Author Topic: Any families in California using Medi-Cal Programs for kids?  (Read 1492 times)

frugalor

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Any families in California using Medi-Cal Programs for kids?
« on: November 14, 2020, 04:24:24 PM »
Hi,

I am trying to understand how I can save on medical insurance when FIREd.

My situation is that I see myself having a 1m taxable investment portfolio when I FIRE.

When I go to coveredca.com and compare rates.  I can only get my kids to be included with us if I enter $100K income.  However, my target income is $43K.

At $43K income, my kids have to enroll in Medi-Cal programs.  My questions are:

1) Will my kids qualify for Medi-Cal programs when we actually have a 1m taxable investment portfolio?

2) If enrolled in Medi-Cal programs, will the government take any money from us when we sell our house?

Are there any families doing similar set up?

« Last Edit: November 14, 2020, 04:32:40 PM by frugalor »

jim555

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Re: Any families in California using Medi-Cal Programs for kids?
« Reply #1 on: November 14, 2020, 06:00:37 PM »
1. CHIP eligibilty is based on MAGI alone.

2. There is no recovery for CHIP.

FINate

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Re: Any families in California using Medi-Cal Programs for kids?
« Reply #2 on: November 14, 2020, 06:38:13 PM »
Our kids were on Medi-Cal for a while.

Your biggest issue will likely be finding a pediatric doctor you like that's taking new Medi-Cal patients.

And your next biggest issue will be dealing with the impenetrable bureaucracy of CoveredCA/Medi-Cal. Not joking, it's many times worse than the DMV. Fun!

We eventually went with a Health Care Sharing network that qualifies for an exception from the CA insurance mandate. Less expensive than the CoveredCA plans. But mainly, so much less hassle and easy to find docs that take cash.
 

lhamo

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Re: Any families in California using Medi-Cal Programs for kids?
« Reply #3 on: November 14, 2020, 07:19:23 PM »
And your next biggest issue will be dealing with the impenetrable bureaucracy of CoveredCA/Medi-Cal. Not joking, it's many times worse than the DMV. Fun!
 

What bureaucracy exactly?

We have been primarily on Washington state's Apple Health program, which is the equivalent of the Medical program, for the last 4+ years.  I have never had to deal with any unreasonable bureaucracy.  When we need primary care services, we go to our primary care clinic and they bill the plan directly.  If you don't like your assigned primary care doc, you can easily change at any time (DH chose a different one than the clinic I use for me and the kids).  If it is urgent and we can't get an appointment quickly, or an emergency, we go to an in-network urgent care clinic or hospital -- just took my DD to the urgent care at the local children's hospital a couple of weeks ago.  You do have to get referrals for any specialist visits, but it isn't an onerous process -- I just had a telehealth visit yesterday to request a dermatologist referral, and was able to ask for the dr. I wanted by name (he takes my plan and is taking new patients).  All billing is done by the provider.  I haven't even SEEN a bill when we've been on Apple Health.

You do have to renew your coverage periodically, but that too is pretty easy -- especially if you use a Healthcare Navigator.  I have one I like and trust, and she is readily available by email and phone.  She is based in our primary care clinic.

I understand that the situation may be different in CA, but it might be helpful if you explained more about the challenges you faced and where you are located -- some places do have shortages of participating providers, but that isn't true everywhere.

FINate

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Re: Any families in California using Medi-Cal Programs for kids?
« Reply #4 on: November 14, 2020, 07:56:41 PM »
And your next biggest issue will be dealing with the impenetrable bureaucracy of CoveredCA/Medi-Cal. Not joking, it's many times worse than the DMV. Fun!
 

What bureaucracy exactly?

We have been primarily on Washington state's Apple Health program, which is the equivalent of the Medical program, for the last 4+ years.  I have never had to deal with any unreasonable bureaucracy.  When we need primary care services, we go to our primary care clinic and they bill the plan directly.  If you don't like your assigned primary care doc, you can easily change at any time (DH chose a different one than the clinic I use for me and the kids).  If it is urgent and we can't get an appointment quickly, or an emergency, we go to an in-network urgent care clinic or hospital -- just took my DD to the urgent care at the local children's hospital a couple of weeks ago.  You do have to get referrals for any specialist visits, but it isn't an onerous process -- I just had a telehealth visit yesterday to request a dermatologist referral, and was able to ask for the dr. I wanted by name (he takes my plan and is taking new patients).  All billing is done by the provider.  I haven't even SEEN a bill when we've been on Apple Health.

You do have to renew your coverage periodically, but that too is pretty easy -- especially if you use a Healthcare Navigator.  I have one I like and trust, and she is readily available by email and phone.  She is based in our primary care clinic.

I understand that the situation may be different in CA, but it might be helpful if you explained more about the challenges you faced and where you are located -- some places do have shortages of participating providers, but that isn't true everywhere.

That's fair. I'll try my best to explain because, honestly, I'm still not entirely confident about which agencies were involved. Apologies if this is fuzzy.

And, yes, this very well may be CA specific.

First, the CoveredCA website is buggy as heck. I sorta works some of the time. But at other times it loses/fails to submit data. This makes it extremely difficult to know if everything is entered into the system correctly.

E.g., an address change. This should be very straightforward, should just be a basic CRUD operation to update the mailing address in the DB. Nope! They made me re-submit my entire application, from scratch, to update my address. And then, after submit, the address never changed. Called the support line, no one knows what's going on beyond the provided call script. Tried submitting the change again. Waited a few days. Called again. Correspondence still getting sent to our old address, then forwarded by USPS. ~6 months pass and, mysteriously, it resolves itself. No idea what happened. Guessing there's a backend batch process that either was stuck, or just runs very infrequently.

