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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.


Should Have Been on Medi-Cal?

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Question: I had a six figure income in 2013 and a 2 thousand dollar income in 2014. I work freelance and some years are very dry. I projected $29,000 in income when I applied for Covered CA. It didn't happen, but I left it as is because I thought one of the jobs would come through. So, I guess I should have been on Medi-Cal, though. What do I do now? And, will there be an issue since I received premium assistance in 2014? Thank you.


Answer: You are obligated to notify Covered California of your change of income which would make you eligible for Medi-Cal, but there is no penalty for not doing so. If your 2014 income was under 100% FPL ($11,670), any excess tax due to over-payment of advance premium tax credit is limited to $0 for the year. For 1-person househol with income over 100%FPL but less than 200% FPL ($23,400), any excess tax due to over-payment of advance premium tax credit is limited to $300 for the year. Any cost-sharing reductions received through Covered California during the year are not recoverable. Covered California will receive your 2014 tax return data in the summer of 2015 and at some point after that, CC will require you to verify your claimed income if your 2014 AGI was more than 10% higher or lower the income you claimed.

8 Comments

Darlene, You need to report your current income to Covered California. You will be eligible for Medi-Cal and can stop paying for your insurance. Once you have a job, you can again report the change and switch back to Covered California coverage. You will not have to pay back any subsidy assistance you received in 2015 as long as your annual income remains below the Medi-Cal income threshold.

Hi Phil: Thank goodness for your insight!!!
In 2014 I made $30,000 and overpaid premiums but received that back in taxes. I have been employed on and off both last year and this year and it is very hard to estimate what a years income will be since employment has been very unstable for me recently. I thought I would at least make $30,000 in 2015 so I left my income at $2500 a month for 2015, but so far this year I have only made $1500.00 and that was in Jan-Feb. I am still unemployed but am hoping to be able to find work soon. I have been receiving premium assistance Jan-July and have been charging my portion on a credit card. I cannot afford insurance and want to cancel Covered California this month. I just realized that more than half the year is over and I may be qualifying for Med-Cal if I do not make sizeable income quickly and I do not want Medi-Cal.
My question is since I have not reported the change in income to Covered California, do I have to do so now and get thrown into the Medi-Cal bubble or can I just cancel my insurance and pay back the premiums at tax time? Also, do you know if I have to pay the full premium back or is it based on my income and is there any additional penalties besides the $325 for not having insurance the rest of the year. I read somewhere if you do not report a change in income within 30 days you may have to pay back all your premiums. Thank you very much for your time and any suggestions.

Joe, I’m having the exact same problem with numerouse clients. One had an emergency situation and went to the emergency room and was told he was terminated by the carrier. No notice, nothing from carrier or Coveredca. I so fed up, I told them to “get an attorney”. HIPAA laws are very strict when it comes to privacy. Even your application for health is covered under HIPAA. But, like everything else, there is no one to contact about what is going on. I tried contacting the Department of Insurance. Get this, their response was “we only do criminal investigations. This is a civil matter. Civil my ass, they are the poster child of “big brother” at his finest.

Sad Regards,

Tony

This is just unacceptable for me. As an agent, the commissions are so low, and then we have to deal with the incompetence of the state going in and screwing up our clients apps. How do they expect us to represent Coveredca when they just are making more work for us agents. I’m fed up and I think we should get some TV stations/publications made aware of these issues. I think they are just trying to make it so hard to receive a subsidy people are just going to give up and go without. Peter Lee is just clueless. Nothing else. Sad Regards,

Tony Rogers roge1234@verizon.net

I’m an agent who has had multiple clients terminated or their subsidy suddenly changed due to the fact that the state of California is going into their applications and changing their income to inaccurate information that causes children to become Medi-Cal eligible or increased income. Thus, Coveredca is sending carriers termination notices or lower subsidies. I was told that the client has to go to their local Medi-Cal office to fix the problem. I’m concerned that the state can go into their applications and make arbitrary changes to applications without their knowledge and given “no notice” that a change is occuring. Is this legal? I thought that subsidy changes will adjust when they file their tax return? What about HIPAA laws? thanks.

Joe: — — Yes, it is ‘nuts’ with what the State’s ‘System’ is doing. As you’ve described, this exact (if not near exact) scenario situation has occurred with my clients.

Peter Lee obviously either has no clue (though I conclude he must), or he has no capacity, or he has no mojo, to get the State to STOP illegally disenrolling people from coverage retroactively, which renders their CovCal accounts to be in total ‘screwed-up’ status. The State has newly established many members’ Covered California accounts so that these members are without ability to Renew and/or enroll in a health plan and/or Medi-Cal for 2015.

And that agents’ form of pay, commissions (very low already), will be undone retroactively as clients’ Covered California and/or Medi-Cal coverage is retro-terminated without reason, or cause, or explanation, or recourse.

When it comes to recourse, Pinnacle informed me that Covered California members will now no longer have to contact Medi-Cal themselves, as the State’s ‘Soft Pause’ issue will be taken up and addressed and corrected by Covered California and its Help Desk, and the State.

Yet, then last I spoke with Pinnacle (their answers do vary daily depending upon the rep on the phone) I was informed, as was my client, that the client’s only option is to file an appeal (as also suggested by a Covered California direct consumer line representative too).

So the State illegally disenrolls members, mucks up their Covered California accounts, and Covered California now effectively says, “oops, can’t do anything for you, good luck, you can file an appeal.”

Once again, CovCal members and brokers are forced to protect thier incomes, and their clients, placed in a position by the State and by Covered California, and by CalHEERS for members and brokers themselves to address and fix the significant errors and problems which Covered California, CalHEERS, and the State create.

For families in mixed-households, the Medi-Cal system went through the application, made changes, and disenrolled the parents from their QHP. Now they are showing as ineligible for Covered CA. I know that their income is far above the limit but Medi-Cal is preventing them from enrolling through Covered CA. They make enough to qualify for Covered CA but can’t afford to purchase their plan off-exchange, leaving them entirely without coverage. In a few cases, not only have they been disenrolled from their plan, their plan was cancelled as “never effective” after 10 months of paying their premium.

I’ve spoken to Covered CA multiple times but their answer is always the same: it is the state system going through the application. By law, Covered CA does not have the power to make changes or override the changes made by the state. They tell me that the only solution is to have the client go to their county Medi-Cal office and have their case worker “release them” from the system. I have never gotten a clear answer about what that entails. I’ve sent a few clients to their county office to speak to their case worker but they have been unsuccessful.

What options do my clients have to get this resolved? They are uninsured while I’m twiddling my thumbs waiting for Covered CA and Medi-Cal to sort this out. I honestly have no idea what actions I can take when I can’t talk to Medi-Cal for my clients and Covered CA can’t do anything about it.

Where can I send my complaints? It’s unbelievable that they’re allowing Medi-Cal to make unauthorized and unchecked changes to the account such as deleting tax information and dropping the income to $0. My clients have no idea about this. They head to the doctor and find out that their coverage has been cancelled without notice. Covered CA says that Medi-Cal is auditing their account but my clients are not being informed and are not given the opportunity to clear this information. Their application is in limbo.

Hi Phil,

As I understand it the Medi-Cal cut off for 2014 for a household of 4 was up to 138% of the Federal Poverty level which in 2014 was $32,499.

If a persons line 37 in 2014 falls below that amount with a 4 person household, will they have to pay back all of the subsidy they were advanced in 2014? Or is there a limit to what a family would have to pay back?

Also could you let me know the same for a family of three and a family of 2?

Thanks!

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