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Covered California Q&A

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.

Worried About Clawback

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Question: Let’s say - A household’s current income is at 150% FPL and takes the advanced subsidy through the Exchange. During 2014, the income dips below 138% but they forget to apply for Medi-Cal when this happens. Will they be subject to “clawback” come tax time since they qualified for Medi-Cal but has taken the subsidy instead (in which case the charge back amount can be substantial)?

Answer: There is no reimbursement or “clawback” required in this scenario. Remember it is your responsibility to notify Covered California of changes of income.


My brother has since passed (August 2012). Because my brother had interest in property at the time of his death (joint tenancy) DHCS is after my sister and I for his medical bills (18,000). Should we pay if we have not received details as to how the nursing home billed. My brother also had private insurances (blue cross and Tri-care, entitlement) which we are currently working on for coverage. The nursing home did not finish billing blue cross and went straight to Medi-Cal. On the Medi-cal application it states that he had Blue Cross and Medi-cal does not have any documentation showing that Blue-cross wouldn’t have paid. DHCS is not threatening to take legal action and/or putting liens on our homes. No documentation that they will just verbal. Who can we talk to about our rights and what they can do or the process?

Tax credits are available to persons/households with incomes between 100% and 400% of the Federal Poverty Level. Even those persons who obtain Medicaid/Medi-Cal coverage through the Exchange enrollment process are eligible for refundable tax credits. In the scenario posed above, the refundable tax credit would likely increase.

The more important discussion is what to do if income dips below 138% FPL? It would be prudent to immediately contact Covered California, because enrollment in Medi-Cal means no out of pocket cost for premiums and lower out of pocket costs for covered medical expenses.

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