Different Ways to Qualify For MediCal

There are many different ways how to qualify for MediCal. There are non-financial eligibility criteria, income and asset tests, and a special needs plan. It is essential to follow the guidelines carefully. Those who do not meet these requirements may be ineligible for MediCal coverage.

Non-financial Eligibility Criteria

There are a variety of non-financial eligibility criteria for MediCal. These guidelines are used to determine if a person is eligible to receive health care assistance. These guidelines differ depending on the program. For example, some programs require applicants to be in certain age groups or have certain assets. Others require applicants to furnish their Social Security number or proof of application.

In addition, there are available managed healthcare plans that can guide you on how to qualify for MediCal. For example, individuals must meet the state’s financial eligibility requirements. Those who meet financial eligibility must also be United States citizens or be qualified aliens. Non-citizens may also be required to meet specific functional criteria.

Certain assets are not countable for Medicaid. Some assets are exempt, including cash, stocks, investments, and vacation homes. Other assets, like IRAs and 401Ks, are not countable. Vehicles, burial funds up to $1,500, and non-refundable pre-paid funeral agreements are also exempt. Some households can have as little as $3,000 in countable assets. Similarly, a primary residence is exempt if the applicant lives in the home and the equity is under $955,000 (after subtracting the debts).

Asset Test

Californians with moderate incomes and assets should not be subjected to an asset test to qualify for MediCal. This policy disadvantages people with insufficient resources to cover their healthcare costs. It discourages saving and puts people in a vulnerable position. For example, long-term care can cost up to $10,000 per month, and a person with a modest amount of assets could find themselves unable to afford it.

Thankfully, the state is changing the asset test to increase eligibility. Under Medi-Cal, an individual can have up to $2,000 in assets. Couples can have up to $3,000 in assets. In addition, Medi-Cal provides a personal needs allowance of $35 per month. Those enrolled in a nursing home can also keep up to $600 of their income.

Although the federal government provides 60 percent of the funding for Medi-Cal, states set the eligibility criteria. While most states set a $2,000 limit for the asset test, some have raised it. Some states allow spouses to enroll in the program and keep more assets. Assets include bank accounts, brokerage accounts, and insurance policies. A beneficiary may keep one automobile and a principal residence up to a specific value.

Income Test

In California, millions of seniors and people with disabilities rely on Medi-Cal for health care. However, policies that favor those with higher incomes and assets block their access to health care. This has resulted in widespread discrimination and deprivation. The asset test discourages people from saving, weakens the stability of families, and puts renters at a disadvantage.

To qualify for Medi-Cal, you need to meet the state’s income eligibility requirements. In California, these limits are based on a family’s Modified Adjusted Gross Income (MAGI) – income earned from employment, self-employment, foreign-earned income, and tax-exempt interest.

To qualify for Medi-Cal, your total countable income must be less than one hundred twenty-five percent of the federal poverty level (FPL). The federal poverty level (FPL) has increased by 5.2 percent between 2021 and 2022 for single adults. For children under age 26, ABLE accounts can be used to save money without being counted.

Special Needs Plan

When it comes to Medicare eligibility, determining whether you qualify for a special needs plan (SNP) is essential. This type of health insurance is available only to people who meet specific criteria. If you are currently enrolled in an SNP, there is usually a time each year called an open enrollment period when you can change plans or switch back to Original Medicare. 

In general, Medicaid is a state-run program that provides various benefits depending on your need and the frequency of services. The cost-sharing required by a Special Needs Plan varies, so you should carefully review the Summary of Benefits document for each plan before selecting one. Pay special attention to the cost-sharing required by in-network providers.