Do I Have To Repay California Medi-Cal?
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- เผยแพร่เมื่อ 30 มี.ค. 2020
- Do you have to repay Medi-Cal if your income went up and you forgot to report the change? Kevin Knauss explains that you should not assume that because your income increased, you were not eligible for Medi-Cal. He also addresses the issues of employer sponsored health insurance, and the Estate Recovery Program for adults over 55 years old who have MAGI Medi-Cal.
Thank you so much! Great content - exactly what I was looking for 🙏
So glad I found your video! I have a question for you.
I have been on disablity since 2013. I got Medi-cal some time after that within a couple years. I can’t remember as I have cognitive problems. My understanding now is that when I die, Medi-cal will take a certain amount out of my estate I live in California and Plaser county. How do I know how much they’re taking out per month, per year for Medi-cal? I hope you can answer this question for me as I can’t sleep since I found out about this.
Thanks, Christy 😊
You can file a request for Medi-Cal expenses subject to Estate Recovery. You can find the form and more information about Estate Recovery on this page of the Department of Health Care Services www.dhcs.ca.gov/services/Pages/TPLRD_ER_cont.aspx
the DPSS has an App that makes it super easy to report any income or other things. very helpful
Most counties use some sort of online portal and it is the best way to routinely provide income updates or other changes. The challenge for most people is they have never interacted with Medi-Cal. Renewing a driver’s license is the extent of most people’s interaction with government. So when they are working with Medi-Cal, with its numerous programs and rules, it can get overwhelming very quick.
whats the name of the app?
Hello Kevin. First of all great content and information. I speak for many when I say thank you. One question. Let’s say hypothetically speaking, if I’m under medical and then I turn in my renewal form but then they determine I no longer qualify, will my future doctor appointments be cancelled? Will there be drastic interruptions? Thank you & I hope you see this.
If your Medi-Cal is terminated, you will be given notice with plenty of time to transition to a Covered California health plan with the subsidies.
This is the tricky part. You need to select a health plan that has those doctors, with whom you have an appointment, in the health plan's network. Plus, if the appointments are with specialists, you will need to find a Primary Care Physician, if the plan is an HMO, that will provide you with a referral to those doctors.
It is important to select a Primary Care Physician who is in the same medical group as the specialists you want to see. This will reduce delays from having to contact the health plan for approvals.
If you enroll in a PPO plan, you may not need a referral to see the specialists, but they still need to be in-network with the health plan. Regardless, you will want to confirm the new health plan with the doctor's office so there are no surprises at your visit.
First of all thank you very much for this informative video. I am a 23 year old person and I’ve been covered under medical for three years now. The thing is, I’m barely finding out about this. I wasn’t well educated up until recently. In the past three years I’ve gotten a new job that pretty well increased my income. My brother who is also covered has been working for a year now. It’s a family of five and my parents never really updated anything. I’m very concerned since I was never given the chance to do anything about reporting anything. We just received the redetermination package and we have to completed before two months come. What’s the worse than can happen once they find out that I’ve been earning more & that it was never reported. Thank you.
The worst that will happen is that you will be determined not eligible for Medi-Cal. The Medi-Cal program is just getting back to normal operations. They were not terminating anyone for the last couple of years. Depending on your age, income, and if your parents claim you as a tax dependent, you may lose Medi-Cal. The good news is that they will transition you to a Covered California health plan with subsidies. However, there is still the possibly that you are still eligible for Medi-Cal, along with your other family members.
@@KevinKnauss thank you very much.
Hi Kevin, thank you for being kind enough to answer these case-by-case questions.
I'd like to know whether I should just quit Medi-Cal, or report the change in income first and then quit.
I got a job about a year ago with its own insurance, obtained said insurance, and have been switching all my doctors and meds to said insurance. I had no idea I had to report changes to Medi-Cal, and I am certain I no longer qualify, and I want to quit it anyways. So I've had it alongside my other insurance but have not been using it, should I report the change in income first in good faith?
I feel terrible that I did not read close enough and didn't report, but I am also scared of getting in trouble. This makes me think it may be better to just request to quit. But I also just want to do the right thing and avoid any hiccups. Any advice is appreciated!
It is always best to report the increase of income and the employer based health insurance to Medi-Cal. You want them to properly terminate the Medi-Cal enrollment with no negative action. In this manner, if you need Medi-Cal in the future you won't have to clear up any past issues. Because Medi-Cal has been operating under Public Health Emergency rules, no one has been terminated from Medi-Cal for not submitting any updates or changes.
Thank you for the peace of mind Kevin!
I have been enrolled with medical for over a year now and have had small changes in income , not much, that I didn’t report at all and have put it off for way too long now! 🤦♀️ I’m at the point where I am scared to report it but don’t want to get back lash in the future for it.
I also just recently received money from PUA due to COVID and Not being able to work since March. I’m in the pickle where I am wondering if they will somehow notice I received the money and kick me off of Medical.
Any advice would be helpful!
First, the PUA is not counted for Medi-Cal, only California state unemployment benefits. There will be no problems reporting the other changes to income. It sounds like your current and past income were still below the threshold for Medi-Cal eligibility. Medi-Cal is looking for consistently higher income that puts you above 138% of the federal poverty level, in terms of terminating coverage.
Second, having one month that fluctuates up, due to extra hours, will not disqualify you because the income drops down the next month. Look into getting an online account with your county Medi-Cal office so you can report little changes easily. That way you won’t have all the stress.
Kevin Knauss you are the greatest thank you for the reassurance and on point advice and quick response.
I am definitely getting an account going and will be on my way to stress free! Thanks again Kevin
DPSS have access and can check your tax filed every year,So they will know if your income increases/medical eligibility
I don’t believe DPSS can access anyone’s taxes and to a comparative analysis of income between years. If that were the case, many people would have been automatically terminated from Medi-Cal.
