Question: I have clients whose kids are ending up on Medi-Cal, but because they are attending college outside the state, they don’t want Medi-Cal. Is there a mechanism by which they can have their kids on their plan and avoid Medi-Cal? Covered California suggested calling the County and refusing Medi-Cal, but most counties have no idea what I’m talking about.
Answer: The family’s household income must exceed 266% of FPL (approximately $52,000 for a 3-person household or $64,000 for a 4-person household) for a family’s kids to qualify for a subsidy in Covered California rather than Medi-Cal. If your 2014 income estimate is under that threshold, the kids cannot qualify for a subsidy in Covered California and are expected to enroll in Medi-Cal. If that is unacceptable for any reason, I think the best way to avoid it is simply not to apply for Medi-Cal for the kids. They can purchase their unsubsidized coverage either in Covered California or off-exchange directly from a carrier. In this example, there is a potential advantage to purchasing through the exchange. If the household income ends up being greater than expected and places the family over the 266% FPL threshold after all, then the family would receive additional tax credits retroactively for the portion that was not advanced for the kids in that tax year.