPL.

Actually the Medi-Cal eligibility for children in California is tiered. In 2013, it is 200% FPL for ages 0-1, 133% FPL ages 2-5, and 100% FPL 6-19. There is no 250% threshold in California.

Children on the SCHIP program in 2012 have been (or remain to be) migrated to Medi-Cal. No new enrollments have been made in SCHIP in 2013.

see: http://kff.org/medicaid/state-indicator/income-eligibility-fpl-medicaid/

Could you provide a source for the 250% threshold? I can’t seem to find it in my searching.

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