Medi-Cal focuses on the monthly income, not the annual income. A tax return does not indicate if the income was made evenly every month of the year, or if the income was all made in one month.
Hi Kevin, thank you so much for the informative video.
I am 27 years old and self employed. I switched to Medi-Cal early in 2020 due to the Pandemic as I was not working. I later started working throughout the 2020 year and forgot to report it and make changes to my account. I understand the income limit is $17,237. I received PUA (EDD Benefits) that totalled to $27,000 and my sales revenue from my self employed work totalled to $33,067 this 2020 year. I understand that this does not make me eligible for Medi-Cal.
I'm trying to understand if I need to repay and how to calculate the cost. Also is there a penalty fee? I'm confused and scared as I'm not sure what to do as the year is already ending.
The PUA does not count for Medi-Cal eligibility, but the self-employment income does. Your self-employment income is your net, not gross income. Consequently, you could still be eligible for Medi-Cal. Regardless, you should report your current PUA and net self-employment income to Medi-Cal. If they determine you are no longer eligible, they will terminate your coverage and you can enroll in a Covered California health plan with the Premium Tax Credit subsidies.
There should be no penalty or pay back of Medi-Cal premiums as you are reporting your income in a good faith fashion as soon as you have learned of the changes to said income.
Hi Kevin, I need your advice.
I mailed in my report of income. I realize I haven't done so for like maybe a couple of years. I apply in 2016-2017 when I didnt have a job and then in 2017 I did get a job but I didnt report my income change until literally now. I gone through like 4 jobs but the job I have right now, I been there for like a year and a half. I reported the income I'm making now but should i let them know about the other jobs I used to work with also. The job that I have right now, I dont have health insurance either. Im still waiting for open enrollment and then my plans were to cancel medical. I totally forgot about reporting my income until I got the renewal packet as of Oct 2021. Also I didnt file my taxes for the 2 years I been working on and off again jobs. I didnt know about the penalty until now but I'm getting that taking care of with a help of a tax lady who used to work with IRS. I am aware that I have to pay back some of services I got when I was not qualified to have medical. I just found out that I made more than the poverty line. The max income to qualify for medi cal is 17,000 and I make 23,000 a year. Also as of 2020 I was gifted my moms house as my inheritance, I should also let them know that too right? Help, what should I do??? Should I call and let them know. A part of me wants too but I'm scared of all the trouble I'm going to be in. What's the best move!!!!???
Thank you in advance
First, who says you have to repay the costs of medical services when you had Medi-Cal, and second, who says you were not eligible for Medi-Cal? If you did not make enough money to file a tax return, you probably had a low enough income to qualify for Medi-Cal. I’m not sure what you mean that you have pay a penalty, if that is tax related or Medi-Cal related. However, there generally are no penalties with Medi-Cal. You are either eligible or you are not.
For the last 18 months, Medi-Cal had not been terminating anyone because of the Covid-19 pandemic emergency. My understanding is that Medi-Cal eligibility and enrollment is back to normal. At a minimum, you should report your current circumstances to Medi-Cal including current monthly income. If you have MAGI Medi-Cal, assets like homes and savings accounts are not counted toward eligibility. It can’t hurt to report the inheritance, but I don’t think it will make much difference.
The best move is to report everything to Medi-Cal. You won’t be penalized. You may be terminated because you are now making too much money, but the termination will not be retroactive, it will be at a future date like the end of the month. Then, you can get a plan through Covered California with the subsidies and you should not have any gap in coverage.
Hi Kevin, thank you so much for amazing content! My mom is 64, is now on medi-cal but she is planning to start working in a few months and it might put her above the limit. When she cancels her medical and will receive her health insurance through employer, will she need to repay her medi-cal coverage (estate) ever?
Nope, she won’t have to repay anything. When she has a change in circumstances (increased wages, employer sponsored health plan) just notify the county Medi-Cal office.
@@KevinKnauss thank you for such a quick reply!
Hello Kevin
My son had a medical emergency ( due to his bipolar disorder and required hospitalization in November -December ) Medi-cal covered his hospitalization ( but the ambulance bill , I was told can also be covered , that’s in the process ) this weekend I received a large bonus from my company, I know I have to report this to my local medi-cal office on Monday , I am worried because the amount I received will definitely throw me out of the eligibility bracket ( single mom with 2 children under medi-Cal ( LA Care) , I’m also nervous because of the hefty medical bill that I will be forced to pay that back , can you offer any insight or advice on what to do ?
If you have Modified Adjusted Gross Income (MAGI) Medi-Cal that is based solely on you income, you should be OK. This is because MAGI Medi-Cal looks at your regular monthly income and not necessarily spikes or fluctuations. People who normally work 30 hours per week, then have a 40 hour week, are not bumped off of Medi-Cal because their income drops back down to 30 hours. They kind of look at a rolling average.
A bonus could also be considered a one-time lump sum and not counted toward your monthly income. A termination from Medi-Cal would not necessarily make you liable for these services just because you are no longer Medi-Cal. The events occurred while you were in a Medi-Cal HMO plan. Coverage for those health care services will be determined by your enrollment and the terms of the health plan.
Hi Kevin, thank you for providing the information.
