What is Adult Expansion / MAGI
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
Who is Eligible for Adult Expansion Medi-Cal?
You can get Medi-Cal under the new Adult Expansion Medi-Cal program
– You are between the ages of 19 and 64;
– Your MAGI income is below 138% federal poverty level (FPL);
– 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%?
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.
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.
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
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-
– Your local legal services organization. The Health Consumer
Alliance lists these organizations at
We want to hear from you! Please complete the following survey about
our publications and let us know how we are doing!
Disability Rights California is funded by a variety of sources, for a
complete list of funders, go to http://www.disabilityrightsca.org/
i The National Senior Citizens Law Center has written a helpful issue brief
on Medicaid expansion in California, which addresses income eligibility.
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
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”
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”
etters/APL2013/APL13-021.pdf. “Return to Main Document”
“Return to Main Document”