What Is Medi-Cal Redetermination?

Know More About Medi-Cal Redetermination
 

Medi-Cal Redetermination (also known as Medi-Cal Recertification, Medi-Cal Renewal, or Medi-Cal Unwinding) is the regular eligibility review that each local county office conducts to determine whether beneficiaries still qualify for Medi-Cal or Children’s Health Insurance Plan (CHIP) coverage.  

When Does Medi-Cal Redetermination Happen?

Prior to the COVID-19 Public Health Emergency (PHE), enrollees were typically subject to an annual eligibility renewal process 12 months after their initial enrollment date. However, during the PHE, redeterminations were paused for most beneficiaries, including those enrolled in Medi-Cal or CHIP coverage before the PHE began and those who became eligible for coverage during the PHE. 

 

As states are restarting Medi-Cal Redeterminations on varying dates, your redetermination may occur on a different date than it has in the past. Your local county office will notify you before your annual Medi-Cal Redetermination review.



 

What Are The Rules And Guidelines For Medi-Cal Eligibility?
 

Medi-Cal and CHIP eligibility can vary state to state. Generally, Medi-Cal coverage is available to people with low incomes, including families, children, pregnant women, older people, and those with disabilities. 

 

Typically, Medi-Cal eligibility is based on income for those aged 19–64. Some individuals are exempt from income counting rules, including those whose eligibility is based on disability or age (65 and older).


 

Does Medi-Cal Redetermination Affect You?
 

Since the COVID-19 PHE first began in March 2020, Medi-Cal and CHIP membership grew to nearly 95 million people.1 As the redetermination process resumes in 2023, many may no longer qualify due to changes in age, income, or other factors.  

 

It's important to check your state’s Medi-Cal and CHIP qualifications to know if you are eligible to remain covered. 


 

What Is The Highest Income To Qualify For Medi-Cal Or CHIP?
 

Income guidelines for Medicaid and CHIP vary by state. In most cases, income qualifications depend on the size of the household. Here are some example income limits:

  • $14,580 for Medi-Cal for an individual

  • $50,560 for Medi-Cal for families of up to eight members 

  • $60,000 for CHIP for families of four with children up to age 19

Visit BenefitsCal.com for specific income qualifications based on where you live.

If you earn too much to qualify for Medi-Cal or CHIP, you have coverage options. These can include Medicare, an insurance plan sponsored by your employer, or an Anthem individual or family health insurance plan offered through the Affordable Care Act Health Insurance Marketplace (Marketplace). In fact, some Marketplace plans are available as low as $0 a month.*



Who Decides If You Can Continue Receiving Medi-Cal Or CHIP Coverage?
 

Your local county office will conduct its eligibility review to determine if you qualify for coverage. They may also review your income, as well as existing assets, and take into consideration other factors such as disability, pregnancy, age, and household size when determining eligibility.

 

 

What You Can Do To Renew Medi-Cal Or CHIP Coverage
 

Here are three things you can do to begin preparing for the redetermination process:

  1.  Update your contact information – your local county office may contact you about renewing your coverage, including any steps you need to take. Be sure they have your current mailing address, phone number, and email.
     

  2. Watch the mail –  your local county office will send you a letter about your coverage and the redetermination process. The letter will let you know if you need to take any action and/or provide information to help your state determine if you still qualify for coverage.
     

  3. Complete your renewal form – if you receive a form, fill it out completely and return it to your local county office by the due date provided. This will help prevent a lapse in your coverage. 

Learn more about renewing your Medi-Cal or CHIP coverage 

 

 

What Can You Do If You No Longer Qualify For Medi-Cal Or CHIP?
 

If you no longer qualify for Medi-Cal or CHIP, you’re eligible for a special enrollment period (SEP) to enroll in new healthcare coverage. The length of the SEP may vary based on the type of coverage you’re considering and by state. 

 

During this time, you may consider enrolling in Medicare, a health plan sponsored by your employer or an Individual and Family Marketplace health plan. Marketplace plans cover essential health benefits including prescription drugs, doctor visits, urgent care, and hospital visits.
 

If eligible for a Marketplace plan, you may also qualify for an Advanced Premium Tax Credit (APTC), also known as a subsidy, that will save you money on any Marketplace plan you select. In fact, 9 out of 10 enrollees qualify for a subsidy.2  Individuals who purchase a Marketplace plan may also qualify for cost-sharing reductions (CSRs), which are extra savings that reduce out-of-pocket costs by lowering your deductible, coinsurance or copays, and out-of-pocket maximum.
 

Learn more about cost-sharing reductions 

 


We Can Help You Navigate Your Health Insurance Options
 

Count on our experience and support when you enroll in a health plan. If you’re no longer eligible for Medi-Cal or CHIP, we can help you understand your options to stay covered.

Find The Best Health Plan To Fit Your Needs


Learn which health insurance coverage and benefits you may qualify for today.

Sources

  1. KFF.org. March 2, 2023 As States Prepare to Resume Disenrollments, Medicaid/CHIP Enrollment Will Reach Nearly 95 million in March, and the Pandemic-Era Enrollment Growth of 23 million Accounts for 1 in 4 Enrollees

  2. Anthem Business Intelligence Analysis: 2021 WEM Application data and FPL Distribution, May 2021.

     

Disclaimer
 

Based on federal and/or state exchange requirements and subject to change. HealthKeepers, Inc. are Qualified Health Plan issuers that in certain geographic areas offers some health plans with a $0 or $1 premium option (after subsidy applied) through the Health Insurance Marketplace or your State Exchange. Health plans with a $0 or $1 premium option are not available in all areas and eligibility for these plans is based on federal annual income guidelines. Call us for information because not everyone will qualify. For example, singles earning up to $19,140, and couples earning up to $25,860 may be eligible. Family income eligibility varies based on number of family members.

Find The Best Health Plan To Fit Your Needs


Learn which health insurance coverage and benefits you may qualify for today.

Sources

  1. KFF.org. March 2, 2023 As States Prepare to Resume Disenrollments, Medicaid/CHIP Enrollment Will Reach Nearly 95 million in March, and the Pandemic-Era Enrollment Growth of 23 million Accounts for 1 in 4 Enrollees


  2. Anthem Business Intelligence Analysis: 2021 WEM Application data and FPL Distribution, May 2021.

     

Disclaimer
 

Based on federal and/or state exchange requirements and subject to change. Anthem Blue Cross is a Qualified Health Plan issuer that in certain geographic areas offers some health plans with a $0 premium option (after subsidy applied) through Covered California. Health plans with a $0 premium option are not available in all areas and eligibility for these plans is based on federal annual income guidelines. Call us for information because not everyone will qualify. For example, singles earning up to $19,140, and couples earning up to $25,860, may be eligible. Family income eligibility varies based on number of family members.