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Post 2014 Medi-Cal 101

Assmaa Elayyat, Medi-Cal Program Specialist &Maria Romero-Mora, Program Coordinator

Purpose

To go over the basics Provide resources, tips and guidance Q & A

The Basics…

Medi-Cal is California's Medicaid program. This is a public health insurance program that provides free or low cost medical services for children and adults with limited income and resources.

As a reminder, Covered California’s annual open enrollment period does not apply to Medi-Cal. Individuals can apply for Medi-Cal 365 days a year.

What would an applicant need to apply for health coverage? Medi-Cal eligibility is based primarily on your income, tax filing status,

and, sometimes, your "countable property". Effective January 1, 2014, Medi-Cal has been expanded to offer coverage to a larger group of Californians. To learn more about this, visit the Medi-Cal Expansion Information page.

Under the new Affordable Care Act Medi-Cal rules, all information (name, income, social security number, etc) is checked electronically first. If it is verified electronically, paper verifications are not required.

Anything else?

If your information cannot be verified electronically, the county will request a copy of the appropriate verification including: proof of social security number, for individuals who have one, identity, income,

And information regarding citizenship or immigration status. Note: Proof of address in California is temporarily suspended until

further notice. See MEDIL I 14-44 http://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/MEDIL2014/MEDILI14-44.pdf

Who can apply for Medi-Cal?

Anyone!

Note: Pregnant women and children are allowed to have a higher income on the Federal Poverty Level scale and are urged to apply.

Individuals who are elderly (age 65 and older), disabled, or blind may qualify for different programs under different income limits as well and are encouraged to apply.

Program Eligibility by Federal Poverty Level (FPL) for 2015 OEP for Coverage Effective after 1/1/16

Household Size Cost Sharing Reduction

Eligible for Income-Based Medi-Cal

Eligible for Premium Assistance (PA) (≥100% to ≤400%)

Medi-Cal Access Program (No PA)formerly AIM (Access for Infants & Mothers)

(> 213% to ≤ 322%)

MAGI Medi-Cal (kids 0-18 yrs.) up to 266% FPL

100% ≤ 138% > 138% 150% 200% > 213% 250% ≤ 266%

1 $11,770 $16,243 $16,244 $17,655 $23,540 $25,071 $29,425 $31,308

2 $15,930 $21,983 $21,984 $23,895 $31,860 $33,932 $39,825 $42,374

3 $20,090 $27,724 $27,725 $30,135 $40,180 $42,793 $50,225 $53,439

4 $24,250 $33,465 $33,466 $36,375 $48,500 $51,654 $60,625 $64,505

5 $28,410 $39,206 $39,207 $42,615 $56,820 $60,514 $71,025 $75,571

For each additional person, add $4,160 $5,741 $6,240 $8,320 $8,861 $10,400 $11,066

How or where do we submit an application? In Person:

Apply at local county social services office, where one can get personal assistance completing application. By Mail:

Apply for Medi-Cal with a Single Streamlined Application , provided in English and other languages. Send completed and signed applications to local county social services office. By Phone:To apply over the phone, call local county social services office or call Covered CA at 1-800-300-1506.

Online:Apply online at www.CoveredCA.com. Applications are securely transferred directly to local county social services office, since Medi-Cal is provided at the county level.

Apply online directly with your county through www.benefitscal.org If one needs additional help applying or have additional questions, one can contact a trained Certified

Application Counselor (CAC) for free. Search a list of local CECs or call 1-800-300-1506.

Tip

Authorize Representative Form

Medi-Calhttp://www.dhcs.ca.gov/formsandpubs/forms/Forms/mc306.pdf

Covered California/CalHEERShttp://hbex.coveredca.com/toolkit/PDFs/CEC%20Auth%20-%20Enrollment%20Assistance.pdf

Tips

If you have already submitted an application online and haven’t been contacted yet, please don’t submit another application.

To check the status of your application, please contact your local county.

The Process to verify Medi-Cal eligibility1. Apply – Complete application and submit it either in person, by mail, by phone, or online.2. Individual will Receive a Notification of Likely Eligibility by mail.3. County’s social services office may contact by mail or phone to request paper verification if income, citizenship and other criteria that cannot be verified electronically. It is extremely important to provide any information that is requested in order to avoid having application denied.4. Receive Final Notice of Action notifying whether or not one can receive Medi-Cal.5. Receive BIC – When one receives BIC in the mail, individual is able to use Medi-Cal benefits available to them. If person already has a BIC, old card will be re-activated.

When person first qualifies for Medi-Cal and receives BIC… Person is covered under Fee-For-Service (also called, Regular Medi-

Cal). Within 45 days of receiving BIC or Medi-Cal approval notice, person will be mailed information explaining their health plan options, if person lives in a county that offers multiple plans.

If person lives in a county with a County Operated Health System, person will be automatically enrolled in the plan.

Tip

For more information on whether or not one lives in a county with one or more plans, please visit

http://www.dhcs.ca.gov/provgovpart/Documents/MMCDModelFactSheet.pdf

IMPORTANT

Person must choose a health plan within 30 days of receiving their health plan information mailer. If they do not choose a plan within 30 days, Medi-Cal will choose a plan for them. The health plans available to the person depend on what county they live in.

On-going Eligibility

Individuals are required to renew their Medi-Cal eligibility once a year. This process is completed electronically. If the information cannot be verified electronically, the individual or family will receive a renewal packet.

The renewal packet will request the information that needs to be provided, such as proof of income.

Families who have members on different types of coverage may receive multiple renewal packets, such as one to request income information and another to request property information.

Medical services

Health Care Options http://

www.healthcareoptions.dhcs.ca.gov/HCOCSP/Enrollment/Choice_Enrollment_Form.aspx

Medi-Cal Managed Care http://

www.dhcs.ca.gov/individuals/pages/mmcdhealthplandir.aspx#yolocounty

Dental and vision

Dental and vision services are available with some limitation. Learn more about dental benefits and further clarification by calling1-800-322-6384 or visit Denti-Cal .

Resources

SingleStreamAPP Property Limitations MC 13 Supplemental for RetroCoverage Medical Benefits Chart And more

Questions

Contact:

Assmaa Elayyat, Medi-Cal Program SpecialistCounty Welfare Directors Associationaelayyat@cwda.org

Maria Romero-Mora, Program CoordinatorCalifornia Coverage & Health Initiativesmromero.mora@cchi4families.org