Nursing Facilities

Nursing Facility Services are provided by Medicaid certified nursing homes, which primarily provide three types of services:

• Skilled nursing or medical care and related services;
• Rehabilitation needed due to injury, disability, or illness;
• Long term care —health-related care and services (above the level of room and board) not available in the community, needed regularly due to a mental or physical condition.

A Nursing Facility is one of many settings for long term care, including or other services and supports outside of an institution, provided by Medicaid or other state agencies.

Where Nursing Facility Services are provided

Medicaid coverage of Nursing Facility Services is available only for services provided in a nursing home licensed and certified by the state survey agency as a Medicaid Nursing Facility (NF). See NF survey and certification requirements. Medicaid Nursing Facility Services are available only when other payment options are unavailable and the individual is eligible for the Medicaid program.

In many cases it is not necessary to transfer to another nursing home when payment source changes to Medicaid NF. Many nursing homes are also certified as a Medicare skilled nursing facility (SNF), and most accept long term care insurance and private payment. For example, commonly an individual will enter a Medicare Skilled Nursing Facility (SNF) following a hospitalization that qualifies him or her for a limited period of SNF services. If nursing home services are still required after the period of SNF coverage, the individual may pay privately, and use any long term care insurance they may have. If the individual exhausts assets and is eligible for Medicaid, and the nursing home is also a Medicaid certified nursing facility, the individual may continue to reside in the nursing home under the Medicaid NF benefit. If the nursing home is not Medicaid certified, he or she would have to transfer to a NF in order to be covered by the Medicaid Nursing Facility benefit.

Who may receive Nursing Facility Services

Nursing facility services for are required to be provided by state Medicaid programs for individuals age 21 or older who need them. States may not limit access to the service, or make it subject to waiting lists, as they may for HCBS. Therefore in some cases NF services may be more immediately available than other long term care options. NF residents and their families should investigate other long-term care options in order to transition back to the community as quickly as possible.

Need for nursing facility services is defined by states, all of whom have established NF level of care criteria. State level of care requirements must provide access to individuals who meet the coverage criteria defined in Federal law and regulation. Individuals with serious mental illness or intellectual disability must also be evaluated by the state's PASRR program to determine if NF admission is needed and appropriate.

Nursing Facility Services for individuals under age 21 is a separate Medicaid service, optional for states to provide. However all states provide the service, and in practice there is no distinction between the services.

In some states individuals applying for NF residence may be eligible for Medicaid under higher eligibility limits used for residents of an institution. See your state Medicaid agency for more information.

Services included in the NF Benefit

A NF participating in Medicaid must provide, or arrange for, nursing or related services and specialized rehabilitative services to attain or maintain the highest practicable physical, mental, and psychosocial well being of each resident.
There is no exhaustive list of services a NF must provide, in that unique resident needs may require particular care or services in order to reach the highest practicable level of well being. The services needed to attain this level of well-being are established in the individual's plan of care.

Specific to each state, the general or usual responsibilities of the NF are shaped by the definition of NF service in the state's Medicaid State plan, which may also specify certain types of limitations to each service. States may also devise levels of service or payment methodologies by acuity or specialization of the nursing facilities.

Federal requirements specify that each NF must provide, (and residents may not be charged for), at least:

• Nursing and related services
• Specialized rehabilitative services (treatment and services required by residents with mental illness or intellectual disability, not provided or arranged for by the state)
• Medically-related social services
• Pharmaceutical services (with assurance of accurate acquiring, receiving, dispensing, and administering of drugs and biologicals)
• Dietary services individualized to the needs of each resident
• Professionally directed program of activities to meet the interests and needs for well being of each resident
• Emergency dental services (and routine dental services to the extent covered under the state plan)
• Room and bed maintenance services
• Routine personal hygiene items and services

Residents may be charged for:

• Private room, unless medically needed
• Specially prepared food, beyond that generally prepared by the facility
• Telephone, television, radio
• Personal comfort items including tobacco products and confections
• Cosmetic and grooming items and services in excess of those included in the basic service
• Personal clothing
• Personal reading materials
• Gifts purchased on behalf of a resident
• Flowers and plants
• Social events and activities beyond the activity program
• Special care services not included in the facility's Medicaid payment

Additional information

This summary is for general information. Specific requirements for Medicaid nursing facilities may be found primarily in law at section 1919 of the Social Security Act, in regulation primarily at 42 CFR 483 subpart B, and in formal CMS guidance documents. Also see:

Nursing Home Compare
How to choose a Nursing Home
Hospital Discharge Checklist

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Wills, Estates, and Probate

California Courts

Losing a loved one is a sad and difficult time for family, relatives, and friends. In addition, those left behind must often figure out how to transfer or inherit property from the person who has died.

To do this, you must usually go to court. And dealing with the courts and the property of someone who has died is very complicated. Sometimes, however, family or relatives may be able to transfer property from someone who has died without going to court. But it is not always easy to tell whether you need to go to court or qualify to use a different procedure.

This section will give you some general information to help you understand what your choices may be, but we still encourage you to talk to a lawyer to get specific answers about your situation. You can usually pay the lawyer’s fees from the property in the case.

