Qualifying for Medi-Cal Made Easier To Expand Coverage

Relaxed eligibility requirements will make low-cost or even no-cost Medi-Cal an option

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    NEWSLETTERS

    Families and individuals who cannot afford the premiums for a Covered California plan may now qualify for Medi-Cal. As the eligibility requirements for the assistance program are easing, adults that do not have dependent children or a disabling disease are now being accepted. Patrick Healy reports from Pasadena for NBC4 News at 6 p.m. on Oct. 2, 2013. (Published Wednesday, Oct 2, 2013)

    Recognizing that the health care plans offered through the Covered California marketplace will remain beyond the financial reach of millions of Californians, public health officials are looking to expand access to Medi-Cal to further reduce the ranks of the uninsured.

    Even as the spotlight focuses on the rollout of Covered California enrollment, relaxed restrictions on Medi-Cal eligibility will move it beyond its decades-old role as a safety net predominantly for low income families with children and disabled adults, health officials said.

    In severe cases of financial hardship, Medi-Cal provides coverage at no cost to the insured -- which will continue. Other Medi-Cal plans cover health services at minimal fees.

    Covered California health plans are offered at several different levels, and depending on income, subsidies are available. But monthly premiums can run into the hundreds of dollars. In Pasadena, with an estimated 27,000 currently uninsured, the goal is to cover 14,000 of them through Covered California and enroll another 7,000 in Medi-Cal, according to Eric Walsh, MD, MPH Public Health director.

    There's recognition that there will be "residual uninsured" -- including individuals who are undocumented, transients, or in some cases returning to society from incarceration. Statewide, as many as three million more Californians will become eligible for Medi-Cal, according to a 2011 report by Helen Lee and Shannon McConville for the Public Policy Institute of California.

    Pasadena's outreach has relied on several non-profit health organizations, including Young & Healthy, which traditionally has focused on finding healthcare for children through a network of doctors donating their services pro bono. In years past, Young & Healthy has assisted many of its clients in obtaining Medi-Cal coverage for their children, said Mary Donnelly-Crocker, executive director.

    She sees that role expanding with the onset of Covered California and the easing of Medi-Cal's eligibility requirements.

    "It's a huge portion of people who will be able to insure with Medi-Cal," Donnelly-Crocker said.

    Since President Obama signed the Affordable Care Act in 2010, "bridge" programs had already expanded access through such programs as Healthy Families and Healthy Way LA. Many covered by Healthy Families have already been transferred into Medi-Cal. Getting out the word remains a challenge.

    This week, Young & Healthy helped an Altadena family with a 16-year-old son and limited financial resources apply for health coverage.

    The father works as a gardener. The mother, Maria Munoz, babysits a grown daughter's infant during the day. Coping with unexpected medical costs has been difficult.

    "Sometimes I took the rent money to pay the doctor," Munoz recalled. Muir High School referred the family to Young & Healthy, which has an office in a former classroom.

    Munoz was asked to bring tax returns and other financial records for the eligibility review conducted by Sabina Gutierrez, a Public Health employee assigned one afternoon a week to Young & Healthy.

    Munoz gave Gutierrez permission to discuss her situation with NBC4. After a brief interview and review of the documents, Gutierrez reached a conclusion.

    "They qualified for Medi-Cal, so they don't need Covered California," Gutierrez said.

    The new Medi-Cal guidelines set the eligibility ceiling for income at 138 percent of the federal poverty level. For an individual, that works out to $15,586 a year. For a family of three, the ceiling is $26,951. The "shop and compare" page of Covered California's online site will provide a quick answer to whether Medi-Cal is a possible option, based simply on household income, family size, and number of dependents.

    Adding to the rolls of no-cost or low cost Medi-Cal will, of course, increase the program expense. Initially that will be covered by the federal government.

    Downstream, it is expected that reducing the number of uninsured and increasing preventive health care will reduce public health costs, Dr. Walsh said. For the Munoz family, Medi-Cal would have been available -- had they known -- even before the relaxation of eligibility requirements.

    Now Maria Munoz wants other families who have gone without health insurance to look into their options.

    Will health insurance benefit her family?

    "Claro que si!" Of course, she said.

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