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Re-determination Rules & Procedure Page 6.227 

iii. Redetermination of Eligibility

The county must determine a beneficiary’s ongoing eligibility upon learning of a change potentially affecting eligibility from the beneficiary or from its own review as follows:

• Determine if the change in circumstances affects eligibility. For example, a change of address may not affect eligibility for Medi-Cal, but a change in household size might. If there is no change in eligibility based on the new information, no other action is needed.  Another example: If income increases $100/month, but the annual household income remains below the eligibility
limit, the individual remains eligible for the same program so no further action is needed.
• If the county determines that the change in circumstances may affect

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Bank Statement Review

Gifts?

This page is Q & A – FAQ on how Medi Cal might review your bank statement to determine how much $$$ you make.  MAGI  Modified Adjusted Gross Income

 

Will a  $40 transfer Birthday give from my biological father in Mexico
(I live in CA) will be ok w/ MediCal annual redetermination on the bank statement.
[one of the accepted proofs on income]

IMHO it’s not income and wouldn’t count towards MAGI Income. At best, it would be a gift which isn’t income either. Are you real close to the 138% Federal Poverty Level? ChartFree Calculator

Disclaimer-  We are not paid to help with Medi-Cal and are not tax accountants.

***

I only receive SSDI, [Social Security Disability Income  – vs SSI] $1091/mo.

However, the month before my fathers transfer was my bday & I desperately asked for cash

***How much cash are we talking about?  Was it a gift?  Loan?  Here’s the best I could find on the Internet about what might be reviewed – discovered in a bank statement.

bc my HOA increased & I’ll be unable to pay my bills.  so I deposited every cent I had-$220 the previous month-the total amount of my bday gifts (more than usual obviously but I think my family is worried I’m going to lose my condo). So I’m worried if they ask for another bank statement from the month before it will show that huge bday money deposit. And it said u can only have $60 deposited quarterly I just read online???

***Please when citing facts, provide the URL – Internet Address.

If my redetermination date is Nov; papers mailed in Oct do u know if I have Til Nov 30th? Should I wait Til my next bank statement comes out- bc I NEVER have deposits like that- this was just a one time thing& it could cost me so much. I’m so scared.

***The way I see it, this is gift income and doesn’t count towards MAGI.  See disclaimer above.

Even if it did, near as I can tell, from the income chart, one person can earn up to 138% of Federal Poverty Level $16k or so.  Your $1,091/month would be $13,092 so you’ve got a $3k cushion anyway.

Even if you went to $17k, you would qualify for $307/month premium subsidy, Silver 94 benefits and a net premium of as low as $39.

Please put your correct MAGI income into the “draft” quote we sent you and see where things are at.  Also, please advise what line 37 on your tax return should be, plus foreign income, social security – send your 1099 and tax exempt interest.

To start fresh on a complementary quote, click here.

****

I was just lost bc [because] I don’t think I have it thru covered CA. As far as I know at least. Nothing on my app says anything about that or those plans.

***You’re referring to the quotes from our complementary engine for those who earn enough for Covered CA tax credits – subsidies.   Covered CA wants to have everyone go through their portal.  One can just go directly to Medi-Cal.  Here’s their contact information.  In Los Angeles County, one can enroll online.

I think I got it bc of my low income & disabilities.

***Sounds right.  Right, near as we can tell Medi-Cal is automatic if one qualifies for SSI.

I find Medicare almost useless bc it only covers 80% & I obviously can’t cover a penny of the other 20%-

***You might look at Medi-Medi Plans

 I’m so desperate to keep the medi-Cal (bc it covers the rest-  ….  MediCal & SMLB (the SMLB helps cover the Medicare deductible & copay a etc).

***SPECIFIED LOW-INCOME MEDICARE BENEFICIARY (SLMB)

Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), or the Qualifying Individual-1 Q I -1) programs. The State will pay Medicare Parts A and B premiums, deductibles, and coinsurance fees for persons eligible for the QMB program. The State will pay Medicare Part B premiums for persons eligible for SLMB or Q I -1.

I’m so scared. All bc of those transfers.

***I doubt it.  See above about 138% of Federal Poverty Level and your cushion.   There is also a difference in some Medi-Cal programs on qualification.  As a Covered CA agent, I’m pretty much only familar with MAGI Income Qualification, not asset tests.   There are also different rules for qualifing for nursing home coverage.

***Medi-Cal asking too many questions might work in your favor?  There might be MORE benefits they can offer you.

****

I only have SSDI, no SSI & I have medicare because of my disabilities (I got it after a year on Social security)

***Normally it’s two years.  Learn More ===> ssa.gov/pubs/EN-05-10029

and also Medi-Cal i’m assuming I think it was because of my low income which is only the SSDI.

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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   

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31 comments on “Bank Statement Review

  1. Hi, my husband & I are in California &

    I receive ssdi & we both receive Medicaid Medi Cal benefits.

    My husband is my IHSS care provider.

    We are being gifted a home, paid in full & $100,000.

