Medi-Cal qualification

Medi-Cal logo for health careMany California low-income residents can benefit from the expansion of Medi-Cal, the state’s Medicaid program.

The sweep of changes brought to health coverage by the Affordable Care Act resulted in Medi-Cal opening enrollment to something like 1.7 million additional residents (estimates are all over the road).

States’ Medicaid expansions, in fact, are expected to provide a large amount of the anticipated increases in coverage under Obamacare. As of late 2013 there were more than 9 million people enrolled in Medi-Cal, about a quarter of the population, state officials say.

The expansion raises the income cap to 138 of Federal Poverty Level Guidelines (or 133 percent after a 5 percent income write-off). For 2013, that meant $15,856 for individuals and $32,500 for a family of four.

Those who make too much for Medi-Cal but have incomes of up to 400 percent of the poverty level most likely qualify for subsidies via the state insurance exchange, which sells health care policies for private insurers.

Those who believe they’re qualified for Medi-Cal can submit applications at any time, unlike those seeking coverage via the Covered California private insurance program, which has “open” enrollment periods.

Update: As of mid-2014, there remains a significant backlog in Medi-Cal applications, many of them filed in the first quarter of the year. If you’re among those people in limbo and it has been more than a month and a half, take action: Check with your county health care services operation, or call the state at (855) 795-0634. /update

Also part of the Medi-Cal expansion is the addition of poor adults without dependent children. That would include single young adults, who make up a significant portion of the uninsured in California.

Covered California, the health insurance exchange, provides a single online channel where residents can learn their status with Medi-Cal and subsidized health insurance plans. (It’s called a “no-wrong door” system.)

Medi-Cal is the state’s primary public insurance program. While the programs are free, there are issues with care that most likely won’t improve with the crush of new enrollees. The Public Policy Institute of California lists these as a limited number of doctors who accept Medi-Cal patients, long wait times to get an appointment, and perceptions of lower quality of care.

“In recent surveys, most current individuals enrolled in Medi-Cal report having a positive experience with the program and agree that Medi-Cal provides access to high-quality care,” the state says.

The institute says concerns about Medi-Care quality, the institute says, “might be ample motivation for uninsured Californians likely to gain eligibility for the Medi-Cal program to pursue public coverage in 2014.”

The alternate route for that public coverage is the state health exchange. This is the Obamacare program for the uninsured or those who can’t afford insurance. (But qualification for Medi-Cal may well disqualify applicants.)

While the government subsidizes the majority of those signing up at this state marketplace, it remains separate from Medi-Cal and administered by the the state’s Department of Health Care Services.

“People need to understand that Medi-Cal is separate,” the department’s director says. But, “I wanted to stress how important this partnership is between the Department of Health Care Services and Covered California.”

As with Covered California, Medi-Cal enrollment began Oct. 1 for coverage effective Jan. 1, 2014. In addition to the health exchange web site, all counties still will process applications (at local social services departments) as well as accept Medi-Cal applications by mail.

There are increasing reports of people being improperly denied Medi-Cal coverage on the Covered California web site. If this happens, appeals must be filed within 90 days — contact your county health services office and/or follow directions on the rejection letter.

Read about
Medi-Cal basics
Applying for Obamacare coverage
and see
Medicare Plan Finder for Medicare Advantage or prescription policies.