I currently lost my job due to the pandemic. I'm trying to trade stocks make some money, but not sure whether I can make profit or not . if the profit exceeded the MAGI Medi-Cal's qualification income limit, will they ask me to repay them next tax season? Or should I just get the regular covered california insurance instead
MAGI Medi-Cal is based on your current monthly income. If that income is under 138% of the federal poverty level for your household size, then all is good. If you have a month of taxable income that is over that amount, you need to report it. You are suppose to report any income changes within 10 days. It is possible that you have one big trade in December that nets a taxable amount over the Medi-Cal limit. However, for those previous months, you were eligible for Medi-Cal. If you trades net you a taxable income consistently over the eligibility dollar amount, and you report it in a timely manner, Medi-Cal will terminate your coverage and you can then get a Covered California health plan with the subsidies.
@@KevinKnauss thank you Kevin
Hi Kevin, I wondering if medi-cal could garnish my wages do to the fact that my employer has offered me insurance since 2016. The insurance my work provides is horrible and would cost 900 a month so I never got it. I live with my GF and we raise our children together not split up. She doesn't work and stays home. We recently received a letter from medi-cal and we have to fill out a this document that says NOTICE AND AGREEMENT FOR CHILD, SPOUSAL AND MEDICAL SUPPORT. We fear after filling it out that they might garnish my wages because I've had access to medical coverage thru work even tho it's expensive. Can they make me pay back medi-cal from 2016?
I have never heard of Medi-Cal garnishing wages on account of past ineligibility for Medi-Cal. I would suggest contacting your local county Medi-Cal office and updating them on your household situation: income, insurance, children, etc. They need to evaluate if the cost of your employer based health insurance is considered un-affordable for you. This could make you eligible for Covered California with the subsidies.
More than likely, your partner and children are eligible for Medi-Cal, but the rules get complicated when one of the parents has income and access to employer based health insurance.
A consequence of not replying to an inquiry from Medi-Cal is the potential loss of Medi-Cal health coverage as they can’t determine the eligibility without the information. In other words, they are forced to terminate enrollment.
Hi Kevin,
I'm turning 26 soon and I'm wondering if automatically I will not qualify for medi-cal? I'm just trying to prepare myself and maybe start seeking other health insurance if I no longer qualify for it once I turn 26. Also, I was trying to search up how to report to Medi-cal income changes? If you could guide me there that would be great! Thank you!
The age of 26 only applies to the ability to be on your parent’s plan. It has nothing to do with qualifying for Medi-Cal, outside of some immigration situations.
Your county Medi-Cal office will use one of several online portals such as MyCalWinBenefits. Los Angeles has their own website for reporting changes. That is the best way to communicate changes to the household and income is online through the your account. That way you know it got to them - no mail delivery issues - and you have a solid record of when you upload the changes and the case workers can see them instantly.
Hello Kevin,
I just recently got a letter in the mail from treasure collector for SFFD-AMBULANCE, 10/29/22 that was $3,498. I was covered under Medi-Cal at the time and specifically remeber giving my card to the nurses at the hospital. I got a job 3 months later. And i recently didn't renew my Medi-Cal so now I'm under Cigna. Can you give me any advice?
In general, ambulance service should be covered by your Medi-Cal health plan. The bill you received is not what is reimbursed to the ambulance company. Odd that you are receiving so long after the event. You may want to call and make sure the ambulance submitted the claim to your Medi-Cal health plan. You should also contact your county Medi-Cal and make they terminated your enrollment based on the effective date of your employer insurance.
Hi Kevin, around May of 2022 I quit my job and later applied for medi-cal. Then in February 2023 I got a new job and signed up with the employer sponsored Kaiser plan. I didn’t realize I had to report this to medical-cal because I thought it would automatically cancel so I never reported the new job. In October 2023, I got a letter in the mail notifying me that my medi-cal coverage has ended and to fill out a renewal form if I wanted to renew. I didn’t do that since I was under Kaiser through my job. And I used Kaiser for my medical appointments and prescriptions since February of 2023. Since they terminated my medi-cal, is there any action needed on my end? Will they make me pay anything for not reporting the new job/kaiser insurance?
There will be no repercussions for not notifying Medi-Cal when you received employer sponsored insurance. The county Medi-Cal offices typically terminate enrollment for failure to return the annual redetermination paperwork. That is how many people, who no longer need or eligible for Medi-Cal, have the coverage terminated.
It would be interesting to learn if your health care services through Kaiser were charged to the Medi-Cal enrollment the employer group plan. And, if Kaiser knew you had both, which usually shows up in the system, why they did not notify you. Well, Kaiser was paid by the county for your Medi-Cal enrollment and your employer health plan. I guess we now know one of their profit centers, double dipping from insurance under 2 policies for the same individual.
Hi Kevin am currently unemployed and not receiving unemployment benefits or any other kind of benefits. A family member recently passed away and left me a life insurance policy. I took the lump sum payment. Am currently not feeling healthy and wanted to apply for Medi-Cal to seek medical attention. Do you think I would be illegible for medi cal even with the recent life insurance money?
Life insurance is not a taxable event and the asset is not counted against you for MAGI Medi-Cal eligibility. Medi-Cal is looking at your monthly and annual taxable income, tax exempt interest, and foreign earned income. It sounds like you are absolutely eligible for Medi-Cal with $0 income.
When the unemployment does come through, you just report that to Medi-Cal. You can apply for Medi-Cal directly through Covered California online application.
Hello there. I am worried because I wasn’t able to report change of income because I wasn’t aware of it. I thought I had to wait for 1 yr after every renewal. I started working 8 months ago but I wasn’t able to report changes.
Just report your current income to your local Medi-Cal office. They will want proof of the income such as pay stubs or remittances. Just because you are earning more money doesn't mean you still are not eligible for Medi-Cal. It is at the annual redetermination that Medi-Cal picks up on the higher income amounts. However, under the Medi-Cal terms and conditions, beneficiaries are supposed to report changes within 10 days. But many of those conditions were loosen during the Covid Public Health Emergency regulations.
