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Decline Medi-Cal for Kids?

By on | 5 Comments

Question: If a family is eligible for mixed health care coverage - the parents qualify for APTC and the children are eligible for Medi-Cal - are the parents still eligible for the APTC if they decline the Medi-Cal benefits for the children and enroll them in a private plan?

Answer: Yes.

5 Comments

Every complaint I have heard had to do with the quality doctors and hospitals. Obviously these came from those who are with major existing medical conditions.

Hi Agent 9.
Really, what are the issues with L.A. Care? Quite interested to know. Thanks.

Thanks for the reply, Michael. I have found out that it was “OK” for them to have both but Medi-Cal still requires them to report about it. I don’t know if they (Medi-Cal) would cancel coverage once it is reported. I’m coming across a lot of people not happy with L.A. Care (program for L.A. county).

Hi Agent 9.

I believe they could to this. And I don’t believe the private insurer will decline because of current Medi-Cal coverage.

I’m not sure, but does having the private plan technically disenroll one from Medi-Cal? Or I think your clients will need to inform Medi-Cal of the other private coverage, and thereby disenroll from Medi-Cal.

Medi-Cal does not pay for services from non-Medi-Cal doctors either. But I think your clients would have to disenroll their son from Medi-Cal. If they do this, and it works well, then timing the new private coverage with termination of Medi-Cal will be important. They should call their Medi-Cal office to find out specifically.

Be cognizant also that any new health plan will not start until March 1st (at this point, as of today), or the 1st of April or 1st of May, and if their child needs major surgery, is there sufficient time to wait for coverage until March 1st or beyond?

There are good doctors and facilities under various HMOs as provided by Medi-Cal.

A client asked me this question and I thought maybe others had better answers/opinions. Their kid is already on Medi-Cal and seeking a major surgery. They want to purchase a private plan off-exchange because the hospital they want to go does not take Medi-Cal. Could they do this? And if they could, could the private insurer possibly refuse primary coverage since the kid is already covered by Medi-Cal?

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