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CFR – Code of Federal Regulations

45 CFR 155.305 Eligibility Standards




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Federal Poverty Level &
Program Chart

Medi-Cal?  Covered CA Subsidies?  Enhanced Silver?
MAGI Income Chart

FAQ’s from Updated Webpage

Gaurav says:

Our combined household income will put us over the limit to qualify for any subsidy. I’m ok with paying out of pocket full premium but this article seems to make even that impossible.

Is this still an issue since the article is from 2016 ? Or do I need to buy insurance directly from insurers rather than on covered CA. Would that fix the problem?

  • Did you check the income chart? Two people would be $100K

    Please use our quote engine cited above.

    What Special Enrollment Reason will we use?

    There is a Special Enrollment for those who don’t have coverage due to COVID 19. We might be able to do that.

    It’s my understanding only Covered CA has the Special Enrollment for COVID 19. I can double check.

    Our webpage on Insurance and COVID 19.

    Our webpage for Health Net PPO & HMO Individual

    Our webpage on dual coverage.

    • Gaurav says:

      Yes income is much higher than that so I’m sure we won’t qualify for subsidies.

      When I enter our ZIP code on covered CA the health net plan doesn’t show up. So I believe I’ll have to buy it outside covered CA.

      Does special enrollment apply to health net plan purchased directly through them as well?

      • Please use OUR quote engine, so that we can follow what you are doing. Also, we only get compensated if you purchase through our affiliate link, no extra charge.

        We do not accept hearsay. We need to see the exact stuff!

        Covered CA not Health Net pay us for our second to none website. Nor for the time it saves their personnel on the phone.

        Here’s a list of plans that Health Net writes by county. Santa Clara shows up for PPO.

        Here’s our online enrollment link and quoter for Health Net.

        Yes, since everything under ACA/Health Care Reform/Obamacare is guaranteed issue, no pre-x, you can only buy at Open or Special Enrollment. Not when you get diagnosed with cancer and have MAJOR bills ahead!

        If you can get Medi-Cal to disenroll you, that would be a special enrollment for loss of coverage.

        Here’s an excerpt of Health Net’s bulletin about the COVID 19 special enrollment

        Here’s what you need to know about the SEP:
        • Any uninsured individual or family can use this SEP to apply for 2020 health coverage.
        • This SEP is for new enrollment only and not available for plan changes.
        • To enroll in one of our off-exchange plans, go to Proof of a qualifying event is not needed to enroll under this SEP. You may also use the existing 2020 IFP enrollment forms to apply by mail.
        • Effective dates of coverage are:
        Enroll by Effective date
        May 31 June 1, 2020
        June 30 July 1, 2020

        • After June 30, 2020, the regular special enrollment period qualifying events apply.
        • First month’s premium payment is required to activate coverage.
        • The impact of COVID-19 on small businesses may be causing some people to lose employer based health coverage. Individuals can use this SEP to enroll with Health Net to regain health coverage.

        • So, it looks like, if you take your Mom as a dependent, Medi-Cal will kick you out.

          Then you would have a special enrollment period for loss of coverage.

        • Medi Cal Plans

          Santa Clara Family Health Plan

          Stanford Health Care is in-network for hospital and specialist physician services only. You would not be able to select a Stanford Health Care physician as your primary care physician.

          In order to be seen at Stanford Health Care, your primary care physician would need to refer you and your medical group or health plan would need to authorize all services provided at Stanford Health Care or by Stanford Health Care physicians.

          Our webpage on appeals & grievances

          Santa Clara Family Health Plan Medi Cal Website

          Member Handbook

          See page 36 for information on getting a second opinion

41 comments on “Eligibility Criteria for Medi-Cal – MAGI Income

  1. Medi-Cal is California’s Medicaid program, which provides health insurance to individuals and families who earn low incomes, including 40% of the state’s children, half of Californians with disabilities, and over a million seniors. In total, the program covers more than 12 million people, or nearly one in three Californians.

    Medi-Cal also covers a large number of working Californians, many of whom became eligible for the program because of the Affordable Care Act’s Medicaid expansion. Working Californians may be one of the least recognized or understood populations served by the program. In a 2018 poll, 42% of Californians said that they believed that most working-age adults without a disability enrolled in Medi-Cal are unemployed. Twenty percent said they didn’t know. This report combines key findings from survey data with insights from 19 in-depth interviews with enrollees to paint a more accurate and complete picture of working Californians who rely on Medi-Cal, why they came to enroll in the program, and the role it plays in their lives.