Also, Kevin are SSDI and IHSS wages counted as income for Magi Medi-Cal?
SSDI is considered income for MAGI. IHSS is not when the recipient lives with the person they care for, but always check with your local agency to see if the rules have changed.
Kevin , when you apply for Medical through Covered CA with $0 income. Will they consider your assets like savings for those who don’t have any income. Thanks alot .
They only consider your monthly/annual income, not assets like home, car, savings accounts, etc.
Hi Kevin, thank you for your excellent explanation on this topic. For my 2022, I will be claiming my remaining balance of EDD approx. $7000 due to being laid off recently. I am currently unemployed and not employable for the near future due to having taking care of both parents in their late 80s and 90s. I do earn dividends from my stock portfolio. I would like to inquire how to go about liquidating some stocks and/or mutual funds for capital gains to add up to the income range just above the minimal FPL range and qualify for Covered CA rather than apply for Medi-Cal since I do not think I qualify because I have stocks and own my own home with my partner. Do I qualify for Medi-Cal? Any advice as to where I start would be greatly appreciated and thank you in advance for your guidance.
First, you assets are not considered for MAGI Medi-Cal, it is based on your monthly income. When you apply for Covered California you will be estimating your income for 2022. As long as that income is over the Medi-Cal income threshold, you will be eligible for Covered California with a subsidy to lower the health insurance premium.
Second, It is very important to properly date your income streams. For example, you will have unemployment beginning in 2021 and continuing into 2022. When that income ceases, you may need to terminate or end the income stream. You need to make sure that when that income ends, the proceeds from the equity liquidation is high enough to continue the Covered California plan.
Finally, You don’t necessarily need to sell equities every month. You may only sell a couple times of year, but spread that income out over several months. The final household income should reflect the total of your remaining unemployment benefits plus your expected proceeds from the sale of your equities.
@@KevinKnauss Thank you Kevin for your speedy generous reply. I am very appreciative and grateful. I am thankful to learn that Medi-Cal would not consider assets for MAGI calculation. However, wouldn't my qualified regularly recurring dividends and interest payments from my stock and mutual funds holdings be considered as income streams even if I were to NOT liquidate any assets? I prefer NOT to be in any cross hair with Medi-Cal if I choose Medi-Cal option and not Covered CA. I've called a CC agent to inquire about this question of earnings from dividends and interests to no avail. I lack confidence to decide on either option because of the unknowns and you're like a torch light cutting the dark for me. Thank you.
@@tokunagian You are correct, taxable interest and dividends (as well as tax exempt interest) is considered for MAGI Medi-Cal. You need to estimate this income stream as best you can, even though you won’t realize it usually until the end of the year. However, you can characterize it on an annual basis and the Covered California system will divide it into 12 equal amounts, for a monthly income stream.
Hi Kevin, I need your advice. I’ve always had Medi-Cal but two years ago i got insurance through my employer. I tried to call DPSS to cancel my Medi-Cal but I could never get a hold of them. So I’ve had Medi-Cal and my employer’s insurance for 2 years now…is having both insurances at the same time allowed?
You can have private insurance and Medi-Cal. However, being offered employer sponsored health insurance makes you ineligible for Medi-Cal. You can create a benefitscal.com account and communicate with DPSS about your current health insurance situation. They will terminate your Medi-Cal.
You may also receive the annual redetermination paper work in the mail. This is where you can also indicate employer health insurance.
Thanks for the informative video. How about if someone has a cost-sharing reduction Silver plan through Covered California, and they sell some stock earning capital gains income? They're still below 250% of the Federal Poverty Level, but no longer in the same FPL range as they thought they'd be when selecting the Silver 87 or Silver 94 plan? One more question if it's not too much trouble, what if their capital gains means an income that year higher than 250% of FPL, but below 400%, since above 400% require paying back all the cost-reduced portions?
You never have to repay the cost-sharing reductions (CSRs) from the Enhanced Silver plans 73, 87, or 94. Any repayment on your federal tax return centers on the Advance Premium Tax Credit or the monthly subsidies. One aspect that might be confusing is that the Enhanced Silver plans 73, 87, 94 have exactly the same monthly premium rate as the carrier's Silver 70 plans through Covered California. So we don't have to worry about extra subsidy being applied to the cost of the health plan. As soon as you learn that you will have a taxable capital gains event, you should try to include it on your Covered California income section.
Hi Kevin, I hope you still see this. I just realized that my change of income form didn’t go through. For 6 months it had the wrong income I reported the change now, but I’m so panicked that something is going to happen. Will I be fined? Any peace of mind would help.
I would not panic. First, you still may have been eligible for Medi-Cal even with the change of income. Second, you did attempt to report the change. Finally, Medi-Cal offices are overwhelmed. It is routine that people who are not eligible for Medi-Cal remain in Medi-Cal because the county office has not processed the paperwork or there is some other glitch.
Hi Kevin I desperately need your advice because I’m having some anxiety about this. So I applied for medical around last August / September and I was qualified for mediCAL/cal fresh. I then ended up switching jobs and now make way above the income level that is required for mediCAL. Like almost a couple thousand more a month. Now I forgot to change any reports but I spoke with a case worker today and I just submitted the changes. Even on the benefitscal website it stated if it’s been more than 10 days if I’m reporting changes “it’s ok.” Worried what this means to me and if I’m gonna get a letter in the email that I have to repay. Please help
The benefitscal website is correct. There is no penalty for late reporting. They will not come after you or try to claw back any money. Medi-Cal is happy that you quickly reported the changes.
