Trying to get out of Medi-Cal and go to Covered CA?

How to Voluntarily Get out of Medi-Cal and Go to Covered CA
if you reported the wrong Income


Here’s the May 20, 2020 Covered CA bulletin on how to do this.  Please Note that Medi-Cal & Covered CA have different definitions of the $600/week PUC Pandemic Unemployment Compensation and if it counts as MAGI Income!

Covered CA states that this is the correct process:

If your case has already transferred to the county, you must:

  • The county will process the voluntary discontinuance request.
  • The system will end-date the consumer’s Medi-Cal eligibility and re-run eligibility**. (Your income will still show as within Medi-Cal limits, so the system will determine the consumer not eligible to financial help through Covered California.)
  • You  will be found eligible to Covered California programs. (If your corrected income makes you eligible to financial help through Covered California, that financial help eligibility will now show.)


**Note: These changes would be moving forward, meaning that if you  were  deemed Medi-Cal eligible, even in error, correcting the application and restoring eligibility for Covered California would be prospective (for a future effective date) only.


How brokers can help consumers who have been found Medi-Cal eligible after incorrectly entering their income

If you were moved into the Medi-Cal income threshold by mistake (i.e., because you reported incorrect income) you must update your  case after the voluntary discontinuance is processed in order to return to Covered California enrollment and be evaluated for financial assistance eligibility.

Please see two sample scenarios and next steps below for a current Covered California consumer who incorrectly reported their income, entering a number within the Medi-Cal limits, and was found eligible to Medi-Cal:

  • If the consumer’s case has been placed into Carry-Forward status and the County has not begun processing the referral*, the consumer or their delegated enroller can update the application within CalHEERS to correct the entered income and remove the consumer’s Medi-Cal eligibility. Enrollers can identify cases in Carry-Forward status by the multiple program eligibilities that show in the Household Eligibility Results Summary page of the application:

*Note: Since the county will have received the referral, they may still attempt to process the referral at a later date even after the consumer’s income is corrected within the application. If the consumer receives a request from their county for information, they should comply with the county request or request voluntary discontinuance at that time. If they do not, the income correction made in the application may be reverted by the county, placing the consumer back into the Medi-Cal income threshold.

Federal Poverty Level &
Program Chart

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

Stuck between Medi Cal & Covered CA

Covered CA Certified Agent - No extra charge for our help

Covered CA Certified Agent

No extra charge if you qualify for Covered CA Subsidies.
We don't get compensated to help you with Medi Cal.  Here's Medi-Cal's contact information.

Get a Covered CA Quote, including subsidy calculation

Video on why you should have an agent

Video I'm charles why have an agent

VIDEO  ---   Difference between Medi Cal & Covered CA

We are not just Medi-Cal

We've developed the Medi-Cal portion of our website, as many of our Covered CA clients unfortunately end up here, if their income drops below 133% of FPL, Federal Poverty Level, see the income chart.

We do not get a nickel, for this site or for helping people enroll in Medi-Cal, nor answering complex questions.  When you have other questions or need coverage, take a look at   our other websites:

Soft Pause

Medi-Cal And Covered California Assistance And Terms

SAWS Soft Pause Removal

SAWS Soft Pause Removal

Currently, the Soft Pause feature of SAWS protects consumers from losing MAGI-based Medi-Cal eligibility when personal circumstances change.  The soft pause allows the county to run eligibility determinations for other programs while keeping the beneficiary on a MAGI aid code.  This generally happens when a MAGI beneficiary becomes eligible for APTCs, premium-based Medi-Cal, or limited scope/restricted/pregnancy-related Medi-Cal, or if the beneficiary becomes ineligible for MAGI Medi-Cal.

The county worker must screen the beneficiary for Non-MAGI programs before removing the soft pause or before sending the case for APTC evaluation.  If the individual is eligible for Non-MAGI Medi-Cal, the county can remove the soft pause to place the beneficiary into an appropriate aid code.  The same 90-day cure period applies to restore a beneficiary to a proper non-MAGI aid code if the individual did not respond to the Non-MAGI evaluation request.

County workers have the ability to remove the soft pause directly.  If an individual has been determined eligible for APTCs, the county worker can help the beneficiary complete plan enrollment in CalHEERS after removing the soft pause.

DHCS ACWDL 17-35 (October 5, 2017)


When Medi-Cal kicks you out for making too much $$$, they don’t enroll you in Covered CA! Insure Me *   Get a quote and subsidy calculation here and we can help you.  No extra charge! 


