Ask the Expert: Medi-Cal for Kids and Enhanced Benefit Plans

Question:  Brent, our 5 person family earns $65,000 a year and we qualify for an Enhanced Silver 73 plan, but when I received our confirmation from Covered California it shows that our 3 children are not enrolled in the same Blue Shield PPO plan that my wife and I are enrolled in.  It shows that our kids are enrolled in Medi-Cal.   How do I still get a subsidy and have it so that my kids are not stuck in Medi-Cal and how do we qualify for an Enhanced Silver 87 or 94 plan?

Answer:  This Covered CA Income Guideline chart shows the number of people in the household in the left column and the income on the top.

In order to qualify for a Silver 94 plan, a 5 person household’s income has to be between 138 to 150% of the Federal Poverty Level (FPL), this would be between $38,047 and $41,355.  For the Silver 87 plan, the income would have to be between 150 to 200% of the FPL, which is between $41,335 and $55,140 and for the 73 plan between 200 to 250% of the FPL which is $55,140 and $68,925.

If you look at the very top of the chart in purple it says “MAGI Medi-Cal/CHIP Eligible greater than or equal to 266% no PA”.

What this means is that for children under the age of 19, they are Medi-Cal Eligible for households with incomes up to or equal to 266% of the FPL – with no premium assistance.  This means that in 5 person household, such as yours, the children under 19 automatically go into Medi-Cal Kids for incomes up to $73,336.  This is where you fall at now at $65,000.  So with this income you actually qualify for the Silver 73 plan, but your kids go into Medi-Cal.

The only way to get your kids out of Medi-Cal and still qualify for a subsidy is to have a minimum income of $74,000, but that also bumps you out of the income range for the Enhanced Benefit Plans – 94, 87 and 73.

Here’s you answer: you can’t have it both ways.  You can’t have it is so that your kids are not Medi-Cal eligible and still qualify for an Enhanced Silver 94, 87 or 73, it’s one or the other based on income.

If you really want a deep understanding of how this all works, we have a 45 minute webinar which explains all of this in great detail, you can watch it here.

AUTHOR - Ali Nagy