Ask Emily

September 25, 2013

Ask Emily: Will you qualify for Medi-Cal under Obamacare?

Oct. 1 is a big day in the evolution of Obamacare. Not only can Californians start signing up for plans from the health insurance exchange, Covered California, but they can also start enrolling in the expanded Medi-Cal program, which debuts Jan. 1. This installment of Ask Emily describes the coming changes to Medi-Cal and explains whether you might qualify.

Ask Emily

Obamacare Q&A with Emily Bazar

Ask Emily is a biweekly column by Emily Bazar, of the CHCF Center for Health Reporting, answering questions about health care reform.

On Tuesday, Obamacare experienced a key rite of passage, when Californians began enrolling in coverage through the new health insurance exchange, called Covered California. Many will qualify for tax credits to reduce the cost of their premiums.

Another important Affordable Care Act milestone also took place. California’s Medicaid program for low-income residents – known as Medi-Cal – is expanding next year. As with the exchange, Californians were able to pre-enroll starting Tuesday.

The expansion is expected to include people of all stripes, from young adults and college students to single, older men. It could include you.

How will Medi-Cal eligibility be expanded? My 37-year-old, single daughter is currently not eligible.

Medi-Cal provides medical services to more than 8 million low-income Californians. The expansion is expected to make roughly 1.4 million state residents newly eligible.

Will Jack of San Clemente’s daughter be among them? I don’t know for sure, but at least one detail he shared sounds promising.

Under the expansion, the income threshold to qualify for Medi-Cal will go up to 138 percent of the Federal Poverty Level. This year, that computes to about $15,800 for an individual and $32,500 for a family of four.

Perhaps even more momentous (pay attention here, Jack), the program will be open to childless adults, who were previously ineligible. This is where the college students and single, older males come in, and single, 37-year-old females, too.

A few other important details:

•  If you’re newly eligible, most of you will have to enroll in Medi-Cal managed care.
•  Legal immigrants will be eligible for full benefits under the Medi-Cal expansion. Those who are in the country illegally will not.
• Asset tests and property limits will go away for most new applicants. There are some exceptions, especially if you’re 65 or older or have a disability. See one of my previous columns for more details.
•  If you’re eligible for Medi-Cal, that makes you ineligible for tax credits from Covered California. You could still opt out of Medi-Cal and buy a plan from the exchange, but you’d have to pay full price. Learn more from another previous column.

I’m 55 years old with no dependents and am employed part time. I currently have individual health insurance that costs me almost 20 percent of my monthly income. My income makes me eligible for Medi-Cal starting next year. Will I still be eligible even though I currently have individual insurance?

This may come as a surprise to Howard, who hails from Fresno, but you don’t have to be unemployed – or uninsured – to qualify for the Medi-Cal expansion.

You can drop your expensive, individual market plan and enroll in Medi-Cal instead. Assuming that you qualify.

The same goes for those who have health coverage through an employer. You, too, can join Medi-Cal if you qualify.

This won’t be a rare occurrence. According to an analysis by the UC Berkeley Center for Labor Research and Education, 310,000 Californians who would have otherwise gotten job-based insurance next year will be newly eligible for Medi-Cal. About 240,000 more would have had individual market plans, like Howard.

“Many folks in the individual market or who have job-based coverage are finding the premiums they’re paying now are unaffordable,” said Laurel Lucia, an Obamacare expert at the center.

“There won’t be any premiums in Medi-Cal and the benefits will be more generous than what they’re probably getting in the individual market.”

How do I sign up?

Start with the Covered California website and phone number: and ( 800)300-1506. The idea is that Covered California agents will act as a one-stop shop to help you figure out what program you’re eligible for and sign you up. If they can’t close the transaction themselves, they’ll transfer you to your county Medi-Cal office.

Let’s hope it’s as simple and easy as the bigwigs say it will be.

A final reminder: As I mentioned early in the column, enrollment for Covered California plans also began Tuesday. The open-enrollment period will last for six months, through March 31, 2014.

If you enroll by Dec. 15, your coverage will begin Jan. 1. In January, February and March, if you enroll by the 15th, coverage will begin the first day of the following month. If you enroll after the 15th, your coverage will begin the first day of the second following month.

Did I mention something about simple and easy?

Questions for Emily:

CHCF Center for Health Reporting partners with news organizations to cover California health policy. Located at the USC Annenberg School for Communication and Journalism , it is funded by the nonpartisan California HealthCare Foundation .

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