Ch 5-Coverage Groups

Question 1

Magi is the second category on the hierarchy of evolution of Medi-Cal, and obtains its own order of evaluation. What is the order of evaluation?

Answer 1

Order of evaluation:
1.infants and children
2. Parent caretaker relative.
3. Pregnant women-must be pregnant at time of application.
4. Adult group also known as the expansion group.
5. Optimal targeted low income child.(OTLIC)
6. MCAP.-administered by MAXIMUS.

Question 2

How would you use the MAGI trolley line?

Answer 2

You would use it to look at the order of evaluation under the MAGI Medi-Cal program and to see what the applicant would be possible would possibly be eligible for:

Stop #1-would be infants and children groups zero through 18
Stop #2-parents caregivers relative no age limit
Stop #3-pregnant women who are pregnant at time of application
Stop #4-new adult group 19 to 64 year olds
Stop #5-optimal targeted low income children (OTLIC) (0 -18)

Question 3

Why are aid codes important for Medi-Cal?

Answer 3

The Aid Codes tell how to be billed

Question 4

How do you use the desk aids?

Answer 4

Look at the desk aids and they will show that adults between the ages of 21 to 64. Have to be at or below 139% FPL.

Children 0 to 18 years must be at or below 266% FPL

Question 5

What is a rule for 19 to 20 year olds?

Answer 5

19 and 20 year olds are considered a child, if enrolled in higher education

Question 6

What is MCAP?

Answer 6

It is a safety net for pregnant women who are at the cost of eligibility to lock them down to their benefits

Question 7

What is the number one ranking in the hierarchy?

Answer 7

Mega mandatory; look at desk aids

Question 8

What does the amount of countable income do to a MAGI household?

Answer 8

The countable income will determine the MAGI codes that will be used to determine what the benefits will be for HH.
Example pregnant women are now eligible to full scope benefits, regardless of income, citizenship, or immigration status

Question 9

Where are aid codes generated?

Answer 9

They are generated in see a LWIN and transmitted to MADS when the case is authorized

Question 10

What is MEDS used for?

Answer 10

MEDS is used by doctors and pharmacies to check the healthcare insurance for billing purposes

Question 11

What two types of categories of coverage for children?

Answer 11

Infant and children has no monthly premiums and covers children from 0 until they turn 19.

OTLIC may have monthly premiums and covers children age 0 until they turn 19

Question 12

What type of coverage with infants have?

Answer 12

Infants will have coverage from 0 to 266% FPL with no premiums

Question 13

What coverage will children from 1 to 5 have?

Answer 13

They will have no premiums from 0-160% FPL
Have premiums 161 -266% F p.m.

Question 14

What coverage with children 6 to 18 years of age have?

Answer 14

No premiums 0 to 160% FPL
Will have premiums 161-266%FPL

Question 15

What does the parent care taker relative group look like for coverage?

Answer 15

There is no age limit.
Children must live with them.
If ineligible to new adult group for non-financial reasons,
65+ Medicare child without MEC,
They will have restricted scope if undocumented non-citizen, not pregnant between the ages of 26 and 49.

Question 16

What coverage would pregnant women get?

Answer 16

They must be pregnant at application .
Pregnant women will get full scope and postpartum benefit coverage through 12 month postpartum. Regardless of changes in income citizenship or immigration status also
Unborn will be counted in the MA, G.I. household size

Question 17

What group will pregnant women in their third trimester with no children be evaluated in?

Answer 17

They will be evaluated under the parent/caregiver relative group

Question 18

Is a household allowed to request for Medi-Cal only for children not just the whole household?

Answer 18

Yes, Medi-Cal allows an option for household request health coverage for children only unlike calfresh where the whole house has to be covered.

Question 19

Here are a few rules for Medi-Cal:

Answer 19

No Medicare
Not pregnant at application
Parents applying with children at home must also apply for them unless they already have MEC

Question 20

What are aid codes for adults?

Answer 20

Adults age 19-64=0-138% FPL =M1 (full scope)
Non-citizens adults, 26 to 49 =M2 (restricted)
Adults, age 19 to 25 and 50 to 64 without SIS are eligible for full scope benefits : M1 (fullscope)

Question 21

What indicators are there for adults with disability?

Answer 21

0-128% FPL
L6 (full scope)
L7 (restricted)

Question 22

What is the transfer station?

Answer 22

Depending on eligibility factors, they may be eligible for a NON-MAGI evaluation or a health plan through CoveredCA if they are unable to meet any of the trolley stop factors

Question 23

What is one of the first steps in determining eligibility for a household?

Answer 23

The household composition must first be determined for eligibility

Question 24

What IRS rules are looked at when determining household composition?

Answer 24

Single
Married, filing, jointly
Married filing separately
Head of household
Qualifying widow, with dependent child

Question 25

What is a tax filer?

Answer 25

Whether filing together or separate for married couples each spouse is considered a tax filer when you count you count tax filer + spouse + dependents

Question 26

What is a dependent?

Answer 26

A dependent is a person being claimed by the tax filer

Question 27

What is a non-filer?

Answer 27

A non-filer is a person who does not file taxes and certain dependents who meet an exception.

Question 28

What are the three exceptions?

Answer 28

1. The tax dependent is not a child or a spouse of the tax filer.
2. Common children under 19 or under 21. If a full-time student living with both parents and parents do not expect to file a joint tax return.
   3, children under 19 or under 21 if a full-time student claimed as a tax dependent by the non-custodial parent

Question 29

How should a tax dependent be treated if they meet one of these exceptions?

Answer 29

If a tax dependent meets any of these exceptions, they are to be treated as a non-tax filer

Question 30

How are married couples counted in their Medi-Cal household?

Answer 30

Married couples, living together, are always in each others medical household, regardless of how they file be at either joint, filing or separate filing