To find a lawyer, click for help finding your bar association's lawyer referral service or call 1-866-442-2529.

If you want information about a probate guardianship case, visit our Guardianship section.

What Is “Probate”?

Probate means that there is a court case that deals with:

• Transferring the property of someone who has died to the heirs or beneficiaries;
• Deciding if a will is valid; and
• Taking care of the financial responsibilities of the person who died.

In a probate case, an executor (if there is a will) or an administrator (if there is no will) is appointed by the court as personal representative to collect the assets, pay the debts and expenses, and then distribute the remainder of the estate to the beneficiaries (those who have the legal right to inherit), all under the supervision of the court. The entire case can take between 9 months to 1 ½ years, maybe even longer.

Deciding If You Need to Go to Probate Court and Whether You Can Use Simplified Procedures

You may or may not need to go to probate court to obtain title to property belonging to a dead person. Figuring out if you have to go to probate court depends on many issues, like the amount of money involved, the type of property involved, and who is claiming the property.

And deciding if probate court is needed may also depend on the how the property is owned (the type of title ownership) or if there is some type of contract with beneficiaries. For example:

• Type of Title Ownership: Sometimes all or some of a dead person’s property passes directly to the beneficiaries because of how the property is owned. So if the property was owned in joint tenancy, if it was community property with the right of survivorship, if it was a bank account owned by several people, or a bank account that is transferred to someone when the owner dies, then, in general, when the owner of the property dies, the property goes to the survivor. Keep in mind that even in these cases, the survivor may have to take legal steps to clarify his or her ownership of the transferred property.
• Type of Contract: Sometimes all or some of a dead person’s property does not need to go through probate to pass to the beneficiaries. This is because this property is a type of contract with named beneficiaries. Examples of this are life insurance that pays benefits to someone else other than the dead person’s estate, retirement benefits, death benefits, and trusts.

If the Person Who Died Left $150,000 or LESS

If you have the legal right to inherit personal property, like money in a bank account or stocks, and the estate is worth $150,000 or less, you may NOT have to go to court. There is a simplified process you can use to transfer the property to your name. The value of the property is based on what it was worth on the date of death —not on what the property is worth now.

Keep in mind, this process CANNOT be used for real property, like a house. If the person left $150,000 or less in real property, including some personal property, you may be able to use a form called Petition to Determine Succession to Real Property (Estates $150,000 or Less) (Form DE-310). You will have to file the Petition with the court, obtain and file an Inventory and Appraisal (Form DE-160), and provide notice of hearing. Talk to a lawyer to make sure you can use this simplified process in your case. Click for help finding a lawyer.

To use the simplified process for transferring personal property

First, figure out if the value of the property (the estate) is worth $150,000 or less. To do this:

Include:

• All real and personal property.
• All life insurance or retirement benefits that will be paid to the estate (but not any insurance or retirement benefits designated to be paid to some other person).

Do not include:

• Cars, boats or mobile homes.
• Real property outside of California.
• Property held in trust, including a living trust.
• Real or personal property that the person who died owned with someone else (joint tenancy).
• Property (community, quasi-community, or separate) that passed directly to the surviving spouse or domestic partner.
• Life insurance, death benefits or other assets not subject to probate that pass directly to the beneficiaries.
• Unpaid salary or other compensation up to $5,000 owed to the person who died.
• The debts or mortgages of the person who died. (You are not allowed to subtract the debts of the person who died.)
• Bank accounts that are owned by multiple persons, including the person who died.

For a complete list, see California Probate Code section 13050.

If the total value of these assets is $150,000 or less and 40 days have passed since the death, you can transfer personal property by writing an affidavit. There is a special form for this that you can get from most banks and lawyers. Your court’s self-help center may also have this form or a sample you can use to guide you.

Click for more information on the affidavit and for help preparing your own form.

If You Were Married to or Were a Registered Domestic Partner of the Person Who Died

You may be able to use a simple form, called a Spousal or Domestic Partner Property Petition (Form DE-221) to get a court order that says:

• What your share of the community property is; and
• What part of your deceased spouse or partner’s share of community and separate property belongs to you.

If the surviving spouse/partner is legally entitled to all of the property, a more complicated probate procedure may not be required. For example, a couple that was married for decades may only own “community property,” which belongs to the surviving spouse/partner and is confirmed by the court in the spousal property petition case.

If the Person Who Died Left MORE Than $150,000

If the dead person’s property is worth more than $150,000, none of the exceptions apply. You must go to court and start a probate case.

To do this, you must file a Petition for Probate (Form DE-111). This one form has different options, such as:

• Petition for Probate of Will and for Letters Testamentary
• Petition for Letters of Administration

Talk to a lawyer if you are not sure which option you should choose on this form. Click for help finding a lawyer.

Steps to Take If the Case Belongs in Probate Court

1. The custodian of the will (the person who has the will at the time of the person’s death) MUST, within 30 days of the person’s death:

• Take the original will to the probate court clerk’s office within 30 days. Contact your superior court courthouse to find out where the probate court clerk’s office is located.
• Send a copy of the will to the executor (if the executor cannot be found, then the will can be sent to a person named in the will as a beneficiary).