Possible reasons why Medi-Cal likes to get as many people enrolled as possible

Medi-Cal takes control of the MAGI Income Process!

See also:

FPL Federal Poverty Level & Program Chart.

Covered CA subsidies cost more than Medi-Cal.  The CBO’s latest projections from earlier this year show government paying out an average of $6,300 annually for every subsidized enrollee in fiscal 2018. It estimates that number will rise to nearly $12,500 in 2028. In contrast, Medicaid spends $4,230 per non-disabled adult, set to inflate at 5.2% annually to just over $7,000 per person in 2028.  Modern Health Care 8.8.2018 *

Insure Me Medi-Cal Problems in Covered CA Accounts 6.9.2016  




Income – Federal Poverty Level can put families into Medi-Cal

More people might wind up in Medi-Cal, due to updates in FPL for 2015 – InsureMeKevin Blog

Modern  saying the churn is not that bad.

One solution, if you can come up with the premium, (Free Quote)  would be to forgo subsidies, tax credits and get a regular private plan direct – through us with an Insurance Company, based on Special Enrollment of Loss of Minimum Essential Coverage.

Another solution – is to use the hints from and get Medi-Cal to change – adjust your income, so that you qualify for Covered CA.

Here’s an excerpt of an email I rec’d 1.7.2015.

Hello Steve,

Thank you for contacting Covered California™ I apologize for the delay in getting back to you.

Unfortunately, the county office Medi-Cal did an audit on this application on 1/2/2015 and they completed an income change and the income is now showing zero. The county overrides Covered CA and the clients will have to contact there local Medi-Cal office and have Medi-Cal update there correct income then you can do a Report A Change and put the income back in for this family and the application will allow you to put the insurance plan back in. If Medi-Cal does not get updated with the family correct income they will keep auditing this application and changing the income back.

You also have access to the Transaction History on the Summary page for this application and when see System that is the county auditing the application.

Excerpt 3.27.2015

It is best for your clients to reach out to a county eligibility worker to correct the state and county systems. Correcting the Covered California application will only do just that, and when the county reviews their information again and the clients information does not match what is on file the state and county systems they will override the Covered California application again. Please have your clients reach out to a county eligibility worker at their earliest convenience to update all their information household members, income, tax information etc. Once the county system has been update then you can log into this application from your agent account and click on Report a Change and correct the income. If the income is above Medi-Cal limits the application will allow to choose a Covered California plan.

Covered CA unable to allow kids to opt out of Medi-Cal even when parents are willing to pay unsubsidized premium –

Learn More ==> CA Healthline 4.7.2016.   Opposing View Point about Agents being Greedy  Insure Me

Carry Forward Status (CFS) 

CalHEERS will automatically place all eligible and conditionally eligible APTC/CSR/CCP individuals into CFS when a redetermination of eligibility results in “eligible”, “conditionally eligible” or “pending” for MAGI Medi-Cal program eligibility. CFS is designed to ensure that the transitioning individual will continue in their Covered California QHP coverage until the resident county completes the individual’s full Medi-Cal determination. DHCS 17-07   *  Cal Heers Job Aid 9.2016  *  FAQ for Enrollers assisting Medi Cal Enrollment  

Hints are fighting with Medi-Cal to get released and go back to Covered CA

With all the alligators in the swamp and at best getting paid $58 to sign someone up for Medi-Cal I never noticed the hearing rights available.

So, get your proofs of income (Covered CA Accepted Documents)  together and ask for a hearing (form).  Better yet, just send the proofs and hopefully Medi-Cal will fix the problem on their own.

Covered CA Talking Points on hearing rights – if more than 45 days – Medi-Cal Determination

Relevant Codes & Regulations

42 CFR 435.603  How to apply MAGI – Modified Adjusted Gross Income to Medi-Cal Application

42 CFR 435.118   Qualifications for Infants and children under age 19

42 CFR 435.110 If you get AFDC they you get Medi-Cal

W & I Code 10850  Records

and 10950   Hearings


We don’t get paid on Medi-Cal…  pay us a consulting fee?

Insurance Agents pretty much can't help you with Medi Cal

Excerpt of email from DHCA

Thank you for contacting the Department of Health Care Services (DHCS).

We are prohibited by law from sharing Protected Health Information (PHI), and Personal Confidential Information (PCI).

Please refer the consumer to the Medi-Cal Now In-Box at [email protected] and we will be happy to assist them with any Medi-Cal issues they may have.

