WEBINAR TOPIC: CoveredCA.com Tipshbexmail.blob.core.windows.net/eap/02 06 14 Covered California...
Transcript of WEBINAR TOPIC: CoveredCA.com Tipshbexmail.blob.core.windows.net/eap/02 06 14 Covered California...
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• WEBINAR TOPIC: CoveredCA.com Tips
• Auto-Generated Forms for New CECs in
IPAS
• Announcements and Updates
• Upcoming Webinars
• Questions
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• Always select “Yes”
if consumer wants
financial help from
Covered California
or Medi-Cal.
• Only check “No” if
the consumer
definitely does not
want to receive
premium assistance
or Medi-Cal (if
eligible).
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• “Source of application”
& “Document ID” fields
are required fields.
• “In-person” option will
be available soon in
“Source of Application”
drop down list, for now,
please select “Phone.”
• Document ID is for
SCRs to handle faxed
applications. CECs
should to enter “0”.
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• The primary
contact
should
always be
the same
individual as
Household
Member 1 to
avoid any
confusion.
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• When submitting an application
that includes children, always
select ‘Yes’ to the question:
“Does this person want health
insurance? Even if you have
insurance now, you might find
better coverage or lower
costs.”
• The system will not evaluate
the parents’ eligibility for Medi-
Cal if “No” is selected for the
children.
• Even If the children already
have Medi-Cal the consumer
should still select “Yes”
• For previously submitted
applications, only the Service
Center can adjust these
changes in order for new
eligibility to be established.
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• Naturalized
Citizens should
answer “No” to
the question of
whether or not
they are a
naturalized
citizen.
• Note: This
question will be
removed from
the online
application.
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• To be eligible, only one individual on
the application is designated as the
Primary Tax Filer.
• In order to be eligible for tax credits,
the primary must check “Yes” to
“Does this person plan to file taxes
this year?”
• Married couples must choose
“Married Filing Jointly” to get the
expected tax benefit from Covered
California if they are on the same
application.
• The spouse should not be marked
that they are claimed as a dependent.
• Head of household will fail if spouse
is marked married filing jointly, so
both must be marked married filing
jointly to be evaluated in the system
for APTC
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• For children, the
primary tax filer must
be selected as the
primary caretaker of
the child from this
drop down, in order to
qualify the child
through Covered
California or Medi-Cal.
• An error occurs if
there is no phone
number entered in for
the primary caretaker
of a child. If the
primary caretaker
does not have a
phone number, please
enter (999) 999-9999.
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• Select “None of the
above” in “Health Care
Information” page to
qualify for affordable,
minimum standard value
health insurance through
Covered California.
• If the consumer receives
Medicare benefits, they
will not qualify through
this application; they
must go to the county
office to apply.
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• The CEC must enter the
same electronic
signature and electronic
PIN # here that they
used in creating their
CEC account in
CoveredCA.com.
• E-signature & PIN #
must belong to the
person logged in and
accessing the consumer
application.
• CECs are instructed to
use PIN 3742, if the
CEC pin is not accepted.
• After you submit, you
will not be able to go
back and edit any
information on the
application.
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• Note: Once the
application is
submitted, you
cannot currently
go back and
edit the
“Maintain My
Consent”
timeframe that
is selected.
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• After submitting the
attestation page, the
Access Code will be
generated for the
consumer.
• The CEC should give
this code to the
consumer so that they
may be able to access
their information at
another time.
• The access code is only
generated when a CEC
uses the “Add an
Individual” feature, not
when the consumer
delegates to the CEC.
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• The required documents are based on
the information entered in the application.
• Ensure any stated required documents
are uploaded for the primary contact
household.
• Documentation will be asked for each
member of the household, only upload
the documents that are relevant.
• Disregard proof of residency and income
for infants/children, unless related to
citizenship.
• The Covered California Eligibility team
will only process the application if
sufficient details related to primary
household are furnished.
