What is Adult Expansion / MAGI
Medi-Cal?
May 2016, Pub. #5551.01
The Affordable Care Act (ACA) (also knownas Obamacare) has
increased the number of people who can get Medicaid (Medi-Cal in
California). “Adult Expansion Medi-Cal” or Medi-Cal for “childless adults”
is part of what is now being called “MAGI” Medi-Cal under the ACA.
“MAGI” Medi-Cal means any Medi-Cal program that uses MAGI
(modified adjusted gross income) to determine financial eligibility for
Medi-Cal.
Who is Eligible for Adult Expansion Medi-Cal?
You can get Medi-Cal under the new Adult Expansion Medi-Cal program
if:
– You are between the ages of 19 and 64;
– Your MAGI income is below 138% federal poverty level (FPL);
i
– You are not pregnant;
– You do not get Medicare;
– You do not have Medi-Cal without a Share of Cost already.
How do I know if my MAGI income is below 138%?
ii
You don’t have to figure it out yourself. You can file a “single
streamlined application” for MAGI Medi-Cal through Covered California,
the county Medi-Cal office, or a number of other places. You can file the
single streamlined application online on the Covered California website.
If you file for benefits on the county Medi-Cal website, it will redirect you
to the Covered California website so you can apply for MAGI Medi-Cal.
Page 2 of 4
Are there rules about how much money or property I can
have and still get Adult Expansion Medi-Cal?
Yes, but they are different from pre-ACA Medi-Cal. Pre-ACA Medi-Cal
has very strict limits on how much income and how many assets you can
have. MAGI Medi-Cal uses a different way to calculate income, and
allows a single person to have up to $16,242 year of MAGI income.
That’s 138% of the federal poverty level. However, under MAGI MediCal,
there are no income exclusions or deductions other than a few
deductions used to determine the amount of your MAGI. And, unlike
pre-ACA Medi-Cal there is no asset test for MAGI Medi-Cal.iii This
means you can have more than the $2,000 per person/3,000 per couple
resource limits of pre-ACA Medi-Cal.iv
What if I have a Medi-Cal Share of Cost Now? Can I switch
to Adult Expansion Medi-Cal?
Yes. You can contact your local County Medi-Cal office and ask them to
check whether you are now eligible for MAGI Medi-Cal with no share of
cost. The County will also check if you are eligible for MAGI Medi-Cal at
your annual redetermination. The county will give you MAGI Medi-Cal if
you are eligible for it.
What Services can I Get with Adult Expansion Medi-Cal?
You can get all of the services available under regular Medi-Cal,
including nursing facility, In Home Supportive Services (IHSS), and other
long-term care services, without an asset test.
v
In addition, you can get
substance use and mental health services from Medi-Cal managed care
plans and from county mental health/behavioral health.
vi If you want
home and community-based waiver services (HCBS) you can apply for
pre-ACA Medi-Cal through the county Medi-Cal office. You can do this
by filling out a SAWS 2 Plus form.
vii
What Resources Are Available if I Have More Questions?
At the bottom of this document, we have listed Internet resources that
may be helpful to do further research. In addition, your county Medi-Cal
agency, http://www.dhcs.ca.gov/services/medical/Pages/CountyOffices.aspx,
and Covered California,
www.coveredca.com, 1-800-300-1506, can answer questions.
Page 3 of 4
The following organizations can help with advocacy:
– Disability Rights California, www.disabilityrightsca.org, 10800-
776-5746, or
– Your local legal services organization. The Health Consumer
Alliance lists these organizations at
http://healthconsumer.org/index.php?id=partners.
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i The National Senior Citizens Law Center has written a helpful issue brief
on Medicaid expansion in California, which addresses income eligibility.
See http://nsclcarchives.org/wp-content/uploads/2013/11/1CA-EligibilityBrief-4.pdf:
the “MAGI formula does not count certain income including, for
example, Veterans’ benefits, child support received, and scholarships,
grants, and awards used for education purposes. Expansion Medi-Cal will
also allow other income deductions that are not permitted under traditional
Medi-Cal income calculations, including for example, alimony paid and pretax
contributions for expenses such as child care or retirement (although,
conversely, it will not allow the usual A&D FPL deductions for health
insurance premiums.” The U.C. Berkeley Labor Center has a one-page
fact sheet with a simple explanation about how to calculate MAGI. It is
available here:
http://laborcenter.berkeley.edu/healthcare/MAGI_summary13.pdf. “Return
to Main Document”
ii For more information on MAGI, see the National Health Law Program’s
“Advocate’s Guide to MAGI,” available at
http://www.healthlaw.org/publications/agmagi “Return to Main Document”
Page 4 of 4
iii Pre-ACA Medi-Cal asks for information about your assets, and if you
have too many, you will not be eligible for Medi-Cal. Under MAGI Medi-Cal
you are not subject to this asset test. “Return to Main Document”
iv http://nsclcarchives.org/wp-content/uploads/2013/11/1CA-Eligibility-Brief-
4.pdf “Return to Main Document”
v California has notified counties that MAGI expansion adults who need
nursing facility services can receive them under MAGI eligibility with no
asset test: http://www.dhcs.ca.gov/services/medical/eligibility/Documents/MEDIL2014/MEDILI14-06.pdf.
California has also
notified counties that MAGI expansion adults are eligible for community
LTSS services as well: http://www.dhcs.ca.gov/services/medical/eligibility/Documents/MEDIL2014/MEDILI14-11.pdf.
Although there is
no disability determination for MAGI Medi-Cal, you must meet medical
necessity standards for LTSS services. “Return to Main Document”
vi See,
http://www.dhcs.ca.gov/formsandpubs/laws/Documents/Pending%20SPA%
2013-038%20not%20ADA.pdf;
http://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyL
etters/APL2013/APL13-021.pdf. “Return to Main Document”
vii http://www.cdss.ca.gov/cdssweb/entres/forms/English/SAWS2PLUS.pdf
“Return to Main Document”