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Introducing “Ask ITUP”

ITUP is launching a new column that answers complicated questions about health reform. As open enrollment approaches (November 15!), you may have burning questions – send them our way! Email ask@itup.org for questions and technical assistance. Answers will be posted here on the ITUP blog for all to benefit.

We have two questions for you today – one on calculating income and another potential eligibility changes.

I am confused about the maximum amount of money you can make to qualify for Medi-Cal. Some sources report $15,857 for one person, others say $16,105. What’s the difference?

Individuals are eligible for Medi-Cal up to 138% of the federal poverty level (FPL). When the feds released the FPL for 2013, one person making $15,857 was at 138% FPL. New numbers for 2014 have since been released, and now 138% FPL has increased to $16,105.

The bigger question is about when do the new year’s numbers go into effect. It’s tricky. Covered California uses the FPL that was in place upon the start of the plan year for the entire plan year, while Medi-Cal shifts to the most recent FPL in spring. This means that a small group of individuals just over the previous cut off line must shift from Covered California to Medi-Cal mid-year without a change in income. For applications submitted during the upcoming open enrollment period, eligibility for all coverage will be assessed using the 2014 FPL.

I heard that some immigrants are going to be moved from Medi-Cal to Covered California. Is this true?

Currently, California pays the entire cost of Medi-Cal coverage (except for emergencies & pregnancies) for low-income legal permanent residents who have been in the U.S. for less than five years, rather than sharing costs with the federal government. In the interest of saving state funds, California plans to shift some of these immigrants (adults without children) to Covered California, offering them additional state-funded premium and cost-sharing assistance.

Stakeholder meetings to develop this proposal (along with a similar program for pregnant women dually eligible for Covered California and pregnancy-only Medi-Cal) are underway, but it is unclear when the programs will launch. Stay tuned – we will keep you posted with any updates.

Check back soon for more Ask ITUP questions and answers.

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