• Consumers have 90 days to submit their
documents. Consumers may mail in
documents and should clearly write their
Application ID on each document.
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• The CEC or the consumer can upload the required documents that are indicated in the
table after clicking ‘Submit Verification’.
• CEC should upload only the required document in the respective section; Do not upload all
documents at once in a single section. This will show the other section as still pending.
• For example – for ‘Proof of California Residency’ – CA Driver License should be uploaded
as a single document in the first section.
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• Consumers have 90 days to upload the required documents after the application is
submitted.
• The consumer will be ‘Contingent Eligible’ based on the information provided in the
application (this is only available during the open enrollment period).
• CECs can always come back to the consumer application and upload the
documents when available, or the consumer may do it on their own.
• To upload required documents click ‘Manage Verifications’ option on the right hand
menu.
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• If you come across a
“Sorry Error” – you
can try to resume your
application from your
CEC Consumer
Dashboard, by clicking
the “Return” button on
the top left hand
corner, and reload the
application.
• If the error persists,
the CEC can try
withdrawing the
application and
starting over using the
“Add New Individual”
link.
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• Consumers requesting delegation to a CEC are not informed if the CEC
declines the request. All CECs intending to decline delegation requests must
contact the consumer directly and inform them to select another CEC.
• Password Reset: a minimum of (8) characters are required for a new
password. The system incorrectly instructs the user that a minimum of (6)
characters are required.
• The Household Members page must be completed and saved before the
progress of the application is saved.
• When in the process of reporting a change, clicking “Cancel All Changes”
does not navigate away from the page. CECs should return to the Home
Page and withdraw all changes by clicking the “Cancel Change” button.
• The “Appeal” button is currently disabled and will be available in a future
release of CalHEERS.
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• New Live Scan and Criminal Disclosure forms can now be auto-generated from IPAS for prospective CECs.
• These new forms are customized for each CEC: they
contain pre-populated fields and other tracking codes for
improved tracking and processing.
• Please be sure to only use these forms for each CEC
they are generated for. Do not share forms between
other CECs.
• Reminder: Only add CECs in IPAS NOT on
CoveredCA.com
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• When all information for a CEC has been completed, a “Download Forms” link will
appear for that CEC on the list of all CECs for your entity.
• The link will not appear unless all information for that CEC has been completed.
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• Click on the links for each form to download the auto-generated forms that
are specific to this CEC.
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• The Live Scan form will
generate with certain
fields already pre-
populated, and barcode
for improved tracking
purposes.
• Be sure to complete the
remaining blank fields
before taking to Live Scan
for fingerprinting.
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• The disclosure form will also
generate with certain fields
already pre-populated.
• Give this form to the CEC to
complete on their own. They
should then mail to the address
stated on the form.
• DO NOT complete, handle, or
mail a completed form for a
CEC. This information is
confidential.
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• Consumers have until February 25th to make their first premium payment for
coverage beginning March 1st.
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Refer consumers to the
CoveredCA.com site for
information about paying.
Information for each plan is
provided at:
https://www.coveredca.com/
getting-covered/how-to-
pay.html
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Local Resource Guides
• CEEs can request copies of the
resource guides through the Print
Shop
• Resource guides will be available
next week
• New CEEs will receive Print Shop
login and password within 2 weeks of
application approval
• Email Print Shop questions to:
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• Covered California has partnered with 27 libraries in the Los Angeles area
to help consumers. o Every Saturday, from now through March 29, 2014, ten (10) libraries branches will host
representatives from Covered California to provide enrollment assistance and education and
explain health insurance options available to consumers and their families through Covered
California health plans.
• Help get the word out.
o Distribute the event flyer - available for download at: http://chilp.it/0b57d2
o Use social media - post event information for the library branch in your neighborhood
o Post on your blog/website – post event information about the enrollment events to help get
the word out
• Covered California’s Executive Director, Peter V. Lee, will be in attendance
at the Panorama City Library this Saturday, February 8 at 10:00 a.m.