Protected Health Information (PHI) is individually identifiable health information that describes the past, present, or future physical or mental health or the condition of an individual. PHI includes information about the health care services an individual has received or will receive and information about payment for health care services provided in the past, present, or future. Personal confidential information (PCI) is information that is not public which identifies or describes an individual including names, home addresses, home telephone numbers, Social Security Numbers, medical or employment histories, personnel records, licensing records or workers’ compensation. Thank you for allowing DHCS to serve you.  Email dated 6.5.2017  10:43 AM   

Try Covered CA's Facebook Page


12 comments on “Release Medi-Cal get Covered CA

  1. I want to make sure the Alameda County Board of Supes understands how their policies have screwed me and my children out of continuous medical coverage.

    Is this needless county-induced interruption in coverage something you have seen elsewhere?

    Or is it isolated to Alameda County?

    • First, let’s read the letter. The main points are:

      Covered CA and Medi-Cal review your income and family size to see what program and subsidy level one qualifies for.

      Here’s an income chart and here’s our free quote and subsidy calculator.

      Thus for a single person one needs to have expected 2016 MAGI income of at least $16,245 to get Silver 94. Less that than one qualifies for no cost Medi-Cal.

      Next the letter says to check out your account.

      Gosh, things are WORSE than my friendly competitors have stated!!! Someone, NOT me, went into your account and changed the income from $20k to ZERO and FORGED my name. I will be reporting this to Covered CA, Dept. of Insurance, Department of Managed Health Care and the Los Angeles Police Department. I will send you the documentation in a private email.

      So, please send me any, all and whatever proof you have that your estimated 2016 MAGI income will be over $17k ASAP.

      Some of the confusion seems to be the documentation you sent Covered CA prior to appointing me as your agent. Did Covered CA send you a request for proof of income? I can’t find that in the Agent Portal.


      • I am on unemployment til April. I thought that was considered income.

        I started my own business and the way it’s going, I will start making money in April. I’m leasing properties and won’t make money til the properties are leased- which will be April.

        Please advise?

        • Unemployment Insurance Information is at The maximum weekly benefit appears to be $1k, that would certainly be enough. I’m not sure how long one can collect unemployment. Here’s their publication # 1275, which probably has it. I don’t get paid to handle unemployment…

          Please send me the documentation of your unemployment and not just tell me about it. Also, the amount you are getting. How much do you expect to earn in your business? Please check the Unemployment Website and see if you can even collect unemployment as you are working, leasing properties. I do not want to be involved in any tax issues.

          Here’s a list of Covered CA Accepted Income Documents=”” target=”_blank” rel=”nofollow”>IRS publication # 525 page 27 shows that unemployment does count towards income on your 1040.

          • I was confused because I thought your previous email meant that showing proof of income via unemployment would put me back at Medi-cal. I just brought up the leasing thing because I thought you were asking for proof that I would start making money from my own business after unemployment. I’m not making any money or doing work that’s bringing income while I’m receiving unemployment, but I have been seeking employment per Unemployment guidelines.

            I’ve attached proof of income from unemployment. Let me know if there’s anything else you need.

            • The question is, will your 2016 income be more or less than $17k. What proof do you have that you will be making that kind of money from your business in April?

              Thanks for sending your unemployment documentation showing $2k/month. I will upload that to Covered CA and see what happens.

              If I can’t fix it there, then I suggest you contact your County Eligibility Worker – Los Angeles or file an appeal.

              • I went into your Covered CA account, corrected the income. I got a automated reply that Covered CA will review and let you know if you qualify for Special Enrollment. I don’t know how? They didn’t allow me to upload the proof of your unemployment income. I will email Agent Support at Covered CA and send you a private copy.

          • It’s 566 every pay period (every 2 weeks), so that’s roughly over 1k per month (your previous email said 2k per month I think, just wanted to correct that).

            I don’t really have proof of income for my business. The properties that I will rent are currently vacant. New tenants are expected to move in May, so I’ll start receiving income from that just luckily after the time unemployment runs out. Sorry I don’t have any documentation to prove this for the future.

            • In that case, all you are showing is $12k in MAGI income and that’s below 138% of Federal Poverty Level or the $17k shown on the income chart. So, it’s Medi-Cal or you can have a private plan direct with the insurance company, without subsidies or enhanced silver benefits. I will send you a new quote privately. Website visitors can get a quote with and without subsidies, here.

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