    The report is accompanied by video stories from a few working Californians who participated in the in-depth interviews

  2. My family is receiving medi-cal in California due to low income.

    If I sell my house, will that disqualify me for medi-cal for that year only or will it disqualify me longer?

  3. I am on Medi-Cal ( CA medicaid) as an “expansion adult” qualified based on MAGI.

    I am turning 65 next week so supposedly my MAGI eligibility ends right then but I haven’t received any “dis-enrollment” or “recertification” notices.

    So I wonder how that works and for how long I am “safe”… That would affect when I want my medicare to start.

    • Hi Steve,

      Confusion about MAGI Medi-Cal.

      For those young adults who are healthy, not pregnant but have no income goes into the MAGI Medi-cal file.

      Although the asset test is said to be no longer required, why do case workers still ask for bank statements and questions about personal assets?

      Are they confused?

  4. Hi Steve,

    I have a Medi-Cal question you might be able to answer or point me in the right direction.

    My wife and I have an adult son with various medical problems. He’s on Medi-Cal since his MAGI is below the limit because he can work only part-time due to his health. So he can’t support himself alone.

    He lives with us and we feed him.

    However, he files his own income taxes, meaning we don’t have him on our return as a dependent.

    Nonetheless, is our financial support somehow jeopardizing his Medi-Cal eligibility?

    Thank you for being generous with your time and knowledge.

    • I’m not familiar with Medi Cal benefits, simply because a parent passed away.

      Please advise what program that is.

      If you only have private documents from Medi Cal or Social Security so stating, please send that to me privately at [email protected]

      If what you mean is, the income for you and the child is below 266% of Federal Poverty Level Chart or $45k for a family of two, then the child would qualify for Medi Cal. Family of 3 $57k.

      Family Size basically goes by whose on the tax return. For Covered CA and I presume Medi Cal, married persons must file jointly.

      So, please respond anonymously with yours and your “fiances” income and I’ll look at the charts for you…

  5. I have too much money in my bank account assets to qualify for Medi-Cal, but I don’t make enough to qualify for Covered CA subsidies. What can I do?

    • There is no longer an asset test for Medi Cal. You need to earn at least $17k to get subsidies with Covered CA. Click here to enroll in Medi Cal in Los Angeles County I don’t get paid to help you enroll or to answer questions.

      H. Assets or Resources

      In an effort to simplify program rules, the MAGI methodology does not consider assets or resources other than income. Thus applications for MAGI Medi-Cal, MCAP, and Covered California do not have any questions about bank accounts, homes, cars, property, etc.

      On the other hand, most non-MAGI programs that count income still have limits on what resources an individual may have besides income to qualify for MediCal. However, like everything else with the non-MAGI programs, the rules vary by program.

      For example,

      the Medicare Savings Programs (QMB, SLMB, etc.) have a countable resource limit of $4,000 for an individual and $6,000 for a married couple, while

      the 250% Working Disabled Program has a resource limit of $2,000 for an individual and $3,000 for a couple.

      In general, non-MAGI programs that do not count income, such as the program for Former Foster Youth or the Minor Consent program, do not look at resources either.

  6. I’m a 45 year old male who is single and on medi-cal. I have a Roth worth $11,000 and a car. My earnings this year will be $20,000 approximately. If I contribute $5,000 to a traditional IRA this year to bring my MAGI to below 138% of the poverty level, will I be able to requalify for Medi-cal?

    • Assets are no longer a factor in MAGI based Medi-Cal qualification. An IRA deduction on line 32 of your 1040 would lower line 37 which is the basis of MAGI income, as most taxpayers don’t have foreign income, social security or tax exempt interest to add back in.

      Please be sure to double check with competent tax counsel, the answer appears to be yes.

      On the other hand, you are nearing age 55 at which point, the Medi-Cal premiums can be deducted from your estate.

      Is there any way you can look for a better job or take another part time job to get your earnings up?

      Send us a private email, we can help you set up your IRA.