If the custodian does not do these things, he or she can be sued for damages caused.

NOTE: If there is no will and a court case is needed, the court will appoint an administrator to manage the estate during the probate process. The person who wants to be the administrator must file a Petition for Letters of Administration (Form DE-111). The administrator usually is the spouse, domestic partner, or close relative of the dead person.

2. Someone, called "the petitioner," must start a case in court by filing a Petition for Probate (Form DE-111). The case must be filed in the county where the person who died lived (or if the person lived outside of California, in the California county where that person owned property).

The Petition for Probate has different options, like:

• Petition for Probate of Will and for Letters Testamentary
• Petition for Probate of Will and for Letters of Administration with Will Annexed
• Petition for Letters of Administration

Note: To start a probate case you will need more forms than just the Petition for Probate form. Talk to a lawyer for help with your case. Click for help finding a lawyer.

3. After a probate case is filed:

• The probate clerk sets a hearing date.
• The petitioner must give notice of the hearing to anyone who may have the right to get some part of the estate, plus the surviving family members even if there is a will and they are not named in it. Any person who is interested in the court case may file a Request for Special Notice (Form DE-154), which means that they must receive a copy of paperwork filed by the person who is chosen to manage the estate.
• The petitioner CANNOT mail the notice. It must be mailed by any other adult who is not a party to the case.
• The petitioner must arrange for notice to be published in a newspaper of general circulation.
• A court probate examiner reviews the case before the hearing to see if it was done correctly.
• Once all the paperwork has been reviewed by the examiner and corrected, if necessary, the judge decides who to appoint to be in charge as the personal representative of the estate (also called the “administrator” or “executor”).
• The personal representative gathers up the assets and prepares an Inventory and Appraisal (Form DE-160) to be filed. The personal representative usually will also need to contact a probate referee to value the nonmonetary assets. Find the contact information for a probate feferee in your county. (Get more information on probate referees.)
• The personal representative provides formal notice to creditors with the Notice of Administration to Creditors (Form DE-157) and pays the debts.
• A final personal income tax return is prepared for the person who died.
• The probate court figures out who gets what property.
• A Report of Sale and Petition for Order Confirming Sale of Real Property (Form DE-260) is filed with the court so that sales of real property are confirmed by the court.
• If the estate earned any money (such as interest or profit in a sale), the personal representative will have to submit a final estate tax return.
• The personal representative reports to the court on how the estate was handled. This report is a final plan and accounting. The report is scheduled for hearing so the judge can review how the personal representative handled everything. The judge needs to be satisfied that everything has been properly taken care of.
• After filing with the court any required final receipts to show that everyone received their property from the estate, the court discharges the personal representative from his or her duties.

More Information on Wills, Probate, Trusts, and Estates

Do I Need Estate Planning?

A State Bar of California pamphlet.

Do I Need a Living Trust?

A State Bar of California pamphlet.

Do I Need a Will?

A State Bar of California pamphlet.

DMV: Transfer a vehicle without probate

Information from the Department of Motor Vehicles' website. Scroll down to the section called "Transferring Ownership" and then to "Transfer Without Probate."

DMV: Affidavit for Transfer Without Probate

Department of Motor Vehicles' form.

California Public Law Libraries

This website provides extensive online self-help information, listing of county law libraries, AskNow law librarian service, mini-research classes, general research, and links to more resources. Talk with a lawyer to understand how law affects you and your rights. Click for help fnding a lawyer.

Sacramento County Public Law Library Legal Resource Guide

This site has a list of books on wills, probate, trusts, and estates and other topics. Click on the topic that interests you for more information.

San Francisco Law Library's Research Guide

This site has a list of books on wills, probate, trusts, and estates. Click to find a book on this list.

Statutory Will Form

This site includes the statutory will form, instructions, commentary, and questions and answers about the form. Created by the State Bar of California.

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Medicare 2017 costs at a glance

Listed below are basic costs for people with Medicare. If you want to see and compare costs for specific health care plans, visit the Medicare Plan Finder.

For specific cost information (like whether you've met your deductible, how much you'll pay for an item or service you got, or the status of a claim), visit MyMedicare.gov.

Find out if Medicare covers a specific test, item or service that's not listed under the detailed Medicare cost information section of this page.

2017 costs at a glance
Part A premium	Most people don't pay a monthly premium for Part A (sometimes called "premium-free Part A"). If you buy Part A, you'll pay up to $413 each month. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $413. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $227.
Part A hospital inpatient deductible and coinsurance	You pay:  $1,316 deductible for each benefit period Days 1-60: $0 coinsurance for each benefit period Days 61-90: $329 coinsurance per day of each benefit period Days 91 and beyond: $658 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime) Beyond lifetime reserve days: all costs
Part B premium	The standard Part B premium amount is $134 (or higher depending on your income). However, most people who get Social Security benefits will pay less than this amount ($109 on average).
Part B deductible and coinsurance	$183 per year. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment.
Part C premium	The Part C monthly premium varies by plan. Compare costs for specific Part C plans.
Part D premium	The Part D monthly premium varies by plan (higher-income consumers may pay more). Compare costs for specific Part D plans.