Hey Kevin, great video - thank you. I am being told that I qualify for Medi-Cal since I am only receiving unemployment after being laid-off which would total only $9,000 by the time my 6 months run out in May. However, my wife is still working, makes $65,000/year, and can put me on her medical/dental/vision plans through her employer, but it would cost us almost $900/month. I guess my question is:
Is eligibility really based just on my income since I’m the only one applying for Medi-Cal or are we supposed to use our entire household income even though my wife already has health insurance through her employer and won’t be applying for Medi-Cal?
When you apply, you MUST include your spouse's income and the spouse MUST be on the Covered California application. Initially, you would not qualify for Medi-Cal based on the $65k income. You MIGHT qualify for the subsidies IF the total annual premium for the employer group insurance (least expensive plan offered) is greater than approximately 8.3% of the household income.
If that is the case, your spouse can keep her employer plan and you could enroll in a CC plan with the subsidies. However, if the annual premium for the lowest cost health insurance plan is less than 8.3% of the household income, then you do not qualify for the subsidies.
@@KevinKnauss Thank you so much for your reply! I had a feeling that I was being misinformed, or at the very least being led to claim that I qualified for Medi-Cal even when I didn’t.
Hi i have a question, I think I totally messed up ! So I have been on Medical most of nursing school , then ladt year towards the end of the year around August I had finished nursing school and got a job…that being said in the four months i worked i had made around $33000 dollars, during the end of the year IEHP renewal i reported my income and tried to apply to covered california assuming I wouldnt be covered for IEHP anymore but instead they automatically renewed my IEHP medical and now 1 year later since getting a job I have been using IEHP! I really don’t wanna pay nothing back im in soo much student debt I honestly dont know what to do at this point?!
It has all been a little confusing with the Public Health Emergency rules not terminating people from Medi-Cal in 2022 and the early part of 2023. The good news is all you need to do is report your increased income to your county Medi-Cal office. They will determine that you are most likely no longer eligible for Medi-Cal and you can enroll in a Covered California health plan with the subsidies. You won’t have tor repay anything. But it is important you report the income increase to Medi-Cal. Only Medi-Cal can reset the flag on your account that prevents getting a Covered California health plan.
Why do they need actual Bank account numbers? They also asked for my Investment account information including bank account numbers. I am a little worried it might turn into a scam?
Some people try to hide income and assets from Medi-Cal. Medi-Cal has the ability to get all of that information. They just want to compare, if needed, to what you report.
I wonder the PPP and grants due to the pandemic have changed or impacted the eligibility of medical (if you're a self-employed )?
The stimulus payments and the federal unemployment benefits are not counted s income for the purposes of Medi-Cal eligibility. Federal unemployment benefits are counted as income for Covered California, but not the stimulus payments.
@@KevinKnauss
Hi Kevin!! Thank you for your guidance!! I really appreciate your inputs. I guess we have to wait how to treat those PPP and grants for the California tax returns at this point right?
@@hotpepper4492 Correct. There is a lot up in the air. Some items will not be included in taxable income - loans - but other items might. Usually, loans that are forgiven can, under the correct circumstances, be considered income. It depends on how the law was written and interpreted by the IRS.
@@KevinKnauss Thank you for your reply, Kevin! I feel much better now. :-)
thank you help video, thanks for helping us understand this zoo that is medical
Good to know. It’s complicated.
Hi kevin, if next year when i renew my medi-cal they terminate me because my income went up is that a permanent termination for life? Like if i am terminated because my income is too high then 6 months later i quit or lose my job will i be able to go back on medical?
Medi-Cal termination only applies to your current situation. If at any time in the future your circumstances change, you can be determined eligible for Medi-Cal. This frequently happens with people who have fluctuating incomes and family situations.
Hi Kevin,
Do I need to file taxes in 2022 to qualify for MAGI medical?
My understand is that tax filing is not a requirement for MAGI Medi-Cal. Many people are not earning enough to meet the tax filing threshold, except to recover withholding taxes. For the subsidies through Covered California, you must file a federal tax return.
So if we got a divorce then my partner would qualify for Medi-Cal for his Nursing Home Care. Would the fact that we got a divorce 'after' applying for, and being denied coverage - IF we got a divorce now would that act disqualify my partner??
Each applicant is evaluated on their current financial state. Obviously, assets and income change rapidly. A person denied for Medi-Cal one month, may be eligible the next.
Hi Kevin, I have been making much over the medi-cal limit for about two years now but have not reported anything since I stopped using it. Will I be penalized or charged anything over the past two years for not letting them know I had an income change? I actually went in to the office about a year ago to try and cancel it but they said it will automatically fall off which has not been the case. I just got it in the mail this week and it automatically renewed thinking I make much below the poverty line which is not the case anymore. Is there anyway to cancel it? Will I be charged for anything in the past like cal-fresh tends to do? Thanks for the help
Medi-Cal has been returning to normal operations since the end of the Public Health Emergency when they were not terminated anyone from the program. You should report your current income to them either by visiting the office or through Benefitscal.com. You need to have Medi-Cal properly terminated by them determining you are ineligible for the program. There will be no repercussions.
@@KevinKnaussthank you! So just to confirm there is no penalty for still having medi-cal the last year or so and making over the income limit?
@@Rj-bc8sn No penalty, in part because you may have still been Med-Cal eligible. Plus, you may have been automatically renewed without any review. Now, just report the change to the income and circumstances and Medi-Cal will be happy.
I am on MSP SSDI and MediCal. Received inheritance below new guidelines but didn’t report it to MediCal because I was advised that I only had to do that during my yearly redetermination. It’s been a few months and I now have &23,000 in my bank account. What do I do? Changing to retirement in November, but it looks like same program as disabled adults. Been thinking about quitting MediCal and paying for supplemental plan, but it’s expensive and I won’t get guaranteed issue at any other time. So many pros and cons. Can’t make a decision. Can you help? Will I get in trouble for not reporting??
