Before the pandemic, Medi-Cal conducted regular eligibility redeterminations every year. That process will resume this spring. Residents in the safety-net health insurance program will receive a renewal packet asking for their income and household size information. They’ll also be asked to declare that they remain eligible for Medi-Cal.
Eligibility Requirements
Medi-Cal is a joint federal and state program that provides low-cost health care coverage to eligible individuals and families in California. It offers no- or low-cost health insurance services, including doctor visits, dental screenings, rehabilitation and surgery, prescription medication, and mental health care. The Department of Health Care Services administers it. Various programs within the Medi-Cal system provide different levels of benefits. Some are managed care plans, and some are fee-for-service. The eligibility requirements for each type of Medi-Cal are additional. Some are based on income, and others are based on asset limits. If you’re a current Medi-Cal enrollee, you should watch out for requests for additional information in the mail. Sometimes, those requests are a scam designed to get you to pay a fee to renew your coverage. Other requests will be official and ask you to confirm your address or additional important information, and they will come from the county agency that administers your Medi-Cal program.
What to Do if You’re Not Eligible
During the COVID-19 pandemic, federal rules allowed states to temporarily suspend regular eligibility checks for Medi-Cal, the state’s version of the public health insurance program. But those annual redeterminations are set to resume in April, and state officials estimate that between two million and three million Californians will be bounced from the program. The redetermination process asks beneficiaries to fill out a form with questions about their income, living situation, and disability status. It also requires they provide updated documents, such as pay stubs or W-2 forms, and a list of assets. It’s a critical step in helping people to transition into Covered California and, hopefully, into a job-based health plan or another type of coverage. If you’re worried that you might lose your Medi-Cal in San Bernardino, check the current status of your coverage by using PECOS or reviewing your Medicare enrollment record online to ensure it hasn’t changed and that your NPI is still correct.
How to Verify Your Eligibility
Medi-Cal, California’s version of the federal health care program Medicaid, covers a wide range of medical services for low-income residents. Both federal and state taxpayer dollars fund it. It is not based on your income or financial resources but on specific eligibility requirements. As a result of the COVID-19 pandemic, the federal government granted states a waiver that postponed annual Medi-Cal dis-enrollments and other eligibility reviews for an extended period. The release expired March 31, 2023, so now the program is once again conducting dis-enrollment checks, except for those who have been determined to be in a special category – like SSI-linked Medi-Cal or individuals receiving benefits from the State Children’s Health Insurance Program (SCHIP). Enrollees are getting reminders via mail and social media ads to check their status and update their contact information. They are also encouraged to visit their county human services departments or Covered California.
To minimize the number of enrollees bumped from the program, the Department of Health Care Services has launched a $25 million marketing campaign with messages in 19 languages and got $146 million in additional funding to help counties cope with the volume of dis-enrollment decisions. The agency has also created an online toolkit to assist county offices, volunteers, and enrollment partners. Those disenrolled from Medi-Cal but still have low enough incomes to qualify for an insurance subsidy through Covered California will be auto-enrolled in a plan the exchange determines is best for them.
How to Change Your Eligibility
Before the COVID-19 pandemic, enrollees in Medi-Cal (the state’s version of the safety net health care program) routinely went through a process known as redetermination that could find them no longer eligible for the coverage. Thanks to the federal public health emergency declaration, Medi-Cal opted to waive that renewal process, allowing many low-income families and individuals to keep their coverage. That waiver has ended, and the state’s Medicaid programs are resuming their normal renewal processes over 14 months. The re-examinations will affect around 15 million current Medi-Cal enrollees. Those who are found no longer eligible will be bounced out of the program, though the vast majority of them may still qualify for other types of affordable health coverage.
The redetermination process will begin with a bright yellow envelope from your county’s health and human services agency asking for your name, address, employment status, household size, income, and other details. The county may also ask to review your assets and other resources. Tip: If you have a disability, consider opening an ABLE account to save your earnings that won’t count against the Medi-Cal program’s resource limit.
In addition to these re-examinations, the Affordable Care Act allows individuals to apply for Covered California and other health insurance through open enrollment periods throughout the year. It is common for people to have different eligibility rules for various health coverage programs within a single household; for example, one person may be eligible for premium assistance tax credits through Covered California while another is enrolled in Medi-Cal, and another has access to affordable health coverage through their employer.