    Will we lose our Medicaid?

    Will my husband no longer be able to be paid as my IHSS care provider?

  2. When submitting bank statements to Medi Cal and Cal fresh, can I blackout personal spending, if it is not a bill?

  3. When sending your verification to medical, i.e. payment stubs for the last 30 day period. must you show all forms of income earned, such as bonuses, and any per diem the employer granted for certain days? These examples are items that are not guaranteed forms of payments for me. Meaning, I don’t get guaranteed bonuses and the per diem paid was a one time deal. So, am I able to black these line items out to only show my consistent pay rate and total hours worked for them to determine if I qualify? I am applying for the 2019 year, but I was asked for December 2018 paystubs.

  4. not a question more of a comment i know your not a medi-cal rep but figured you may have some insight as to how they do things.. but you said you dont thanks for trying though i do appreciate it

    • Here’s what I consider a worthwhile comment.

      Please only ask a specific question here, after you’ve read the original webpage or make a factual statement that can be verified, preferably by you. This is not a website for chatter, but for actual statements of verifiable facts.

      Please only use the initial of your last name. I don’t want to get busted for privacy issues.

  5. well its for annual redetermination for medi-cal i uploaded letter from SS showing the backpay but i havent actualy TOLD the worker so wondering if i need to call and tell him about the backpay

    • Personally, I don’t call anyone. This is a question for your therapist. How about checking with a local college or something and see if you can find a course on communications. IMHO if you uploaded the documents, that’s all you need. I’m getting annoyed with all your comments, how do you think your paid social worker feels?

  6. I uploaded documents that Medi-Cal requested. Should I follow up and make sure I’m approved, that Medi Cal has the paperwork or what?

  7. The Medi-Cal Redetermination Form where it says income was i supposed to list my back pay there as well?

    or just my monthly benefit?

    if i was supposed to list the backpay as well im SCREWED because i told the lady that intaked me BUT i didnt list it on the form because i thought it was for regular income…just great i didnt know

    Old Redetermination Form

    • The form you are citing is dated 5.2011 and is out of date. Check our redetermination page. The current form is dated 4.2015. ObamaCare ACA Medicaid expansion changed everything.

      I’m not interested in a debate with you, about if some Rando at Medi Cal sent you a different form. It’s not my job. All I can do is search the internet and pick what I believe is the most current and reliable information. Ask Medi Cal why they didn’t send you the 4.2015 form. I don’t work there.

      We don’t get paid to maintain this website nor to answer questions. Please direct your questions to your county social worker. Please note also, that different Medi-Cal programs may have different methods on how they count income. See Western Poverty Guide.

      Here’s Covered CA’s listing of Income. See also IRS publication 525, Taxable and Non Tax Able Income, back pay.

    • Looks that way to me. See the actual CFR – I guess you can’t go overboard… though.

      I’m not an authorized Medi Cal representative. Check with them. They get good salaries and maybe even belong to the Union. Check the actual CFR 20 C.F.R. §§ 416.1210 (effective 3/9/05) for a list of excluded resources;

      Exclusions from resources; general.
      In determining the resources of an individual (and spouse, if any), the following items shall be excluded:

      (b) Household goods and personal effects as defined in § 416.1216;

      20 CFR §§ 416.1216, Exclusion of household goods and personal effects

      (a)Household goods.

      (1) We do not count household goods as a resource to an individual (and spouse, if any) if they are:

      (i) Items of personal property, found in or near the home, that are used on a regular basis; or

      (ii) Items needed by the householder for maintenance, use and occupancy of the premises as a home.

      (2) Such items include but are not limited to: Furniture, appliances, electronic equipment such as personal computers and television sets, carpets, cooking and eating utensils, and dishes.

      416.1218. Exclusion of the automobile

      • Reply from Leonard H. The indenting isn’t working properly…

        go overboard? i mean if something is exempt its exempt or they should have to say if over certain amount its not exempt

        i see nowhere in that code saying there is a dollar limit and then it counts if there was i would think they HAVE to say so, you can’t say something is exempt and then say JUST KIDDING its NOT exempt because its over certain dollar amount if they don’t have the code saying so

        • https://www.elderneedslaw.com/blog/medicaid-exempt-assets

          1. One Car – regardless of value (within reasonable limits, don’t buy a Lamborghini). Also a second vehicle that is seven years old or older, will not be counted by Medicaid.

          2. Personal property – also have to be reasonable. Medicaid is not going to expect you to inventory your jewelry, clothing, refrigerator and armoires…but if a new diamond ring is purchased, or if an original Picasso is in the living room, those will be questioned and counted.

          https://www.dcf.state.fl.us/programs/access/docs/esspolicymanual/1630.pdf

          1640.0565.01 Personal Property (MSSI, SFP)
          Household goods and personal effects of reasonable value are excluded as assets. Household goods and personal effects are of reasonable value if the individual’s equity in such property does not exceed $2,000. Equity value is the value of an asset on the market less amounts owed on the asset.

          michaelbest dot com
          Under federal rules, household goods and personal effects with a value of up to $2,000 are exempt; wedding rings and personal medical equipment are excluded regardless of value. Under the Wisconsin Administrative Code, household goods and personal effects of “reasonable value” are exempt.