Detailed Medicare cost information for 2017

Medicare Part A (Hospital Insurance)
Medicare Part B (Medical Insurance)
Medicare Part C (Medicare Advantage)
Medicare Part D (Medicare prescription drug coverage)

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Medi-Cal Benefits

Medi-Cal

Medi-Cal provides a core set of health benefits, including doctor visits, hospital care, immunization, pregnancy-related services and nursing home care. The Affordable Care Act ensures that all Medi-Cal health plans offer what is known as “essential health benefits." These 10 comprehensive services include the following categories:

• Outpatient (ambulatory) services.
• Emergency services.
• Hospitalization.
• Maternity and newborn care.
• Mental health and substance use disorder services, including behavioral health treatment.
• Prescription drugs.
• Programs such as physical and occupational therapy (known as rehabilitative and habilitative services) and devices.
• Laboratory services.
• Preventive and wellness services and chronic disease management.
• Children’s services, including oral and vision care.

Take a look at the Medi-Cal health benefits chart to learn more about the services in each category. For a definition of any of the terms used, please browse the Covered California online glossary or the glossary at the federal site HealthCare.gov.

Dental Benefits

Medi-Cal also provides dental benefits for adults and children.

You can find a Medi-Cal dentist through the Denti-Cal search engine.

For information on children’s dental services, visit the Denti-Cal website.

• The following dental benefits are available for adults:
• Exams and X-rays.
• Cleanings.
• Fluoride treatments.
• Fillings.
• Anterior root canals (front teeth).
• Prefabricated crowns.
• Full dentures.
• Other medically necessary dental services.

Learn more about dental benefits and get further clarification by calling (800) 322-6384 or visiting Denti-Cal.

Vision Benefits

Vision benefits are covered for those with full-scope Medi-Cal benefits. For information about Medi-Cal eligibility, individuals can contact their county human services agency. Vision benefits are described below.

Routine Eye Exam Once Every 24 Months

• All Medi-Cal members are eligible for a routine eye exam, which checks the health of the eyes and tests for an eyeglass prescription.
• Only members under 21 years old and residents of a nursing home receive coverage for eyeglasses (frames and lenses).

Other Services

• Contact lens testing may be covered if the use of eyeglasses is not possible due to eye disease or condition.
• Low-vision testing is available for those with vision impairment that is not correctable by standard glasses, contact lenses, medicine or surgery and that interferes with a person’s ability to perform everyday activities (e.g., age-related macular degeneration).
• Artificial-eye services and materials are available for those individuals who have lost an eye or eyes to disease or injury.

Finding a Vision Provider

Contact a Medi-Cal provider directly for an appointment. For a list of vision providers, visit the online directory at the Find a Vision Care Provider page on the California Department of Health Care Services (DHCS) website. For other vision program questions, individuals may contact DHCS’s Vision Services Branch at vision@dhcs.ca.gov.

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Medi-Cal Eligibility and Covered California - Frequently Asked Questions

Health Care Services

Below you will find the most frequently asked questions for current and potential Medi-Cal coverage recepients. If you do not find an answer to your question, please contact your local county office from our County Listings page or email us at Medi-Cal Contact Us.

Medi-Cal Health Coverage

1. What is Medi-Cal?

Medi-Cal offers free or low-cost health coverage for California residents who meet eligibility requirements. Most applicants who apply through Covered California and enroll in Medi-Cal will receive care through managed health plans.

Medi-Cal has always covered low-income children, pregnant women and families. On January 1, 2014, California expanded Medi-Cal eligibility to include low-income adults. When you complete a Covered California application, your eligibility for Medi-Cal will automatically be determined. You can apply for Medi-Cal benefits regardless of your sex, race, religion, color, national origin, sexual orientation, marital status, age, disability, or veteran status.

2. How much does Medi-Cal cost?

For many individuals who enroll in Medi-Cal, there is no premium, no co-payment, and no out of pocket cost. Some households will see affordable costs, such as a low monthly premium. For some Medi-Cal children, the monthly premiums are $13 per child up to a family maximum of $39 per month. In general, individuals in Medi-Cal will get the same health benefits available through Covered California at a lower cost.

3. What is the difference in coverage between Medi-Cal and Covered California?

Medi-Cal is health coverage, just like the coverage offered through Covered California. Medi-Cal provides benefits similar to the coverage options available through Covered California, but often at lower or no cost to you or your family. All of the health plans offered through Covered California or by Medi-Cal include the same comprehensive set of benefits known as "essential health benefits.” Essential health benefits consist of:

1. Outpatient (Ambulatory) services
2. Emergency services
3. Hospitalization
4. Maternity and Newborn care
5. Mental Health and Substance Use Disorder Services, including Behavioral Health Treatment
6. Prescription Drugs
7. Programs such as physical and occupational therapy (known as Rehabilitative & Habilitative Services) and devices
8. Laboratory services
9. Preventive and wellness services & chronic disease management
10. Children’s (Pediatric) services, including oral and vision care.

A recent survey of Medi-Cal members by the California Healthcare Foundation (CHCF) found that 90% of respondents rate Medi-Cal as a good or very good program. Medi-Cal emphasizes prevention-oriented health care that promotes health and well-being and works to ensure members receive the right care at the right time.