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Tell us if you have changes
It is important that consumers let Covered California know of any changes that may affect whether they qualify for health insurance, qualify for another program or qualify to get premium assistance to help pay for health insurance.
What changes should consumers report?
You should let us know within 30 days of the change. Tell us, if:
• You move
• Your citizenship status changes
• You qualify or other health insurance
• Your household size changes because of marriage, divorce, pregnancy, new child
• Your household income changes
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To see how your changes to your income and household size might affect your household’s health insurance coverage, refer to the chart below:
Family
Size Annual Household Income
1 $0- $15,970 $15,971- $17,235 $17,235-$22,980 $22980-$28,725 $28,725 - $45,960
2 $0 - $21,558 $21,559- $23,265 $23,265-$31,020 $31,020-$38,775 $38,775 - $62,040
3 $0 - $27,146 $27,147 - $29,295 $29,295-$39,060 $39,060-$48,825 $48,825 - $78,120
4 $0 - $32,499 $32,500 - $35,325 $35,325-$47,100 $47,100-$58,875 $58,875 - $94,200
5 $0 - $38,047 $38,323 - $41,355 $41,355-$55,140 $55,140-$68,925 $68,925 - $110,280
6 $0 - $43,910 $43,911 - $47,385 $47,385-$63,180 $63,180-$78,975 $78,975 - $126,360
7 $0 - $49,498 $49,499 - $53,415 $53, 415-$71,220 $71,220-$89,025 $87,025 - $142,440
8 $0 - $55,086 $55,087 - $59,445 $59,445-$79,260 $79,260-$99,075 $99,075 - $158,520
To use this chart to decide if you should report changes, follow these instructions:
1. Find the household size that you put on your application.
2. Find the household income range that is closest to the income that you put on your application in that same row.
3. Circle the box.
4. Find your current household size and your current household income in that row.
If the change in your income or household size causes your income to move from one box to another box on this chart, your eligibility may have changed. This means that you should report the changes to Covered California.
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Understanding Covered California Premium Assistance Premium Assistance (Advanced Premium Tax Credits or APTC)
• Individuals and families may be eligible to receive a federal tax credit which can be
paid in advance to lower the cost of monthly plan premiums or claimed during tax
filing process. This includes consumers who:
o do not have affordable or adequate coverage through an employer;
o are not eligible for or enrolled in any other minimum essential coverage; and
o with household incomes between 100% - 400% of the federal poverty level (FPL).
• The APTC is calculated according to income, family size, and rating region, based
on the cost of the second-lowest silver plan available to a consumer.
• Consumers are not obligated to enroll in the second-lowest silver plan; they may
apply premium assistance to any plan available to them and thereby lower the cost
of the premium.
• Generally, consumers that are eligible for or enrolled in minimum essential coverage
are ineligible for premium assistance
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Modified Adjusted Gross Income (MAGI) What is MAGI?
• Modified adjusted gross income (MAGI) is used to calculate eligibility for Covered California financial assistance and for Medi-Cal and CHIP eligibility.
• Eligibility under the Affordable Care Act is calculated by the household MAGI which is governed by IRS, Medicaid and Treasury regulations.
• For most consumers that apply for coverage, MAGI will be equal to their AGI. (Adjusted Gross Income)
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Employer-Sponsored Affordability Test (9.5%)
Affordable Plans and the 9.5% Standard
• A job-based health plan is considered “affordable” if the employee’s share of
premiums for the lowest cost self-only coverage that meets the minimum
value standard is less than 9.5% of their family’s income.
• If your share of your premiums for a plan that covers only you (the
employee)--not your family--is less than 9.5% of your family’s income, the
plan is considered affordable.
• You may pay more than 9.5% of your income on premiums for spouse or
family coverage from your employer.
Affordability is determined only by the amount you’d pay for self-only coverage from your employer.
