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. Alabama ZIP code map and Alabama ZIP code list. View all zip codes in AL or use the free zip code lookup. 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. Covered California has made numerous changes to their online enrollment application including changes to reporting income. For a review of the changes and to download documents visit. California Zip Codes By County Excel' title='California Zip Codes By County Excel' />Covered California enrollment. Counties play a big role in Medi Cal. Medi Cal, Californias version of Medicaid is big and complicated. Overview of a presentation to certified insurance agents on the basics of MediCal and how it works with Covered California. Downloads MediCal Forms. Postal codes, Zip code, Country code, Postal zip code. OCRegister. com covers local news in Orange County, CA, California and national news, sports, things to do and the best places to eat, business and the Orange County. The County ZIP Code Database lists every county ZIP code combination in the USA and its territories. Updated monthly. Download immediatelyIt 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 Californias 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 1. Medi Cal programs. See 2. 01. 5 California Medi Cal Health Plans by County. DHCS MAGI Medi Cal individual household size flow chart. Archery Software Free more. New DHCS MAGI Medi Cal individual household size flow chart. Covered California doesnt 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 applicants 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 1. 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 3. 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. Should you report your pregnancy to Covered CaliforniaThis blog post reviews how some women may be placed into Medi Cal after they report that they are pregnant. Covered California is now screening women for Medi Cal pregnancy programs when they indicate they are pregnant. Even if you were determined eligible for a private health plan with the premium subsidy, indicating you are pregnant changes the household size and drops the woman into Medi Cal potentially losing her OBGYN who may not accept Medi Cal. Updated February 1. 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 3. Medi Cal wants to be notified in 1. 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 Adult eligibility solely based on income for ages 1. Former foster youth eligible regardless of income under age 2. These applications should go through the county office not Covered California. Senior and those with disabilities retain eligibility. Whats covered in a Medi Cal health plan Cover all the same benefits as private health plans sold through Covered California. Expanded benefits under Medi Cal plans include mental health services such as individual or group evaluation and treatment, substance abuse and adult dental services. A beneficiary who is identified as having a significant impairment from a mental health disorder will be referred to and can access Specialty Mental Health Services provided by the county Mental Health Plan. In order to qualify for these services, a beneficiary must meet criteria designated in a regulatory statute. Eligibility is determined when the patient is assessed by a mental health professional. What about Access for Infants Mothers Now known at Medi Cal Access program. Must be pregnant, but not more than 3. Not receiving full scope Medi Cal. Can be uninsured or in private health plan with a separate maternity deductible or co payment of more than 5. That would include Covered California health plans tier level Bronze, Silver and Enhance Silver 7. Income greater than 2. Federal Poverty Level. County Childrens Health Insurance Program C CHIPSpecific to San Francisco, San Mateo and Santa Clara counties. Children under 1. Federal Poverty Line. This is a higher income level than Medi Cal kids in the other counties. What about Former Foster Youth ageing out of the system Under the age of 2. No income or asset test. Can self attest to foster youth status, by completing form MC 2. AAdditional information at www. What are the two types of Medi CalFee For Service beneficiaries must find their own doctors that will accept Medi Cal reimbursement. Managed Care beneficiaries are either assigned or select a managed health care or HMO plan with a set provider list and must see their primary care physician for any referrals to specialists. Types of managed care plans. COHS County Organized Health System, non profit independent public agency that administer Medi Cal benefits. Residents in a COHS, enrollment is mandatory, no Fee For Service. Non COHS these counties offer either a local HMO or private HMO to administer Medi Cal benefits. Beneficiaries will be able to choose the HMO they want. Special Population Usually dual eligible beneficiaries, Medicare and Medi Cal, with special health needs. Such as PACE Program of All inclusive Care for the Elderly or special health plans for HIV positive individual. Slides 1. 7 2. 3 lists the various counties and the plan offered. Is Medi Cal freeTypically there are no monthly premiums, deductibles or prescription costs or copayments. Some children may have a monthly premium of 1. No family will pay over 3. Some Medi Cal prescription refills will be 1 per month. Do current Medi Cal beneficiaries, pre ACA, need to re applyNo, all current recipients retain coverage with annual re determination. Are medical bills covered prior to Medi Cal Medi Cal will pay prior months medical bill for three months prior to acceptance. Medi Cal questions What are the Medi Cal Income and Asset tests There are two types of Medi Cal eligibility those who must meet Modified Adjusted Gross Income MAGI of the ACA and Non MAGI individuals.