4. How is the state and/or counties reaching out to the homeless population to sign them up for health care?

Outreach and Enrollment Grants for Targeted Populations:

Individuals who are homeless are one of the target populations for $25 million ($12.5 million in The California Endowment funds plus $12.5 million in federal funds) for grants to counties under AB 82, trailer bill language enacted as a part of the 2013-14 budget (see excerpt attached). The Department of Health Care Services (DHCS) has released guidance to the counties about these funds (attached) and held a webinar (attached) to date, with the goal of distributing grants to counties by February 1, 2014. For more information on Outreach and Enrollment efforts click on the link Outreach and Enrollment.

California Policy Academy to Reduce Chronic Homelessness Workgroup:

California is one of four states that recently participated in a federal Substance Abuse and Mental Health Services Administration (SAMHSA) Policy Academy to Reduce Chronic Homelessness. With the expansion of Medi-Cal eligibility, many people who are experiencing chronic homelessness will be able to enroll in Medi-Cal. The Policy Academy state team and consultant are currently engaging homelessness subject matter experts in a Medi-Cal Outreach and Enrollment workgroup to explore preparing a toolkit of best practices for outreach and enrollment of the chronically homeless population that DHCS could then share with Outreach and Enrollment grantees. This will build upon best practices from the Low-Income Health Program (LIHP) as well as recent philanthropic funding efforts to enroll the chronically homeless population.

5. What health plans are available through Medi-Cal?

Medi-Cal managed care offers a selection of 21 health plans. Your health plan options will vary depending upon the county in which you live. Most counties offer commercial plans, which also operate in Covered California including Anthem Blue Cross, Kaiser, Health Net, and Molina. Other plans are public plans administered by the community. Every county’s Medi-Cal plans provide the same high quality care at the same low or no cost to Californians, no matter where you live. The directory of health plans available through Medi-Cal managed care is available online at: Medi-Cal Managed Care: Health Plan Directory.

6. Will I be able to stay with my doctor?

More than 400 hospitals and approximately 130,000 doctors, pharmacists, dentists, and other health care providers participate in the Medi-Cal program to provide medically necessary services to members. Most Medi-Cal members who participated in the CHCF study said it is easy to find a primary care physician nearby. You can search for a managed care provider on the Department of Health Care Services website at Health Care Options.

7. Is it possible for the members of the same family to qualify for different coverage at the same time?

The Covered California application is a single application for multiple health coverage programs. It is common that members of the same family or tax household are eligible for different programs. For example, both parents could be eligible for tax credits through Covered California, while the children are eligible for Medi-Cal. This is because the eligibility rules for Medi-Cal kids are different than for adults, which ensures that no child lacks affordable coverage. In other cases, one parent may be eligible for Covered California without subsidies because they have access to affordable coverage through their job, while their spouse is eligible for premium assistance tax credits through Covered California and the children are eligible for Medi-Cal.

8. What do I do if I have questions about medications, accessing doctors, or specialists?

If you have questions about your coverage under Medi-Cal managed care, you can call your health plan’s customer service representatives directly, just as you would under any other health coverage plan. To access the Medi-Cal managed care health plan directory, please log on to: Medi-Cal Managed Care: Health Plan Directory.

9. Can I decline Medi-Cal and enroll in a Covered California health plan and receive the federal premium assistance?

Under federal law, if you are currently enrolled in or are eligible for Medi-Cal, you are ineligible to purchase subsidized coverage through Covered California. If you are eligible for Medi-Cal, you can still purchase a health coverage plan through Covered California, but you cannot receive premium assistance to reduce its cost and will have to pay the full cost of the Covered California health care plan’s premium.

10. Is there a deadline to enroll in Medi-Cal?

No. There is no deadline to enroll in Medi-Cal. You can apply at any time during the year. When you are determined eligible for Medi-Cal, your eligibility goes back to the month of your application. In some cases, you may be able to receive Medi-Cal coverage right away. Contact your county human services agency at County Offices for more information. However, enrollment in Covered California only occurs during an open enrollment paper, so if you are trying to enroll some household members in Medi-Cal and others in Covered California, be sure to enroll in time for the households seeking coverage through Covered California.

11. If someone's Medi-Cal coverage is cancelled due to increased income or decreased household size, does that person qualify for special enrollment into Covered California?

Yes, losing health coverage such as Medi-Cal is considered a qualifying event that would trigger a special enrollment period. Other qualifying events include:
Permanently moved to/within California

1. Lost or will soon lose their health insurance, including Medi-Cal eligibility (also known as loss of Minimal Essential Coverage (MEC)
2. Had a baby or adopted a child
3. Got married or entered into a domestic partnership
4. Domestic violence survivors (If married, abuser’s income not counted if survivor lives apart and is unable to file joint tax return.)
5. Returned from active duty military service
6. Released from jail or prison
7. Gained citizenship/lawful presence
8. Federally Recognized American Indian/ Alaska Native
9. Other qualifying events as identified on the Covered California portal 

In the event that one of these life events does occur, you would be eligible to enroll within 60 days of that event. During that period you could not be denied coverage by a health plan in Covered California or in the individual market if you are otherwise eligible, and you could be eligible for the premium assistance that is only available through Covered California.

