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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.


What is Income Cut Off For Medi-Cal?

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Question: I currently have insurance through Covered California (signed up Dec 2015). I have KP Silver 94 HMO plan. I'm trying to predict if I'm going to be dropped into MediCal based on my tax return for year 2015 which I'm close to completing and will be turning in soon, prior to extension deadline of Oct 17. It looks like my AGI will be around $17,480. Will I still qualify for Covered California...especially in consideration of any new changes to income qualifications during the upcoming enrollment period this fall 2016?... ...or will I be dropped into Medical?

Answer: In 2017, the annual income cut-off for Medi-Cal eligibility for a one-person household is $16,394.40, a two-person household is $22,170.60, a three-person household is $27,820.80, and a four-person household is $33,534.00.

40 Comments

My son graduated from college in another state, and lost his student health insurance. He doesn’t have a job, or a home, though he has an address where he can get mail. He has been staying with family and friends since he graduated. I am no longer declaring him as a dependent, and he is not a member of my household. Can he quality for medi-cal until he can go to grad school and get on another student plan?

My mom -74yrs old,divorced, retired, in nursing facility and only receive pension for$914. She has soc for $757 which she can’t afford to pay due to she has to pay life insurance $341 a month and this leave her to no $ in the bank for personal use. Is it a mistake in SOC amount? Should I request for hearing?pls advice me Thank you..

I am a 66 year old green card holder ( not a US citizen). I am unemployed and have no income and I don’t get any benefit except Medi-Cal. My adult child whose income is above medi-Cal limit helps me for my costs and accommodation . My question is, if my child claims me on his tax return, would his income as head of household be considered my income? Will I lose my Medi-Cal benefits as a result of this?

Reese …

The County Eiigibility Worker is wrong. $33,948 (138% of FPL) is the upper income limit for adults in a household of four to be eligible for Medi-Cal. But the law in Californis is CRYSTAL CLEAR — children are Medi-Cal eligible if the household income is below 266% off the FPL. You will probably need to file an appeal of the Eligibility Worker’s improper determination. If either of your children suffers from a chronic health condition, you can request an “Expedited Appeal.” If not, you’ll have to get in line and wait about five to seven weeks for a hearing to be scheduled another few weeks down the road (2-4 months total from the time of tiling). You should be able to file your appeal via telephone by calling 800-952-5253

Hello, I applied for Covered California for my two children ages 2 and 9.

We are a family of four with an annual income of $63,589.68. My results I received from Covered California said my children did not qualify for coverage through the marketplace because our families annual income was below $65,436. However, when I spoke to my County Medi-cal worker he said my children did not qualify for ANY type of Medi-Cal program including Healthy Families because our familiy’s annual income was above $36,000 and said I should go back to Covered California.

I called Covered California back and they reiterated the same about not qualifying because our family income was below $65436 and that I needed to call my county back.

Who is right? This is overwhelming and I’m just trying to insure my children.

Michael, Your eligibility for Medi-Cal is based on cutrent income for 2018. The problem with the application is that you may be asked to submit “Proof of Income.” How do you prove $0 income with a prior tax return that shows income? You don’t. You write and sign a statement that you have no income and upload it on request. The local county Medi-Cal agency will likely need to meet with you in a face-to-face eligibility determination interview and, if so, will notify you by mail. Don’t miss that appointment!!.

Based on my income for 2017, I do not qualify for Medical. But I am currently unable to work and will probably have no income for 2018. I am not eligible to apply for Social Security Disability or California State Disability. Am I eligible for Medical now, based on my expected income for 2018, or am I disqualified based on my income from 2017?

I am a single parent, household of 3. If my monthly income is $2,560, will we 3 still qualify for Medi-Cal?

Housing allowance is not reportable as income. If your adult children are under age 26, you may be able to include them as members of your household, which would make you a household of 6. As a household of four, income below $33,948 qualifies as Medi-Cal eligible.

My husband is looking at a position that has housing allowance that is not taxable income. We have 2 adult children that are college students and 2 children that are minors that are all dependants. Would we be considered a family of 6? And would we qualify for Medi-cal if our taxable income was around $29,000 and housing allowance in LA area of $36,000?

Shelly Marie, If your monthly income varies, use an estimate of your annual income divided by 12 to get an average monthly income.

Are medi-cal income limits based on annual or monthly income? Some months I have an extra payday or holiday pay, bonus etc. that would put me over the $1,386 monthly but I am under the annual $16,643.

Cindy, You are not eligible for Medi-Cal based on your income, but you may be eligible for premium assistance through Covered California.

I make $19.000 , a year and my husband getting social security around $ 1735 a month do we qualify for medica? Thank you

Fariba …

You won’t be penalized, but you are defrauding the State of California and the Federal Government by your failure to report your true income. You signed a statement, under penalty of perjury — a separate crime — that you would “immediately” report such changes. You are a thief.

Hello,

I am a full-time student who makes income on the side. I made $30K in 2017. I converted to Medical after I turned 26 in July 2017. Since my pay is variable and depends on the school schedule, I have not made an attempt to change from Medi-cal to Covered California. Also, I was not sure if Affordable Act stays or will be replaced by a new system. Am I going to be penalized when I file my income tax in 2017? I appreciate letting me know how much is the penalty.

Shiela33, Income that satisfies the FPL requirements is known as MAGI — “modified adjusted gross income”. It includes certain non-taxable sources of income such as unemployment insurance and disability income benefits (which were not paid for with employee after-tax dollars) which must be added back into income for the year. It’s convoluted, and the 2018 Covered CA application makes it even more so with several pages of check-offs that can mostly be ignored without affecting eligibility for premium tax credits or Medi-Cal.

