Medi-Cal basics for Certified Agents

Throughout the past year of enrolling individuals and families into the Covered California health plans, Certified Insurance Agents were in the dark when it came to Medi-Cal. The Department of Health Care Services held a webinar on July 31^st to review of the essential basics of the Medi-Cal program. Even if you only review the power point slides in the PDF document, youll get a feel for how big the Medi-Cal program is and the variety of programs that your clients might be eligible for.

Department of Health Care Services Medi-Cal Essentials presentation

Agent compensation for Medi-Cal

The big question was, Will Certified Insurance Agents be paid for enrolling individuals and households into Medi-Cal? While the answers from the hosts on the webinar were a little fuzzy, the bottom line is that agents should receive some reimbursement this year. A brief overview of the presentation concluded –

• There is funding to pay agents but additional legislation needs to be passed for complete authorization
• The reimbursement will be $58 per household, regardless of the number of family member enrolled.
• The household or individual must be newly eligible for Medi-Cal and not have been Medi-Cal recipient in the last 12 months.
• There is no payment for mixed family application such as parents with tax credits and children with Medi-Cal.
• Payments are expected to be made through the Covered California from funds provided by the Department of Health Care Services
• Payments begin for approved Medi-Cal applications submitted by agents for July enrollment
• Payment will continue until funds run out
• The Medi-Cal reimbursement program will not be renewed after the funds are exhausted
• There is confusion if only online applications through CalHEERS are eligible for the $58 or also paper applications.
• There will be no reimbursement for Medi-Cal renewals

Viewing the Medi-Cal basics webinar

http://hbex.coveredca.com/agents/webinars/

Select view Medi-Cal Essentials Webinar July 31st 2014

If you open the webinar in Windows Media Player I found the audio to be garbled. When I switched to Adobe Flash Player by clicking on an icon within the Covered California web page, the audio portion greatly improved in quality.

What are the basics of Medi-Cal

The presentation covered the following topics.

• Medi-Cal eligibility
• Simplified application process
• Expanded Medi-Cal income only test
• Additional services such as mental health, substance abuse and adult dental
• Medi-Cal Access for mothers and infant, income and plan qualifications
• Former foster youth eligibility to age 26, self-attest to status
• Managed Care, HMO, versus Fee-For-Service Medi-Cal
• County Organized Health Systems
• Private HMO Medi-Cal plans by county
• Costs per beneficiary for Medi-Cal
• MAGI versus Non-MAGI eligibility determination
• Aged, blind, and disabled Medi-Cal eligibility
• Estate recovery
• Mix Family households
• Residency requirements
• Immigration Status issues and Dream Act or DACA youth.
• Full Scope versus Restricted Scope Medi-Cal
• How reporting windows for changes are smaller than Covered California
• Medicare, Medi-Cal and theAPTC
• Presumptive eligibility for families who have not received a Medi-Cal card for emergency services
• Tips and tricks for the Covered California website to avoid being deemed ineligible for Medi-Cal
• Dual eligible and restricted scope Medi-Cal with Covered California health plan
• If agents will get paid for Medi-Cal enrollments

Counties play an important role in Medi-Cal

Medi-Cal is as big and complicated as Covered California. I wish they would have had this presentation before open enrollment. The one element it lacked was a greater discussion of how Medi-Cal eligible beneficiaries interact with their county social services case worker. These are the folks that really make the determinations if an adult is Medi-Cal eligible. Ive had San Diego County reject an adult applicant after Covered California said the individual was eligible. So there are still some mysteries and questions that werent cleared up by the webinar.