12. My Medi-Cal has been discontinued and I am now able to enroll in Covered California during a Special Enrollment Period (SEP), how can I avoid a gap in my health coverage?

If your Medi-Cal will be or has been discontinued, in order to avoid a gap in your health coverage, you should pick a Covered California plan before the date your Medi-Cal ends. If you do not select a Covered California plan in the same month your Medi-Cal ends, you will not have health care coverage for at least a month. You must also pay your Covered California premium by the due date when you are billed in order to be covered. If your request for enrollment is completed within 60 days of the qualifying life event date, the soonest your Covered California health plan can start will be the 1st of the month following your Covered California plan.selection. If you wait more than 60 days after your Medi-Cal ends to pick a Covered California plan, you may not be able to enroll until Covered California’s next Open Enrollment Period. You may contact Covered California online at CoveredCA.com or call 800-300-1506 or contact your County Eligibility Worker for assistance in selecting your Covered California plan. You may reach your County Eligibility Worker at the county social services agency via http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx.

13. I previously was denied Medi-Cal due to owning a car. Do I qualify now?

The Affordable Care Act simplified financial eligibility requirements for Medi-Cal program eligibility. Under these simplifications, “property” such as a car, is no longer counted. You should apply through Covered California for health coverage even if you previously were determined to be ineligible for Medi-Cal coverage and even though you may think your financial situation has not changed.

14. If I sign up for Medi-Cal, will anything happen to my assets?

Medi-Cal only tries to recover its costs for medical assistance after your death when a recipient is over age 55, or when a member of any age is cared for at an institution, such as a nursing home. Medi-Cal does not seek payment during your lifetime or the lifetimes of your surviving spouse, disabled son or daughter, or while your child is under 21 years of age. If you are under 55, you can sign up for Medi-Cal knowing that nothing will happen to your assets unless you are institutionalized. For those over age 55 or in an institution, the Department of Health Care Services may present a claim for the cost of your care. It would be paid from your estate at the time of your death. For more information, please visit Third Party Liability.

Family

1. Will my family and I qualify for the same program?

Depending on your household size or family income, you or your family may qualify for different programs. For example, you may qualify for affordable private health insurance available through Covered California. However, your child may qualify for free Medi-Cal. We will tell you which health insurance you and other members qualify for.

2. I just found out I am pregnant. Can I apply for health insurance that will cover me during my pregnancy?

Yes. Make sure to answer yes to the application question “Are you pregnant?” or tell the person helping you to fill out your application. You can apply for health insurance that can cover pre-natal care, labor and delivery, and postpartum care. Health insurance plans can no longer deny health insurance if you are pregnant.

3. I just had a new baby. What should I do about health insurance?

If you did not have Medi-Cal or the Medi-Cal Access Program at the time of delivery, fill out this application for your newborn. If you did have Medi-Cal or the Medi-Cal Access Program during your pregnancy, you do not need to fill out this application. Call your county worker to make sure your baby is covered from birth, or fill out a newborn referral form. Print the MC 330 form. If you had coverage under the Medi-Cal Access Program call, 1-800-433-2611, or go to http://mcap.dhcs.ca.gov to register your baby.

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How Does Covered California Work?

AT A GLANCE

1. The state has set up a new online marketplace, called Covered California, where people can buy insurance.
2. All health plans offered in Covered California feature the same standard set of benefits.
3. Effective Jan. 1, 2014, insurance companies may consider only three factors to determine the cost of your premium: age, geography and family size. Your health history may no longer be considered in setting premiums.
4. To help you pay for insurance, the federal government is offering tax credits for people who qualify, based on their income.

For millions of Californians, the online marketplace — Covered California — is the heart of the health law. If you are uninsured, or buy insurance for yourself or your family, Covered California is where you can shop. So far, two million people have purchased insurance on Covered California, and many others are eligible for subsidized coverage, but not signed up. If you do not have health insurance, you may need to pay a penalty. In tax year 2015, that penalty is 2 percent of your income or $325 per person, whichever is greater. If you do not have insurance in 2016, the penalty rises to 2.5 percent of income or $695 per person. (Penalties for children are half the amount of adults.)

Buying Health Insurance Today

Before the Affordable Care Act, if you bought insurance for yourself or your family, it may have been hard to find a policy with comprehensive benefits. Health insurance companies were generally not required to cover specific areas of care. If you had an illness, the health plan might have charged you a very high premium to get the care you wanted, perhaps more than you could afford. Or you might have found an affordable plan, but the company would not have covered the care you needed. For example, the company might have excluded specific illnesses based on your health history.

What Changed With the Health Law?

Under the Affordable Care Act, the state set up an online marketplace, called Covered California, where insurance companies, like Kaiser or Anthem Blue Cross, offer plans.

A big part of Covered California's responsibility is to negotiate with insurance companies to get the best quality plans — at the best price — for you to choose from. In 2016, 12 companies are offering plans on the Covered California marketplace, including statewide companies Anthem Blue Cross, Blue Shield, Kaiser and Health Net, as well as eight plans that will offer coverage in certain regions: Chinese Community Health Plan, L.A. Care, Molina Healthcare, Oscar, Sharp Health Care, United Healthcare, Valley Health Care and Western Health Advantage.