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Access to Consumer Information After Payment
• CECs are not authorized to have access to case
information once premium payment has been made.
• The payment transaction severs the link between the
CEC and the consumer and applications become
“inactive” on the dashboard until all automated
transactions have taken place and the case is no longer
displayed to CEC at all.
o This is to protect the consumer’s personal information
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Access to Consumer Information After Payment
• If the consumer wants a CEC to have access to their
case information, they must grant access to the CEC by
designating the CEC as an authorized representative.
• If a consumer needs to report a change and wants the
CEC to assist with reporting the change, the consumer
must re-delegate the CEC via the “Find Help Near You”
feature.
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New Fax Line for CEC Disclosure Forms
• CEC candidates may fax disclosure forms to:
(916) 323-3729
• Forms may be mailed to:
Covered CA
ATTN: Disclosure Unit
PO Box 1199
Sacramento, CA 95812
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New Resource • CEE/CEC Assistance Line: 855-324-3147
Monday through Friday, 8am to 5pm.
• You can call the help line for direct assistance with the following:
o Eligibility questions
o Status update on paper applications submitted
o General CoveredCA.com errors
DO NOT SHARE THIS PHONE NUMBER WITH CONSUMERS.
• Consumers should be referred to the Service Center 800-300-1506
45 https://assisters.ccgrantsandassisters.org/
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RESOURCES
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• All Webinars are scheduled for Thursdays 10:00-11:30 am
o February 13, 2014
o February 20, 2014
o February 27, 2014
o March 6, 2014
o March 13, 2014
o March 20, 2014
o March 27, 2014
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QUESTIONS?
All questions for next week’s webinar
should be submitted by COB today.
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Questions Answers Application
When editing an application from your dashboard there is no way
to edit the birth dates, Social Security Numbers, or whether the
person wants subsidies. How does a CEC change this
information on an application?
If the application has not been submitted, you can go back and
remove the page with incorrect information and click the add
member button to re-enter the correct information. If the
application has already been submitted, it will need to be
withdrawn so corrections can be made.
When will it be possible to add or remove a family member
through the Report a Change function? Currently, there is no
radio button for either in the website and the only way to do so
was to call the Service Center.
This feature has always been available. Once you Report a
Change, the buttons are at the bottom of the household member’s
page.
CECs Are CECs supposed to call to follow up on a client's case status?
Clients call us about their case status, about changes in their
income etc. Is that the role of the CEC or do we refer them to the
Service Center?
CEC should be able to look up case information for their clients
up until the time clients pay their premium. After that, the client
would need to re-delegate the CEC for the CEC to assist them
with the reported change. CECs/CEEs may contact the new
CEE/CEC Help Line for assistance with these types of issues at
1-855-324-3147.
What if a CEC who helped a consumer enroll quit their job? How
do consumers follow up with their applications?
They can use the “Manage Delegates” link from their home page
and remove the current CEC and then designate a new one. The
process for this was included on the Webinar presented on
1/30/2013.
Consumers can also call 800-300-1506 to get the current status
of their applications or to request an Access Code so they can
create an account linked to their case
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Questions Answers
Eligibility
A consumer has 2 dependents (nephews not living in US) on
his income tax and makes less than 133% FLP. He doesn’t
qualify because of the 3 people on the household, for Medi-
Cal he does not qualify because dependents are not his
children. Should he only include himself on his Covered
California application?
A consumer that claims dependents, that are qualifying
relatives, may still be eligible for Medi-Cal. This may be
related to a “glitch” in the online application. When submitting
an application with children, always select ‘Yes’ to this
question: “Does this person want health insurance? Even if
you have insurance now, you might find better coverage or
lower costs.” This will enable the system to process the
parents’ eligibility for Medi-Cal too. For previously submitted
applications, only the Service Center can adjust these
changes in order for new eligibility to be established.
What would a Dream Act recipient making less than 100%
FLP qualify for?