Phil - You wrote, “Answer: In 2017, the annual income cut-off for Medi-Cal eligibility for a one-person household is $16,394.40…”

What is this on a tax return? Is this the Fed AGI, Fed taxable income, or state taxable income amount? Thanks in advance.

John, You don’r have to report your temporary (less than 4 months) income to MediCal. If you earn more than $34,000 in 2018 you will lose Medi-Cal in 2019, but there is no penalty or added tax if that happens.

My family of four (including two small children) are all currently covered under Medi-Cal. I recently started working on a temporary project that will last approx. 3 months (the job pays anywhere between a couple of hundred dollars a week, to a thousand dollars a week, but never more than that). Will my family and I lose our Medi-Cal coverage during my work on this temporary project? If so, when can we expect to lose our coverage and how long would it take to get back onto Medi-Cal once this project ends and we do not have an income?

I heard from a someone that this person and her spouse makes $80,000 per year and they have four kids and all of them get regular medical. How’s is that the parents are still able to get medical? Maybe one of them is not reporting income and is hidden the address I assume. How would these people get caught and why they haven’t when they file taxes together.

Your family size is three until your baby is born.

Maria, you are eligible for Medi-=Cal based on your income.

I am currently pregnant making my family size of 4 with an income of 995.00 biweekly do i qualify for medical?

Morris …

If your employer “offers” you and your dependents “coverage,” unless the premium for your own coverage as an employee exceeds about 9.5% of your gross income, the total premium you are required to pay for your employer’s plan is considered “affordable.” While nothing prevents you from going to Covered CA to obtain health insurance for you and your family, you would NOT be eligible for Premium Tax Credits to reduce your out of pocket cost of premiums, and your total premium would probably be higher than that of your employer’s plan.

If myself and family members are offered medical coverage through our employers but we are required to pay for it are we eligible for Covered Calif or Medi Cal if our incomes fall within limits?

With regard to Ann’s question — you wrote “IF she’s reporting the rental income.” Can she legally NOT report the rental income when applying for Medi-Cal? The “if” implies she doesn’t have to report it.

Ann, If she’s reporting the rental income, her income is over the limit for Medi-Cal.

Can a 78 year old California resident that owens a mobile home qualify for medical? Their income is 987 dollars monthly from social security ,about 150$ from Charles Schwab & 600$ dollars a month from a bedroom in her house that she rents out. So her income is approximately 1730 a month. Does owning her mobile home make her more eligible then if she did not own a home.

Joel, your income is above the Medi-Cal limit for a family of three which you can claim now or a family of four later. On the other hand, you are eligible for Silver 87 level health insurance coverage through Covered California. This is excellent low-deductible coverage at a low price.

Diana, your income is above the Medi-Cal. On the other you are eligible for Silver 87 level health insurance coverage through Covered California. This is excellent low-deductible coverage at a low price.

Hi, would I qualify for medical if my household income is 2,880 a month and a year is $34,800. The size of my family is 3 (me,wife and my 4 year old son) and my wife is pregnant. Is that considered a family of four now?

I have income 28,060 for a household of two. I have son 7 year old. Can he qualify for Medical?

My mother, who’s 68, has had Medi-Cal coverage for several years, and has been going to Kaiser in Santa Clara for years. Earlier this year, the County of Santa Clara requested a bunch of tax and bank account information from her. It took her a while to pull all the information together and submit it to the County. After they reviewed it, they sent her a letter stating that her coverage will continue as before. Then this summer, they sent her another letter stating that they made a mistake and she no longer qualified for Medi-Cal. They a few days later she got a letter fom Kaiser stating that her Kaiser coverage, which she’s had for 30+ years, was abruptly terminated - retroactively - because she lost Medi-Cal coverage.

We called the County of Santa Clara for an explanation and they said they had more than $2,000 in her bank account and for her to get her coverage back, she needed to spend her money to get her account below $2,000. What kind of advice is that?!!

Since we didn’t want my mother to lose health coverage, we asked them for advice. They recommended that we contact Social Security Admin to get my mother Medicare Part B (she already has Part A). However, SSA said that she has to wait until next January for Open Enrollment Period to enroll. And Part B would not take effect until the following July! This is crazy, since she will be without health coverage for almost a year! We went to SSA in both Walnut Creek and San Jose to ask for help. After waiting for over an hour at each branch office, the response was the same: They’re very sorry but could not help; suggested we go talk to the County of Santa Clara who canceled my mother’s coverage. Back to square one!

We contacted Kaiser to see if we can get her a temporary health plan until she is able to sign up for Medicare Part B. They said there’s nothing they could do!!! They offered a market-rate plan (“Bronze package”) to her, which would cost her $700/month with a very high deductible. They said they were very sorry!

We feel so hopeless! Is there no government agency that can help my mother to get her health coverage back? Please help!

Elena, Your son can remain a member of the “household” under current law until he turns age 26.

I have a 20 year old son who works only seasonal, college student, and lives with me. Can he also qualify for medical if we are 5 in total in the family?

Suzanne, Yes. A child 18 years or older counts as a member of the household.

Does a child 18 years or older count as a member of the household?

Max, thanks for the correction. We had set up our table with 139% of FPL rather than 138%. However, I don’t think you are correct in adding $5,741 for each additional person. It should be $5,713.

I don’t know where Phil got his FPL information from, but it’s wrong. 138% FPL in 2017 has been set at $16,394. for a household of one. It increases by $5,741 for each additional person in the tax household. Children are swept into Medi-Cal if MAGI is below 266% of FPL which begins at $42,612 for a household of two and increases by $11,012 for each additional person in the tax household.

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