Before We Dive Into How Much This Will Run You, Let's Explain a Few Terms.

You've probably heard of premiums, deductibles and co-pays. In considering what health insurance policy to sign up for, you need to think about your health status, what health risks might come your way and your own financial ability to cover those risks. For example, do you have diabetes? You can probably calculate the cost of the prescription drugs you need. Are you an avid athlete who might sustain an injury? You might want to think about how much a broken leg might run you.

Here's some jargon to help you in your decision:

• Premium: this is the amount you pay, generally monthly, to a health insurance company for your plan.

• Deductible: this is the amount you pay — out of your own pocket — before your insurance begins to pay, although some services on Covered California plans are covered outside of the deductible. For example, on all Covered California plans, you can see your primary care doctor with just a copay. Some preventive services are free.

Two cautionary notes: First, you want to be careful to pick "in network" providers, as they are usually less expensive than doctors and other providers not in your network. Second, plans with lower monthly premiums generally have higher deductibles. When you're considering different plans, think of how much health care you are likely to use, then add your total annual premium and your deductible to consider what your annual costs might be.

• Copayment: this is set amount you pay — out of your own pocket — when you access care, such as when you see a doctor or buy a prescription drug.

• Coinsurance: this is a set percentage you pay — out of your own pocket — when you access care. Some plans may charge a copay, some may charge coinsurance.

• Out-of-pocket maximum: This is the maximum amount you will pay, out of your own pocket, in a year. For many Covered California plans, this is $6,250 for an individual or $12,500 for a family. Once you reach the out-of-pocket max, all your medical expenses are generally covered by your health insurer, at no additional cost to you. Again, this is for in-network care. If you go out of network, your costs could be higher.

How Much Will I Pay?

Under the health law, insurers may consider only three factors when setting premiums: your age, where you live and your family's size. Insurance companies cannot turn you down or charge you a higher premium because you are sick or had a previous illness or accident.

To set up Covered California, state law established 19 geographic regions. That's the "where you live" factor insurers may use in setting premiums.

You can easily compare specific plans and premiums available to you — according to where you live, your age and the number of people in your family — by using Covered California's online calculator.

I've Heard the Government Is Offering Subsidies to Buy Insurance. Tell Me More.

You may qualify for a subsidy — in the form of a tax credit — to help you pay for health insurance. Tax credits are available on a sliding scale, according to your income. About 90 percent of people who purchase a Covered California plan qualify for a subsidy.

If you earn between 138 and 400 percent of poverty ($16,243 - $47,080 for an individual; $33,465 - $97,000 for a family of four), you may qualify for a federal tax credit. The credit will be applied to the cost of your premium. You choose when you want to receive the credit. You might want to receive it monthly, so that you will pay less each month, or you may elect to receive it all at once when you file your taxes in the following year.

In order to receive the subsidy, you must buy a plan through Covered California. You cannot apply the subsidy to a plan you find outside of Covered California.

Covered California offers a calculator to help you estimate the cost of your insurance after the tax credit has been applied -- and to help you compare the prices of the different plans available to you. The tax credit is based on your ability to pay for the second-lowest-cost silver plan. But you can apply the credit to any plan you wish to buy (except for a catastrophic plan). More on the "tiers" of plans further below.

The health law is using a new calculation of income, called Modified Adjusted Gross Income (MAGI). In general, it's the total of your adjusted gross income — plus any tax-exempt income you might have. But to calculate your subsidy you don't use last year's income. When applying for insurance, you will be asked to state what you expect your 2016 income will be. If you think you will earn roughly the same next year, you can estimate your MAGI by adding lines 8b and 37 from your 1040 tax return. But if you think your income will change, you will need to estimate.

If you want more specifics of what income is counted — and what income isn't — check this helpful summary from the UC Berkeley Labor Center (pdf).

What If My Income Changes During the Year?

If your income changes, your subsidy amount may go up or down. You should contact Covered California right away to adjust the amount of subsidy you receive. If you estimate your income too low — and get a higher subsidy as a result — you could have to pay back some of the subsidy at tax time. Alternatively, if you estimate too high, you could get a refund.

What Kind of Coverage Can I Get?

Any plan offered in Covered California must include a standard set of benefits across 10 categories. These are:

• Ambulatory patient services (that means routine doctor's office visits, lab tests, etc.)
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including pediatric dental care

What Is the Difference Between a Silver-Tier Plan and Other Plans?

Individual health plans in Covered California are offered in tiers of coverage: platinum, gold, silver and bronze. The difference between the tiers is not what benefits are covered. Under the health law, each plan must offer the same standard benefits.

The difference between the tiers is cost. If you pay more each month for the premium, you will pay less when you need health care. The less you pay each month for the premium, the more you will pay when you need health care, the more you pay for the premium, the less you pay when you need care.

The platinum tier has the highest monthly premium, but there is no deductible and you have a $20 copay when you see your primary care doctor.

