Issue link: https://digital.copcomm.com/i/398224
The People's Guide 2013-2014 44 Medi-Cal 3. Share of Cost if you are under 65, not blind, not disabled To find out your monthly Share of Cost, start with your gross monthly income. Include spouse or parent income, but not other people living in your house. Then subtract the need level for your family size on the chart on page 40. The balance is your monthly Share of Cost. The way share of cost is calculated will change in 2014. For more information contact Legal Aid (Pg. 68) 4. Share of Cost if you are over 65, blind or disabled To find out your monthly Share of Cost, start by adding your earned and unearned income, and subtract $20. Then subtract the need level amount for your family size in the chart on page 40. The way share of cost is calculated will change in 2014. For more information contact Legal Aid (Pg. 68) RESOURCE LIMIT The resource limit does not apply to pregnant women for care related to their pregnancy, or to children under 19 in cer- tain Medi-Cal programs. For anyone else, your family's resources must be below the following limits to get Medi-Cal: # in Family Resource Limit 1 $2,000 2 $3,000 3 $3,150 4 $3,300 5 $3,450 6 $3,600 7 $3,750 8 $3,900 9 $4,050 10 or more $4,200 The home you live in, furnishings, personal items, and some non-term life insurance policies don't count. For some Medi-Cal programs one car does not count, and for some programs a car is not counted if its value is under $4,650. If you are caring for children under 19 and apply for free Medi-Cal not based on a disability, the resource limit for 1 or 2 persons is $3,000. A car doesn't count if it is worth less than $4,650 or if it is worth under $1,500 after deducting what you still owe on it and the costs of repair and damage. There are exemptions for vehicles used as part of employment and for transporting a family member with a disability. In 2014 some adults who are not disabled will be able to get Medi-Cal without a resource limit. STAYING ON MEDI-CAL 1. Once a Year Eligibility Form People receiving Medi-Cal get a form in the mail every 12 months that needs to be completed to redetermine eligibility. 2. Mid-Year Status Report for Adults Adults now must also fill out a new form – the Mid-Year Status Report (MSR) – in order to keep Medi-Cal. Some groups of people do not have to fill our the MSR: a child under 21; the parent or guardian of a CalWORKS child; Seniors and People with Disabilities; pregnant women (if they already reported the pregnancy), or a woman in the Breast and Cervical Cancer Treatment Program. The report should come about five months after you start getting Medi-Cal and must be returned to the Medi-Cal office by the date on the form. SHARE OF COST Some people must pay, or agree to pay, a "Share of Cost" for each month that they have a medical expense. Medi-Cal will then pay the rest of the bill for covered services that month. You do not have a Share of Cost if: • You are in one of the groups listed above that receive free Medi-Cal (such as those getting CalWORKs, SSI, foster care, adoption assistance, 1931(b) Medi-Cal, or the Aged and Disabled programs) • Your countable income is below the limit in the chart on page 40. If you have Medi-Cal with a Share of Cost, your Share of Cost starts over every month. You don't have to pay anything in months that you have no medical expense. You can use your past medical bills and the medical bills of family members listed on your application to meet your Share of Cost, including unpaid bills that they are trying to collect from you. You cannot count the same billed item or service twice, but you can carry the balance of an unpaid bill over to later months if a bill is for more than your Share of Cost. If your income goes down, tell your worker so that your "Share of Cost" will go down. 1. Share of Cost for pregnant women Any pregnant woman applying for Medi-Cal who is told she will have a share of cost should consider the Access for Infants and Mothers (AIM) program (call 800- 433-2611). In Medi-Cal, an increase in income is not counted toward a Share of Cost during pregnancy and up to 60 days after the birth. 2. Share of Cost for children Children whose family income is too high for free Medi-Cal can get Medi-Cal with a Share of Cost. An increase in income is not counted toward a share of cost for children up to age 19 who are on no-cost Medi-Cal until their next scheduled annual redetermination. So, even if the child's parents start making more money and the parents have to start immediately paying a Share of Cost as a result, the child still receives Medi-Cal for free for a while. Share of Cost for children As of January 1, 2013 children from birth to age 19 can get free Medi-Cal up to 250% of the Federal Poverty Level. Children whose family income is between 151% and 250% of the Federal Poverty Level have to pay a monthly premium for their Medi-Cal. The premium is $13 per child with a maximum of $39 per family. 0-150% FPL No Premium 151-250% FPL $13 Premium Family Size Monthly Income Limit Family Size Monthly Income Limit 1 $1,437 1 $2,394 2 $1,939 2 $3,232 3 $2,442 3 $4,069 4 $2,944 4 $4,907 5 $3,447 5 $5,744 6 $3, 949* 6 $6,582** *add $503 for each add. family member **add $838 for each add. family member