Medi-Cal, couple with Medicare, has different income and asset requirements for eligibility. In general, changes are picked up during the annual redetermination. I think it is always good to notify Medi-Cal of the changes. In this manner, you know that you have done it and there are no surprises or anxiety like you are experiencing now. You won't get in trouble for not reporting.
Now that you are moving into Social Security, Medi-Cal will re-evaluate your financial situation for continued Medicare Extra Savings Program and the extra help. While you are educating yourself on the various options (Medicare Supplements, Medicare Advantage, Part D plans, etc.) let Medi-Cal redetermined your eligibility. Once they notify you of your eligibility status, that's when you can really make an informed decisions.
@@KevinKnauss thank you!!! can I pay my brother back for dental implant procedure he paid for or would they see that as giving away assets. He paid $28,000, either way I’m under the asset limit, but it may qualify me for MSP. ALSO, I received a 38,000 IRA is it true that in California you can give away inheritance in the first month you receive it?
@@annlaselva2323 I don't think the repayment of a loan would be an issue for Medi-Cal. Distributing assets is more of an issue when you are applying for Medi-Cal to cover a skilled nursing facility and people try to shield their assets from spend-down rules by giving the money away. You'll need to contact a tax professional or the Franchise Tax Board about the rules regarding a taxable inheritance.
Thank you so much. 😊
Medi-Cal: ok sir, and your income?
Me: $1200
Medi-Cal: last month?
Me: No, this year.
...truth.
Hi @KevinKnauss im freaking out, sick to my stomach worried. I started a new job in nov 2022 i got a medical renewal form for a member in my household in sept 2023 and i thought oh crap i never reported the change i made 31,835 in 2023 im a mom to an 8 year old and i have a bf who is disabled in my household. Im so worried i will get in trouble for not reporting. I submitted current check stubs and reported my job change in sept 2023. I currently get free coverage through medical. Am i going to owe😮 please respond.
You are not in trouble. Even though Medi-Cal requests that you report changes within 10 days, it is through the annual redetermination paperwork that most changes that make people ineligible are reported.
Never assume you are not eligible, but always report changes. Many adults or their children are still eligible for Medi-Cal even after getting a new job or raise at work. The math can be complicated. You have done the right thing be reporting all the changes and there will no financial repercussions to you.
@@KevinKnauss okay, ive been trying to contact the welfare office to make sure they have recieved the items i submitted online. They sent me a letter asking for my income for the last 30 days of my old job not my new one. I also havent recieved my 1095 yet for taxes from medical.
I received an inheritance almost 5 years ago and when I called in to report it, I was told I didnt have to claim that money. Now I'm scared to report it. Can they take my inheritance?
In most situation for MAGI Medi-Cal, an inheritance or one-time lump sum distribution is considered an increase in assets, not monthly income. Eligibility is based on monthly income, not how much money you have in savings. I see no reason to fear losing your savings.
I just did my taxes paying a penalty of $500, how much are you paying for insurance a month group it up to the whole year tell me what you got, laters people and by the way if you're not dying don't go to hospital don't go to ER, you're just making it worse for yourself and for everybody else eat right stay healthy that's all you got to do, and remember everybody else is getting richer you're just getting poor do you really want to stay like that.
It is a personal decision to enroll in either Medi-Cal or Covered California with the subsidies to reduce the cost of health insurance. Sometimes you have no decision when you are taken to the emergency room because of an accident or sudden illness. Health insurance, at its basic level, is asset protection. It limits your liability for catastrophic health care services.
All I ask of people who decide to forego health insurance is that if they rack up large medical expenses, don’t file bankruptcy to get out of paying them. Skipping out on paying your debts raises the costs for the rest of us that participate in the system, flawed as it is.
Hey Kevin so my renewal is due February and my income increased to 33,600 yearly and I have a surgery coming up that medical was going to cover. I just started the job in October. I been waiting for the surgery for month. What can I do?
Medi-Cal termination, as a result of reporting an increase of income, is not immediate. If it happens after the 15th of the month, Medi-Cal is usually not terminated until the end of the next month. Medi-Cal must send you a notice of action in the mail. This notification gives people ample time to enroll in a Covered California plan with the subsidies.
With a new health plan, there are continuity of care provisions where scheduled procedures and treatment must be accepted, even if the providers are out of the network of the new health plan.
@@KevinKnauss 🙏Thank you I was so worried. You're a great help God bless you and your youtube channel.😊
I understand after I die Medical can come after my ALL assets to recover for being on Medical. If I stop Medical can they still do this?
You are referring to Estate Recovery. This program only applies to certain types of Medi-Cal payments such as covering the cost of a skilled nursing facility. Most types of Medi-Cal will not trigger Estate Recovery provisions. I don’t know what type of Medi-Cal program you are in. However, you need to weigh the immediate cost of paying for health care covered by
Medi-Cal and any estate recovery after you die.
My parents are 56 and still using medi-cal(probably soon they will end it and buy it from coveredca instead) if they pass away in the future with other insurance. Do Medi-cal still able to come take their property? should they move their property under my name? even though I had medi-cal during early year.
Several years ago California changed the rules regarding Medi-Cal Estate Recovery. MAGI Medi-Cal managed care HMO health plan premiums are no longer subject to Estate Recovery for individuals over 55 years of age.
@@KevinKnauss Are there other type of Medi-Cal beside MAGI? Not sure if I am in Magi or other
@@TheCupfulBoy Yes, there many variation of Medi-Cal that are based on income, assets, age, and medical condition. You should reach out to your county social services Medi-Cal case eligibility worker for a full evaluation of your specific situation.
My partner is 99, I'm 80 applying for Medi-Cal for my partner in a Nursing home. I want to protect my home (condo) how can I do that?