      • Using the link in the upper right-hand corner and getting a free quote and subsidy calculation you may find that covered California with subsidies will look very appealing

      • Thanks Steve – much appreciated. Two more questions regarding your answer:
        At 55 can medical seek premiums from an estate that I am a beneficiary?
        Are interest or dividends that are received within a ira considered untaxable intrest/dividends, and therefore added to MAGI?

        • I don’t think Medi-Cal would have a lien of what you inherit. Their lien would be on what remains in your estate when G-d forbid, you pass away.

          On my estate recovery page I’ve done say 20 hours of research putting together the links and information. I’m not an attorney, so I suggest you contact one or read through all the links and brochures that I’ve thought were good enough to make it to my website.

          IRA interest is also tax exempt until you withdrawn the money. I’m not a CPA and don’t know your full situation. Learn More ===> IRS Publication 590

  7. This is a lady who was in a major car accident. Her Father called and we set her up with coverage through Covered CA where I did get a measly commission. She flat out accused me of fraud, lack of integrity, criminal motive, etc. for not putting her into no premium Medi-Cal! Thus, we don’t do coverage for competent adults through 3rd parties. Yes, it’s a quandary, as she wasn’t competent at the time.

    Hello Mr. Shorr,

    I wanted to tell you I’ve two modes of resolution now for the dilemma I’d been fighting w/BS thru Covered CA. First and this was my initial thought I should have just done on the outset was dispute the charge with my bank. They gave BS what they were owed and returned my overpayment to me immediately as I’d proof I no longer had need for their service and was being enrolled in Medi-cal. It took about ten minutes and I already have my money back.

    After spending twenty days and three hours on the phone (mostly holding or educating inexperienced employees) the resolution Blue Shield sought was simply finalizing enrollment in Medi-cal. The Medi-cal Ombudsman had told me to bring my issue back to the county and ask for a hearing and all this run around and I threatened them with a lawsuit so they called me somewhat immediately at least ten times. I’d not answered any of the calls as the caller ID was blocked and so I’d not answered the phone. I couldn’t figure out who’d be so rude to call and not leave a message so many times that I finally answered the call mostly as I wasn’t on another call. Every other time they’d called I was already on with one agency or another getting nowhere. The unknown caller was the actual Ombudsman who said they couldn’t help me and again said to file for a hearing at the county. Then she’d noted I’d not enrolled in Medi-cal yet and I told her in response I’d had no time. She said well let me at least do that for you. I chose the same Medi-cal program as my son and immediately everything fell into place. A letter was issued to Blue Shield with correct ending and beginning dates (that would initiate a refund if appropriate) and I’d met the 20 Sept deadline so I wasn’t just thrown into an unknown plan. All that was required to activate the refund. It’s likely that tomorrow on the deadline it would have also been “magically” solved yet I likely would not have known why if the Ombudsman had not told me all that completing enrollment would entail and not realizing herself that she’d issued the statement to Blue Shield that they’d been awaiting and I’d asked for… It’s almost too crazy to believe…

    There are so many gaps in these systems and so many people who don’t understand what they’re supposed to do or what they are doing yet their actions often lead to success unknowingly and it must happen often enough that I’m rare if not the only one who had to suffer for weeks all because I’d not had time to phone and select a plan out of all the horrible plans they offered as I was trying to gain a refund first and the clock kept ticking. I don’t really care what I choose as I’m going to keep paying to see my neurologist in cash and only want my medication to still be covered by insurance as it’s quite expensive.

    I realize you don’t wish to work in this area any longer yet it’s possible you may encounter this in a transitional phase. Please note if any of your customers had other insurance they must complete signup in every way to close out the current coverage that then initiated a number of automatically generated forms and communications. The same is true for people on Medi-cal who seek different insurance if they’re able to afford it. Someone must finish the entire enrollment process completely or Medi-cal won’t terminate itself even though a refund wouldn’t be an issue in that case. I won’t likely be needing nor receiving anything from Blue Shield as my bank paid for August and I’m enrolled retroactively so I owe them nothing for Sept. Amazing that no one knew this. Amazing that no one else asked me to complete enrollment given that the deadline is tomorrow. I was only made aware of it yesterday. Thought it might be of some value as this wasn’t a minor undertaking.

    Jennifer M

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