          Skip to 2:25 for personal property

  8. question about DAC [Disabled Adult Child] MEDI-CAL in california

    i got a back payment from SS [Social Security] after the 9 months before they count it against your property

    at next review are they going to make me show receipts to PROVE i spent the money?

    the property supplement says give bank statement showing current balance in account/s if you have more then 1

  9. My a Medi-Cal but they continued because she have more than $2,000 on her checking account. What if she’s going to send some of them to her daughter in other country to help her daughter can she re-apply again for Medical-Cal?

    • Your question doesn’t quite make sense. Please review and rewrite it.

      Here’s links and excerpts to the rules on spending down for Medi-Cal:

      Can You Spend Down Resources?

      You may spend down your resources to the $2,000 limit in order to become eligible for Medi-Cal. Resources must be reduced to the $2,000 level by the end of the month in which you want to be eligible. You may spend down your assets on any item for your own benefit: to remodel or repair the home, buy new furniture or pay off a mortgage or car loan, pay off other bills and debts, buy new clothing, medical equipment, outings, or even a vacation.

      Can You Give Away Assets & Still Be Eligible For Medi-Cal?

      You may be able to give away (gift) or transfer property (money, land, etc.) and still be eligible for Medi-Cal, depending on to whom and when you gave away the assets. The current California transfer of assets law requires a 30 month “look back” period to determine if an institutionalized Medi-Cal applicant made an improper transfer or gift of non-exempt assets to a third party, excluding the spouse. Transfers to spouses are without any penalty, regardless of the asset, or its value.

      An “improper” transfer is basically giving away or gifting away property without receiving something of equal value in return, or done so specifically for purposes of qualifying for Medi-Cal. The transfer rule is triggered when you apply for Medi-Cal. The Medi-Cal application will ask if you transferred any property or made any gifts within the prior 30 months. The Medi-Cal eligibility worker will review the application and all supporting documentation submitted with the application, e.g. bank statements, trusts, brokerage statements, life insurance policies, deeds, etc. These transfer rules apply only to assets that are not exempt.

      Not all transfers are subject to these transfer rules, and not all transfers result in a period of ineligibility. Transfer penalties will not apply if the transfer was made:

      with the intent to dispose of the resource either at fair market value or for other valuable consideration;
      exclusively for a purpose other than to qualify for Medi-Cal;
      to a spouse;
      to a blind or totally disabled child;
      if the asset was exempt; or
      if denial of eligibility would result in undue hardship

      http://elderlawventura.com/Limits.php

      Medi-Cal Eligibility Manual
      http://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/Article9-Property.pdf

  10. Aplique para medical retroactivo…para el mes de abril de este año..el stement del banco mostraba 8.000 al empezar elmes pero el mes termino con solo 2.60.00 dolares ese mes el ingreso fue de 2,300 dolares y estaba con mi esposo..ahora estoy sola y mi ingreso es de 800 por mes cuando aplique ese era mi ingeso…puedo calificar para medical retroactivo?

    Google Translate

    Apply for retroactive medi-cal … for the month of April of this year .. the statement of the bank showed $8,000 to start the month but the month ended with only $2,600 that month the income was of $2,300 and was with my husband.

    Now I’m alone and my income is $800 per month when I applied that was my ingeso … can I qualify for retroactive medi-cal?

    • Check this page for more information.

      a. Retroactive Medi-Cal

      An applicant can receive Medi-Cal coverage (and payment for Medi-Cal covered benefits received) for up to three calendar months preceding the month of application if they would have been eligible for Medi-Cal during those months.148 Applicants can apply for retroactive Medi-Cal on the Medi-Cal application or after applying for Medi-Cal or CalWORKs by indicating the request on the application or by separate written request.149 Retroactive Medi-Cal can be requested for up to one year after the date of application 150 so if there are outstanding bills, the Medi-Cal member should submit them to Medi-Cal for reimbursement or ask the provider to bill Medi-Cal.

      148. Welf. & Inst. Code §§ 14019, 14019.6; 22 CCR § 50197; MEDIL 14-27 (May 15, 2014), http://
      http://www.dhcs.ca.gov/
      149. 22 CCR § 50148(a)(2).
      150. 22 CCR § 50148(b).

      https://wclp.org/wp-content/uploads/2016/06/Western_Center_2016_Health_Care_Eligibility_Guide_Full_rev.1.pdf#page=224

      • Reply from Medi Cal

        An individual who wants retro-active Medi-Cal needs to completed an application for retro-active Medi-Cal. They will need to contact the County that administers their Medi-Cal. The County will review the application and determine based on the new circumstances whether or not the individual is eligible.

  11. I am applying for redetermination.

    I refinanced my home and have the monies in my account.

    Will this affect my eligibility if i withdraw the funds prior to submitting my paperwork?

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