Will you qualify for Medi-Cal under Obamacare?

Regular readers of Ask Emily know that on Oct. 1, Obamacare will experience a key rite of passage. That’s when Californians can begin 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.

There’s another important Affordable Care Act milestone taking place that day. California’s Medicaid program for low-income residents – known as Medi-Cal – is expanding next year. And as with the exchange, Californians can start pre-enrolling Oct. 1.

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

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

A: 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.

Q: 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? 

A: 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,” says 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.”

Q:  How do I sign up?

A: Start with the Covered California website and phone number: CoveredCA.com 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, you also can start enrolling for Covered California plans on Oct. 1. 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:  AskEmily@usc.edu
Learn more about Emily here.

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Emily Bazar

Senior writer Emily Bazar is based in our Sacramento office, where she covers stories about the federal health care overhaul, Medi-Cal budget cuts, children's dental care and variation in the use of medical treatments.  Prior to joining the Center for Health Reporting, Bazar was a national reporter for USA Today, where she covered immigration, the effects of the current economic recession and other topics. Her first journalism job was at The Sacramento Bee. Over nine years, her beats included transportation, higher education, California politics, the energy crisis and immigration. In 2003, she was one of two reporters who produced an award-winning special project, “Liberty in the Balance,” which explored civil liberties after Sept. 11, 2001. She appears regularly on KQED’s Forum,Capital Public Radio’s Insight and other radio shows to discuss health policy. Bazar graduated from Stanford University.

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