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Don't Want Kids on Medi-Cal?

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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.


Peter …

If you are not eligible for Medi-Cal, you can file an eligibility determination appeal within 60 days of the determination. If you are eligible, but want to be dropped from Medi-Cal, you must petition the County Medi-Cal agency to release you. You would be eligible to obtain an individual health plan, but you would not be eligible for premium tax credits to pay some of the premium.

I you are beyond the appeal deadline, you may have to wait until you are formally dropped from Medi-Cal because you did not file required proof of income..

Max, I have been trying to 10 months to cancel my medi-cal. I have contracted covered california, medi-cal and the san mateo health plan. I still have coverage and my HMO will not charge me anything. I got forms saying I didn’t fill out the survey and called back saying I didn’t want it anymore, then I got a letter saying I might be dropped but I could request a hearing. I just want it gone!

“our son qualifies for medi-cal and his eligibility is to be determined. How can I get him on the same policy we will receive?”

Unfortunately, this is not possible without lying about your income and giving up a portion of the advance premium tax credit. The PPACA is designed primarily to increase the number of persons on Medi-Cal/Medicaid.

You could modify your application to restate your household income above the 266% FPL ($4350 per month = 267%). When you file your income tax return for 2014 in 2015, and your income is lower, you will receive an additional PTC factored into your income tax return.

Then uncheck the automatic verification of income so that you will have to reapply for coverage next year, and do the same thing all over again.

Understand that lying on your CoveredCA application is a crime. But who’s to say your 2014 income won’t be what you believe it is today? They can’t arrest you for not earning enough money. The real cheats are the ones who misrepresent their income lower in order to obtain Medi-Cal enrollment or larger premium tax credits.

But as long as your household income is below 266%, a child age 18 or younger must be enrolled in Medi-Cal. Even if you were to apply for a plan off the exchange (giving up your tax credits altogether), theoretically, the insurance agent/company who receives your application is supposed to advise your that your child qualifies for Medi-Cal if that is the case, and direct you to the exchange or local Medi-Cal agency.

I applied for Covered CA for myself, my wife & my 18 year old son who is presently in high school. My wife and I were approved and instructed to choose our plan, but it states our son qualifies for medi-cal and his eligibility is to be determined. How can I get him on the same policy we will receive?

“I applied in October for January 1, 2014 coverage and have heard nothing from Medi-Cal. I ended up calling my local county Medi-Cal office. At this time they have only 2 people working on over 900 applications and are currently working on October applications.”

To the other Anonymous …

I have no idea how anyone expected local agencies to deal with the thousands (potentially millions)of Medi-Cal application this was going to produce. And I have no idea why the local agencies did not make better plans for this.

The good news for Medi-Cal beneficiaries is that their medical expenses can be paid retroactively for up to three months from the date of approval, which can also be made retroactive to the date of application as I understand it.

I have no doubt that enrollments in December have no chance of being approved and pushed into the system given the fact that CoveredCA is simply an added layer of bureaucracy between individuals and their health coverage.

We already know they haven’t been forwarding applications to the insurance companies in any timely manner either.

Bureaucracy is a wonderful thing … as long as it does not interfere with your life. Bureaucracy usually means finding the best way of turning something simple into something else as complex as possible.

Anonymous … I’m a bit confused about who is calling whom, but the opt out of Medi-Cal is not possible through the exchange. A person whose income makes them eligible for Medi-Cal enrollment cannot apply for insurance through the exchange.

The system is designed to prevent that courtesy of federal law that seeks to get as many people enrolled in Medi-Cal/Medicaid as possible. Getting folks attached to the welfare fountain of joy in the first place, makes it all that much harder for them to get off later. They tend not to vote for candidates who say they will move them off the welfare system.

The good news is that capitalism is still alive for a few more years and if willing to pay the premium, your client’s child may be enrolled in a standalone private plan off the exchange. No premium tax credits will apply, and your client can select any plan of her choosing. Any licensed agent representing the same insurance company can help with this.

I have been told my client can opt her son out of Med-Cal and buy insurance for him without the subsidy on or off the exchange.. Or at least that is my latest understanding. She was call by Social Services today asking for a birth certificate on a withdrawn application that contain errors. I gave her the new number because the client is my office manager and was at work when the call came in. I explained she wanted to opt her son out of Medi-Cal, placed her on hold, came back after 5 minutes and said she would have to call her back. Said there was no way for the client to call her directly. Help?? You experts out there!!!

If you have successfully completed your Covered California application and uploaded your “proof of residency”, you may receive a notice that you may be eligible for Medi-Cal coverage and that your local county Medi-Cal office will send you notice and information. I applied in October for January 1, 2014 coverage and have heard nothing from Medi-Cal. I ended up calling my local county Medi-Cal office. At this time they have only 2 people working on over 900 applications and are currently working on October applications. I should be receiving mail from them within the next 2 weeks. But to all others waiting, be patient. Local Medi-Cal offices are backlogged. There are going to be a lot of unprocessed Medi-Cal applications on January 1, 2014 for those applying in December. Call your local county office if you have concerns. Why can’t Covered California at least provide news updates of such backlogs on their website?

A college or university should have a student health plan that meets minimum essential coverage. They can purchase that plan without premium tax credits. On the other hand, if the family income is less than 266% FPL, the children may still qualify for Medicaid in the other state. They need to apply through the state/federal exchange as applicable.

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