Individuals with certain types of DACA status or PRUCOL
status may be eligible for full-scope Medi-Cal. If the
consumer was incorrectly determined ineligible for full-scope
Medi-Cal and instead granted restricted Medi-Cal they
should contact their county eligibility worker and request a
reevaluation and override of their eligibility determination.
For children who claim their parents as their dependents
include the parents in the family size or should parents
continue to file as a separate household?
The parents and their income should be included in the
family size and income. Make sure to clearly indicate the
individual who is the primary tax filer.
If someone is a dependent from a tax return, who should
apply for Covered California? Example: An unemployed
dependent aged 24, should the parent be the primary
applicant or the child?
It depends how they file their taxes. Whoever is the primary
tax filer would be considered “the primary applicant”.
However, the application clearly asks which individual is the
primary tax filer, as there can only be one. Consumers
should indicate that the primary tax filer is the primary
caretaker for the children on the application.
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Questions Answers
Plans
Can a consumer put his girlfriend on their insurance as a
dependent? Is this an "offer of affordable health insurance?"
No, consumers must apply with their tax household. If they
are not married then they must apply separately.
After a consumer enrolls in Covered CA and chooses a plan,
can they change the plan or metal tier? If so, how do they
change the plan? What are the rules for changing your plan?
Consumers may terminate their participation in a plan by
contacting the plan and requesting a termination code. The
consumer must then contact the Covered California Service
Center to provide them with that termination code and date.
There is a discrepancy between the premium quoted during
enrollment and the bill sent to the consumer by the Health
Plan. The consumer called the Health Plan and was told
that they did not qualify for subsidies. Where should the
customers go to appeal or get an explanation? One of them
did get a bill for the lower premium from the Health Plan and
she paid it on time. Then a few day later she got a letter
from Covered California requesting her to send in her proof
of income. On the same day, she also got another bill from
the Health Plan for a much higher bill, which she cannot
afford.
Without having more details about this specific case we
cannot comment on if the bill she received was in error or
not. She should contact the Service Center or the CEC may
contact the CEE/CEC Help Line for a possible explanation of
why she received that bill. If you believe the eligibility
determination to have been made in error in CalHEERS
please direct the consumer to the Covered California
Request for a State Hearing to Appeal an Eligibility
Determination Form located on IPAS.
How to you change your health plan? Consumers may terminate their participation in a plan by
contacting the plan and requesting a termination code. The
consumer must then contact the Covered California Service
Center to provide them with that termination code and date.
Medi-Cal Managed Care members may contact Health Care
Options (see resource guide).
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Questions Answers
Plans
How do you change your metal level? See above.
How often and when can you change your health plan? Covered California Health Plan Consumers may change their
plan only during Open Enrollment. Medi-Cal Managed Care
Members may change their plan throughout the year.
How often and when can you change your metal level? See above.
Immigration
For “Certificate of Citizenship”, what number/id should we use
since is not letting us use the same one as for “Certificate of
Naturalization”.
This question will be removed from the online application. Even
if the consumer is a naturalized citizen please select ‘No’.
When a consumer is a Resident, when asking to upload
verification, there is no option for “Resident Card” or “Green
Card”. Where can we enter this?
You do not need to select the type of document in order to
upload. We are aware that the Green Card is not listed as an
acceptable document. Consumers should still upload this
document for verification or mail it in. This will be added to the
list of acceptable documents in the future. Make sure to upload
one document per section only.
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Questions Answers
Immigration
We have several consumers that are "lawfully present" with
income below poverty level; the system sometimes automatically
assumes Medi-Cal coverage, but these patients are not
Citizens/US Residents. Example: we assisted a 40 y/o woman
with TPS (work permit) making $16,000/year. We processed the
application through Coveredca.com, but now the system shows
her as ineligible. Profile indicates that we need to show "proof of
residency". We verified with our DPSS worker and a person with
just a Work Permit will not qualify for Medi-Cal. What can we do?