Same problem with income change. Incidentally, the way MAGI is used to determine MediCal vs. premium subsidy on the exchange is extremely irritating if you're near the threshold, as you bounce between both. And the ACA assumes income is predictable. I'm FIRE, I don't really know what my exact MAGI will be for the next year. Regardless, as our income changed (sold RE, other changes) we had to resubmit the entire application for each change. In each instance the data wouldn't update correctly, and the phone support people couldn't figure it out.

That's just the CoveredCA side of things. And this is where things start to get fuzzy for me. At some point our MAGI was too low and the kids were kicked onto MediCal. Website said we didn't have to do anything, they would auto-enroll our kids. Called the support line to verify, which they did. Fine, that works for us. Several months later we get paperwork from a state agency (forget the name) to apply for MediCal. Uh, ok, I guess it's not actually auto-enroll. Fine. Filled it out and returned it. But there's a problem processing the application. If I recall correctly, it had to do with our old income level in CoveredCA that we couldn't get to update correctly. We explained the situation, but they couldn't help us and sent us to a county agency. So we contact the county agency. Goes a little smother this time, but then yet another county agency starts calling us and sending us mail. I still don't know why this other agency got involved, or why the state agency was unable to help. In any case, eventually it was resolved and the kids got their MediCal cards.

Then we moved out of state this year. We called MediCal to cancel, which they said was done. But they didn't. Instead, they continued sending bills to us at our new out of state address. Call again. Get whatever form we need to cancel. Send this in, but now it's past the billing period date, so we get billed for another month. Which I don't understand, how is it possible for us to remain on MediCal after we moved out of state? Whatever, as far as we know it's finally done.
« Last Edit: November 14, 2020, 08:00:52 PM by FINate »

lhamo

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Re: Any families in California using Medi-Cal Programs for kids?
« Reply #5 on: November 14, 2020, 09:35:45 PM »
TBH, the online system in washington is also full of glitches. I messed up some things with our first ACA policy, my own fault but it ended up costing us hundreds of dollars. So when it was time to update our coverage to add my daughter, I decided to make an appointment with a Navigator. By that time we had no steady income, so she signed us up for Apple Health. I made a second appointment with her to declare the capital gain on our beijing property sale (VERY large capital gain) but she told me since it was a one time thing it didn't matter -- once you are on the program you only get kicked off if your income exceeds the monthly limit two months in a row, or in the month when you are up for renewal. Just to be safe I still let her know whenever we have a one time jump in income, but it has never been a problem. We did have to sign up for an ACA policy for two months last year, when our 18YO DS had a high paying tech internship, but as soon as that income ended we just went back on Apple Health.

Anyway, my strong recommendation is that anyone exploring their options who might be near the expanded medicaid thresholds for the family or just the kids talk with and apply through a healthcare navigator. They know the system and can get advice from higher ups if they need to. I have been VERY up front with ours that we are deliberately keeping our income low at the moment. I am not trying to cheat the system. I'm just getting benefits we are eligible for given how the program is structured.

Stepping off soapbox now.....

frugalor

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Re: Any families in California using Medi-Cal Programs for kids?
« Reply #6 on: November 15, 2020, 12:20:58 AM »
1. CHIP eligibilty is based on MAGI alone.

2. There is no recovery for CHIP.

This is good to know.  Thanks for the info!  It seems I will be able to afford insurance on 4% or less withdrawal rate :)

nalor511

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Re: Any families in California using Medi-Cal Programs for kids?
« Reply #7 on: November 15, 2020, 12:36:17 AM »
Our kids were on Medi-Cal for a while.

Your biggest issue will likely be finding a pediatric doctor you like that's taking new Medi-Cal patients.

And your next biggest issue will be dealing with the impenetrable bureaucracy of CoveredCA/Medi-Cal. Not joking, it's many times worse than the DMV. Fun!

We eventually went with a Health Care Sharing network that qualifies for an exception from the CA insurance mandate. Less expensive than the CoveredCA plans. But mainly, so much less hassle and easy to find docs that take cash.
 

Do you save with your health sharing network? How much does it cost in premium, and maybe a typical dr visit? Thx!

FINate

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Re: Any families in California using Medi-Cal Programs for kids?
« Reply #8 on: November 22, 2020, 03:47:34 PM »
Do you save with your health sharing network? How much does it cost in premium, and maybe a typical dr visit? Thx!

@nalor511  Oops, sorry. I forgot to respond to this question.

Just to be super clear, it's not insurance so there are no premiums. Instead, every month we sent a check/paypal directly to someone to help with their medical bills. For our family of 4 it's about $300/month. We also belong to a local Direct Primary Care group that is health sharing network friendly. The DPC is about $150/month and includes routine visits, urgent care, and a bunch of other stuff. While not strictly necessary, we wanted to have more of a relationship with a family physician for continuity of care.

We are saving some money on this arrangement. Even compared to when we had our highest ACA subsidies, we are now paying a bit less than the Bronze Plans. We're saving a significant amount compared to when our subsidies dropped due to income changes. Not even close in the case of no ACA subsidies. Plus we now have zero issues finding a dr or getting appointments, and we mostly deal with a handful of folks in a small medical office who know us by name.

There are tradeoffs, of course. A lot of stuff isn't covered by health sharing networks. This is fine with us, we don't want a tone of stuff covered as this drives up rates. And since it's not insurance there are no guarantee we'll get reimbursed. But then, insurers are pretty bad about this as well, often make claims difficult. So it's a risk we're willing to live with.
« Last Edit: November 22, 2020, 03:51:16 PM by FINate »