Obamacare FAQ: Will You Qualify for Medi-Cal?

Editor’s note: For people buying on the individual market who want health insurance starting Jan. 1, the deadline to sign up is Monday, Dec. 23. We will run one post a day with questions and answers on the Affordable Care Act and Covered California until that deadline. Readers can also consult KQED’s Obamacare Guide, written specifically for Californians.

By Emily Bazar, CHCF Center for Health Reporting

While more than 80,000 people have enrolled in coverage through Covered California, an additional 140,000 people appear to be eligible for Medi-Cal, the state's version of the Medicaid program for low-income residents. It's part of the Medicaid expansion, which 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.

Most lawfully present immigrants will be eligible for full benefits under the Medi-Cal expansion. Those who are in the country without proper documents 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.

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.

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 -- with its website or phone number: 1-800-300-1506. 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: You have until Dec. 23 to enroll for coverage that starts Jan. 1. The open-enrollment period will last for six months, through March 31, 2014.