Unless your partner is on the title or somehow has an ownership stake in the condo, it would not be a part of his estate subject to Medi-Cal Estate Recovery. Assuming your partner is on the title, even if they die, Medi-Cal would not come after the surviving partner if that is their primary residence. However, if you die after your partner, there is a possibility that Medi-Cal could seek the repayment of prior expenses from the remaining assets.
You can see how quickly all of the relationships, assets, estates, and exemptions get complicated.
Hi Kevin, thank you very much for the info, i also just found out that i have not updated my income for like 3 years 😅. I just assumed medi-cal will discontinue my coverage. Now im findinh out i should have reported or else they just automatically renew, the last redetermination package came in march this year, i forgot to even fill it out, i just assumed theyll just discontinue medi-cal. Now im finding out they didnt and its still active 😮. So how should i go about doing this, should i just report the income change for the most recent tax filling online via benefitscal, then also submit the form mc215 to request medicial eligibility discontinuation and beneficiary waiver notice of 10 day period? And if so, what is the timeline between those two actions, like can i submit fhe change of income then wait a day and submit the mc215 forn?
Medi-Cal resumed normal redetermination operations in April-May. You may not necessarily be terminated as they were not terminating people who failed to return the renewal paperwork during the Public Health Emergency of Covid.
Assume nothing with Medi-Cal. I think you have the correct course of action with updating your income with the 2022 tax return AND proof of your current income. I would not request a termination. You want Medi-Cal to terminate your enrollment as they find you ineligible for benefits.
If you voluntarily discontinue Medi-Cal, you can’t get into Covered California with the subsidies. You want an involuntary termination, that is a qualifying life event for a Special Enrollment Period for Covered California, individual and family plan off-exchange, or enrollment into an employer group plan.
@@KevinKnauss I see, well I do currently have an employer plan which will actually end june 30th. So I won't have insurance after June except for medi-cal, after that I will be working a different job, self employed job. The timing made it tricky. Because if I report my income change from last year, my current income will be different since I'm changing jobs 😅.
@@NM-gx5or Medi-Cal is focused on your current income, not last year’s income. Just lay out all of the facts in sequential order. If your projected and verified self-employment income is above the Medi-Cal income threshold, you can segue to Covered California.
However, you cannot go to Covered California with your current Medi-Cal eligibility. They need to terminate your enrollment. The soonest that could happen, under the circumstances you have presented, would be the end of July.
@@KevinKnauss then wouldn't be fastest to just send in form mc215 to request discontinuation of my medical. Because I am 100% certain I wouldn't be eligible for medical based on my income.
@@NM-gx5or It is best to have Medi-Cal terminate your enrollment because they have determined you are ineligible. If you do it that is an involuntary loss of coverage. You will have problems enrolling in Covered California if your account is flagged through the Medi-Cal system as potentially being eligible, but with voluntary termination. Believe me, I’ve seen it and it is a hassle.
Well. My income was higher than the limit for 3 consecutive years .. I got any auto renewal For 3 years that I was automatically re eligible for medi cal So.......not my problem... They checked my income automatically and said I was still eligible for medi cal even when I was above the limit
The important aspect is that the county Medi-Cal office determined you were still eligible. But also be mindful that Medi-Cal beneficiaries agree to report any changes to their income within 10 days.
I'm on Med- iCal because of my cancer treatment I'm aslo going through worker comp nightmare where my whole case is in denied because of a bed report from the QME doctor I'm going to take my case to trial because 50k won't cover all medical spend on saving my life
I assume that the $50k you refer to is for lost wages/worker's compensation. I need to do more research, but if a Medi-Cal beneficiary receives a settlement from an injury or accident, Medi-Cal must collect part of the settlement for health care costs. I don't think this applies in your situation, but you should clarify it with your attorney.
This only applies to people who are 55 or older right? Is better to be in covered California at that age? Since you can get prescription drugs and not worried about having to pay back through estate recovery after one’s death.
In most cases, the cost of the Medi-Cal coverage is not the expense of the drugs. Medi-Cal pays a monthly capitation or premium to an HMO health plan who that assumes all the risks and liabilities for your health care and prescription drug costs associated with your enrollment in the plan.
In order to qualify for Covered California, the monthly income needs to be higher than the eligibility for Medi-Cal. Assuming your income could be higher, you would potentially be subject to a monthly premium (albeit a small amount) and the copayments for the drugs and other health care services.
If everything is working with Medi-Cal, why would you increase your out-of-pocket now, to save money after you died?
@@KevinKnauss We have a house. We want to give the house to children after we die. I want to know if I understand it correctly. Before we turn 55, any benefits we receive from. Medi-cal are not subject to repayment. But once we turn 55 and are still on Medi-cal, anything except the monthly premium that are paid through Medi-cal is subject to repayment. So just before we turn 55, it's better to move onto a covered California plan if we can get extra income. Is that correct?
@@frugalorfrugalor3513 In 2017, under the new law SB 833, MAGI Medi-Cal costs accrued to a beneficiary are supposed to be exempt. The focus of the Estate Recovery is on individuals in Non-MAGI Medi-Cal, Medicare, and those in skilled nursing facilities.
You may not incur any repayable Medi-Cal costs while you are under 65. But once you go into Medicare and you also have Medi-Cal to help pay for health care expenses, those would be subject to Estate Recovery from my understanding.
I would like to leave my estate to my child as well. But before he gets a dime, I will make sure all of my debts are paid.