At the other end of the spectrum, in the bronze tier, you will pay much less each month for the premium. But bronze plans have a $6,500 deductible and a $70 copay when you see your primary care doctor. Silver tier plans have a $2,500 deductible. All plans have a limit on your maximum out-of-pocket costs for the year. For most plans, what you pay for health care, after your premium, is capped at $6,250 for individuals and $12,500 for families. This is a big change under the health law. In the past, in some cases, out-of-pocket costs could have been tens of thousands of dollars.

You can decide which tier — and which plan — is for you by considering your own finances and health care needs. The best way to know your options is to plug your household income and other data into Covered California's calculator. It will show you specific plans that are available to you, what the cost will be to you, and what subsidy you are likely to qualify for.

I Would Like to Talk to Someone in Person. Where Can I Go For Help?

Covered California has certified thousands of people across the state to provide in-person assistance to help consumers enroll. There is help available in both English and Spanish — and some certified counselors speak other languages as well. This page of the Covered California website provides links to certified counselors and insurance brokers trained in Covered California insurance plans as well as county offices where you can go for help. You can also call Covered California: 1-800-300-1506.

I Can't Even Afford the Copayment or Deductible. What Do I Do Now?

In addition to the tax credit, the federal government also offers special subsidies based on income and family size. If your income is less than about 2.5 times the poverty level — $29,425 for an individual or about $60,625 for a family of four — you may be eligible. These subsidies can help reduce what you have to pay when you see the doctor or get other health care.

I'm 28 and Healthy. I Only Worry About What I'd Do If I Were Hit by a Bus. Which Plan Should I Pick?

You can certainly look at the bronze plan and see if the coverage makes sense for you. Covered California also offers a catastrophic plan. It does not cover doctor's visits or even emergency room visits, but is meant to protect you against catastrophic medical bills. This level of coverage is available to people up to age 30. It's also available to other people who can demonstrate that they are experiencing financial hardship and to certain people whose policies were canceled because they did not meet the requirements of the health law.

Even With All This Help, I Cannot Afford to Buy Insurance or Pay The Penalty. What Do I Do?

If you are looking at the least expensive plans, and your cost for the premium is greater than 8 percent of your household income, you are exempt from the requirement to have health insurance. You do not need to pay a penalty.

I Don't Like the Insurance My Employer Gives Me. Can I Buy Insurance on Covered California?

You can, but because you are turning down insurance you already have through your job, you are probably not eligible for the tax credits. But, again, there are exceptions. The insurance offered by your employer must be "affordable" as determined by two criteria. First, the total annual premium you pay for coverage for yourself must be less than 9.5 percent of your income. And, second, the plan must cover at least 60 percent of health care costs. Your employer can tell you how much your plan covers. If you do not meet these two criteria, your plan is not "affordable." You may visit Covered California, buy insurance there and apply for a tax credit.

I'm Covered by My Employer, But My Family Is Not. Are They Eligible for Subsidies?

If your employer does not offer insurance to your spouse and dependents, then, yes, they can buy insurance at CoveredCA.com, and they may be eligible for subsidies.

If your employer does offer family coverage, your family may not be eligible for subsidies — if the insurance for you, the employee, is "affordable" as described above. The "affordable" coverage from your employer negates other family members' eligibility for subsidies — unless your contribution is greater than 9.5 percent of your income and covers 60 percent of costs, as described above. It does not matter how expensive the spouse and dependent coverage is. If the premium for you, the employee, is "affordable," they are not eligible for subsidies with Covered California.

https://prelicensetraining.com/page/Affordable-Care-Act

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I Am Covered by Medi-Cal

AT A GLANCE

1. Before the health law went into effect, many low-income people were not eligible for Medi-Cal. For example, adults who did not have children could not get Medi-Cal coverage.
2. Under the health law, California is expanding Medi-Cal so that more people will be covered.
3. You qualify if your income is less than about $16,243 for an individual or $33,465 for a family of four.

Medi-Cal is the government health insurance program for people who are low-income or disabled. In the past Medi-Cal did not cover all poor people. For example, unless they were disabled, adults who did not have children were probably not eligible for Medi-Cal.

What the Health Law Does

The Affordable Care Act provides significant funding for a dramatic expansion of Medi-Cal. The program is called Medicaid in other states.

Effective Jan. 1, 2014, anyone earning up to 138 percent of the federal poverty level became eligible for Medi-Cal.

In real dollars, that means individuals making up to about $16,243 a year or a family of four making up to about $33,465 a year are now eligible for the insurance.

In the Past, I've Found the Sign-Up Process Confusing. What Do I Do?

The Affordable Care Act mandates changes in the application process to simplify it and make it more streamlined. People can apply in person or by mail. Medi-Cal applicants may also apply at CoveredCA.com, the website of the state's new insurance marketplace.

The health law also created a new definition of income for Medi-Cal. It's called Modified Adjusted Gross Income, or MAGI. Your assets will no longer be used in determining whether you are eligible.

I'm on Medi-Cal Now. Do I Have to Do Anything to Keep My Coverage?

No. You will continue receiving benefits. You don't need to do anything new. But, just like you do now, you will need to continue to reapply periodically to maintain your benefits.

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