We were also told that restricted/emergency Medi-Cal is not
insurance, therefore these consumers might be penalized for not
having qualified coverage.
Lawfully present individuals are eligible for full-scope Medi-Cal
and APTC/CSR with Covered California. If the county determined
eligibility for limited-scope or restricted Medi-Cal because the
consumer has Temporary Protected Status (TPS) or holds only
an Employment Authorization Card (EAD or work visa), the
consumer should contact the County Eligibility Worker and
request a reevaluation of their eligibility and an override. For
Covered California or APTC/CSR determinations, all lawfully
present individuals (including TPS and EAD) need to reside or
intend to reside in California for the entire benefit year and file
taxes for the benefit year (they must select ‘yes’ they will file taxes
for the benefit year). If you are seeing cases where the consumer
is unable to receive full-scope Medi-Cal or APTC/CSR due to
their lawfully present status please email
[email protected] with the case number.
Visa holders' children - these children are lawfully present, as
derivatives of visa parents. However, these children do not have
social security number because obviously they don't work.
CALHEERS doesn't allow people to enroll in health care unless
they do not have social security number, so is there a way to
enroll them and verify their identity through other means?
They may apply for an I-TIN number with the IRS. They may use
this number in lieu of a Social Security Number.
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Questions Answers
Immigration
Employment visa holders (lawfully present) but in Medi-Cal
income bracket: We have encountered a few families that
have work permit and pay taxes, but in Medi-Cal income
range. They are NOT eligible for Medi-Cal because they are
not green card holders. This means they need to purchase
qualified health plans through Covered CA, BUT CALHEERS
system automatically states them as ineligible for qualified
health plan based on their income and sends their application
to Medi-Cal even though they are NOT Medi-Cal eligible. Is
there any way to override these cases so these families can
apply for qualified health plans (QHP)? Rejecting them from
QHP based on their income when they cannot even apply for
Medi-Cal (at most, they can only get restricted-scope that will
only cover emergency services, they cannot receive regular
care) seems quite flawed.
Lawfully present individuals are eligible for full-scope Medi-
Cal and APTC/CSR with Covered California. If the county
determined eligibility for limited-scope or restricted Medi-Cal
because the consumer has Temporary Protected Status
(TPS) or holds only an Employment Authorization Card (EAD
or work visa), the consumer should contact the County
Eligibility Worker and request a reevaluation of their eligibility
and an override. For Covered California or APTC/CSR
determinations, all lawfully present individuals (including TPS
and EAD) need to reside or intend to reside in California for
the entire benefit year and file taxes for the benefit year (they
must select ‘yes’ they will file taxes for the benefit year). If you
are seeing cases where the consumer is unable to receive
full-scope Medi-Cal or APTC/CSR due to their lawfully present
status please email [email protected] with the case
number.
CoveredCA
How does a consumer create an account using the "access
code"?
A consumer does not need an access code to create an
account. If the CEC created the account for the consumer, a
consumer access code is generated at submission of the
application that the consumer will need in order to access
their application on their own. You must give this to the
consumer. If a consumer delegates the application to the CEC
then they will not need an access code.
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Questions Answers
Other
Is a pregnant women counted as 2 people or 1 person? IRS rules do not allow unborn children to be claimed as tax
dependents. Therefore, for purposes of calculating the
Covered California APTC/CSR household size, a pregnant
woman is counted as one person. However, Medi-Cal has
special rules for counting pregnant women that include the
number of babies expected. Thus, a pregnant women
expecting twins could be counted as one person under the
Covered California APTC/CSR rules and as three people
under Medi-Cal rules.
Would you please review the minimum essential coverage? Please refer to the section in this Webinar for a review of
MEC.
Are there going to be Webinars for CECs after March,
2014?
Yes, there will continue to be webinars. The frequency of
the webinars is subject to change.