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The basics of Medi-Cal and how it works with Covered California

The basics of Medi-Cal and how it works with Covered California.

Medi-Cal was one of the biggest mysteries during open enrollment in the new ACA health plans. Even though Covered California advertised a “no wrong door” approach to signing up for health insurance, when a client had to go through the Medi-Cal door, not even Covered California could tell them what to expect. Finally, seven months into the expanded Medi-Cal program, the Department of Health Care Services has finally put together a presentation that goes over the various parts of Medi-Cal and how the system works. New Covered California – Medi-Cal guide available for download at end of post.

For latest news on Medi-Cal visit the Medi-Cal News Page .

Counties play a big role in Medi-Cal

Medi-Cal, California’s version of Medicaid is big and complicated. It starts with the federal government funding to California for the Medi-Cal program. On the state level, the Department of Health Care Services, which is under California’s Department of Managed Health Care, administers the overall program. However, each county is actually responsible for enrolling residents in one of the numerous managed health care plans. Each county will have anywhere from one to four different choices of HMO plans that a resident eligible for Medi-Cal will have to enroll into. Currently there are over 10 million people enrolled in Medi-Cal programs.

Covered California doesn’t administer Medi-Cal

The role of Covered California is to determine if the applicant is Medi-Cal eligible by the stated annual income and then hand the information off to the respective county of the applicant’s residence. Individuals and families eligible for Medi-Cal can upload their income and residency documents into the Covered California system to be verified by county. Even though the expanded Medi-Cal program under the ACA is open to every household with

an annual income less than 138% of the Federal Poverty Line, there are many different programs within Medi-Cal and programs specific to certain counties that people may qualify for beyond straight enrollment through Covered California.

Medi-Cal basics overview

The Medi-Cal Essentials presentation was a webinar developed for Certified Insurance Agents to answer the numerous questions agents and their clients had about enrollment. The webinar is approximately 2 hours long and can be opened via this link.

Select view Medi-Cal Essentials Webinar July 31st 2014

I found the audio was garbled when the recorded presentation was viewed through Window Media Player. I was able to improve the audio by switching to Adobe Flash Play by clicking on one of the icons next to the refresh media button.

Medi-Cal Essentials power point presentation

The power point presentation is a fairly good overview of everything they participants discussed during the recorded webinar. There were some clarifications in the audio portion that are not displayed in the power point presentation slides. It was also evident that there are certain Medi-Cal rules that are different from Covered California. For instance, Covered California gives households 30 days to update their income when it changes, but Medi-Cal wants to be notified in 10 days if the income increases.

Below I have tried to hit some of the main points of the presentation. For additional information you should review the power point presentation or actually listen to the webinar. You can download the full power point presentation with all the slides and commentary at the end of the post.

How is Medi-Cal eligibility verified?

  • Consumer information is verified through federal electronic hub
  • Electronic enrollment through Covered California

What determines Medi-Cal eligibility?

What’s covered in a Medi-Cal health plan?

What about Access for Infants & Mothers?

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