@@KevinKnauss Thanks for sharing the info Kevin. I am learning all the nuances to see whether to choose Medi-cal or covered California. I am in the planning phase of early retirement. If Medi-cal will cause me debt while covered California won't, then I will try to make enough income to avoid Medi-cal. But from what I have learned from you so far is that before age 65, there is no advantage of choosing covered California over Medi-cal except maybe for doctor or service availability. Because before age 65, one will not take on any debts by using Magi Medi-cal -- Hopefully I get this part right.
@@frugalorfrugalor3513 Are the doctors, hospitals, and specialists that you would like to see in the Medi-Cal networks? If you are a current Kaiser member, you can probably get Kaiser Medi-Cal and keep all of your doctors.
If you want to be seen by primary care doctors at Stanford, Cedars-Sinai, UC, Hoag, Sutter, or any sought after medical group, you won’t find many of those - if any - in a Medi-Cal network.
They keep renewing my medi-cal they sent me a packet to fill out i was hoping they would cancel my medi-cal since i didnt fill it out but they keep renewing it i have another insurance plan through an employer now and dont know how to cancel my medi-cal
Fill out the packet of information from Medi-Cal and inform them you have employer group insurance. You can make a photocopy of the member ID and send it to them.
@@KevinKnauss is there an email i can send it to?
@@tiko5750 kevin at insuremekevin . Com
Is Magi Medi-Cal still available in 2023? Also, Kevin are SSDI and IHSS wages counted as income for Magi Medi-Cal?
Yes, millions of people are enrolled into it.
@@KevinKnauss Just one more question. With Magi Med-Cal. Do they still send a renewal form every year? Thanks.
@@dwaynelasater2350 The annual redetermination forms were suspended during the Covid public health emergency, but will be reinstated in 2023. The annual renewal is how Medi-Cal learns of many of the individuals and families are earning too much for Medi-Cal. People generally forget to report their income changes to Medi-Cal. When the Medi-Cal recipient receives the annual renewal paperwork, they update their household income.
@@KevinKnauss Good morning Kevin, I was just wondering why does medi-cal send out 20 page renewal packets asking about everything and anything you own if all they really care about is where you live and how much you make? Doesn't make much sense to me.
@@dwaynelasater2350 Medi-Cal administers many different programs and is associated with other programs under the Department of Health Care Services such as CalFresh. They are screening families to see if they might be qualified for other programs and to make sure they have the proper aid codes for those who do depend on their services. There is a method to the madness.
Do you have to pay back Covered California?
If you owe excess subsidies because your income was higher than estimated, you repay it on your federal tax return, not Covered California.
@@KevinKnauss ok, but besides that, they can't come after us to repay, like with Medi-cal?
If your final income is below the level to qualify for the subsidies when you do your taxes, you do not have to repay the subsidy you received during the year. You must only repay any excess subsidies you received back to the IRS IF your income is higher than you estimated in Covered California and you receive too much subsidy during the year for the final higher income.@@user-cv4ew3yl5m
You sound like Scooby TH-cam fitness channel
They are harassing the hell out of me. I went over one month and now they want to take my benefits away saying I make too much. But the income they have down for me is incorrect. Now I have to go through a whole appeals process, what a mess.
Which benefits are you referring to? There are many Medi-Cal programs and some have tighter conditions for eligibility than others. For medical insurance, exceeding the income limit for one month - when the individual has fluctuating income - would not trigger termination.
@@KevinKnauss that is exactly what happened to me, I went over in the month of May and now they want to terminate my Medi-Cal and they’re using the income. I made that month to determine how much I ‘m making now which is a lot less than I was making that month. That’s why I appealing it so I can show my Social Security how much I make monthly from that and I no longer work.
@@Katie-xn9je Sounds like solid ground for a successful appeal. Did you report the income to them or did they use another source? I have heard some county Medi-Cal offices using Social Security data within the eligibility determinations. However, other income the beneficiary may have reported may have decreased, actually placing the beneficiary in the MAGI Medi-Cal eligibility range.
@@KevinKnauss I live on Social Security and the income they’re talking about is a temporary job that went over in the month of May. Trouble is there still using that income as my current income and it isn’t, I’m only living on social security.
@@Katie-xn9je Once you are able to prove to them that the temporary job has ended, you should be reinstated. It's a lot of bureaucracy, unfortunately.
How much money can you have in your bank account?
For Modified Adjusted Gross Income (MAGI) Medi-Cal, they don’t look at your bank account or any other asset you own. Medi-Cal is focused on your monthly income. Assets, such as bank accounts, come into play for conditional Medi-Cal for individuals with disabilities or people on Medicare.
@@KevinKnauss that has changed, you can only have no more than 2, 000 total monies in savings, checkiing
@@ansonarnold1584 What has changed is that for Non-MAGI Medi-Cal, as of July 1, 2022, you can have $130,000 in non-exempt assets, such as a bank account. MAGI Medi-Cal still only looks at your income, not your assets.
@@KevinKnauss they have to look at your asset under magi regulations .if you have more than 2, 000 in assets. You don't qualify for magi medi- cal. When you reach 63 years of ago then you qualify for elderly medi- cal
@@ansonarnold1584 From experience, reading through the regulations and all of the guidance, I can absolutely tell you that MAGI Medi-Cal is NOT dependent on your assets, only your income. Medi-Cal will ask for additional information on assets to see if you qualify for other programs under the Medi-Cal umbrella. Aged Medi-Cal occurs when a person turns 65 and gains entitlement to Part A of Original Medicare and sometimes enrolled in Part B of Original Medicare. That is the Medicare Savings Program for individual who are eligible for both Medicare and Medi-Cal.
What health insurance do undocumented immigrants get when they don’t qualify for Medi-Cal?
If an individual has Tax Payer Identification Number (TIN) they could purchase and enroll into a private health plan direct from one of the insurance companies.
Eu nap estou neste canal
Translation please.