Advice about Medi-Cal and Covered California

Covered California Website (Medi-Cal)

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FTM COBRA vs Medi-Cal insurance coverage

May 2013

We're recent transports to the area from Washington, DC and are expecting our first in June! As you can imagine, lots of transitions. I have the ability to either elect COBRA coverage from my DC job or get Medi-Cal as a consultant/self employed person. Aside from the obvious cost difference, I'm looking for advice on Medi-Cal in pre-natal and post-natal care (including for baby). Is it comprehensive? Would you recommend going the tried and true and expensive COBRA route instead? Looking for local advice as this is a completely new world for me - I've always had an insurance plan until now. Thanks so much.

If you have any substantial income at all you will probably not qualify for Medi Cal. You need to prove your income, show bank statements, tax returns etc. and just being self-employed does not mean you will qualify. Also, if you just move here from another state, I suspect there is some residency requirement in order to qualify. Additionally, under the new Health Care Law your employer is required to cover you but only if they employ 50 or more employees, otherwise they still do not have to cover you. However, if you do not have health insurance, beginning in 2014, you personally will receive a fine through your income tax. human resource person

Help to Legally get Medi-cal & Protect Assets

Jan 2013

My daughter is having some major ''issues'' & needs to get financial assistance & medi-cal, soon. She does have a few assets that may put her over the limit for public assistance. Reading on.line, there is legal help that can help to guide her through a ''spending down'' process, so, with these few assets, she can still qualify to get the financial assistance & medi-cal assistance she needs more quickly, & wisely. Often, this help may pertain the an elder person, who has assets to protect, so they can enter a nursing home, but basically the same principals apply. I don't want to close my eyes & just ''pick someone out''. Have you had experience or can you recommend someone you've used that has done this sort of work? Perhaps it could be a low cost agency. She happens to be in San Mateo. Thank you. anon

If your child is a client of the Regional Center, I'd start there to get help on the medi-cal waiver. Otherwise, request to speak with the social worker at the hospital/specialty clinic where your daughter receives care. You can also check with the family resource center for a referral. I'm not sure the name of the resource center in San Mateo; in SF it's Support for Families. anon

I'm sorry to hear your daughter is going through this. This is definitely an area where you need to be careful. I specialize in elder and dependent abuse law and have seen (and sued) my fair share of charlatans who will tell you they can ''pre-qualify'' someone for Medi-Cal. Frequently, these people charge exorbitant amounts of money and perform legal work when they aren't qualified to do so. And they give bad advice and mess things up. I recommend calling California Advocates for Nursing Home Reform,, to see if they can either, 1) give you advice about this, or 2) refer you to someone reputable. Good luck! Sarah

MediCal and inheritance

April 2012

An older couple (neighbors) came from Europe and signed up with MediCal as their income was low (with large copay). Now they are inheriting some money, and they think MediCal has the right to get paid retroactively for services received until now. They would like to find out more about that, and need legal help. Any suggestions? Thanks. Susan

Senior Medi-Benefits in Berkeley may be able to help answer Qs, or at least be a starting point. They are a fantastic non-profit focused on serving the needs of the elderly, veteran and disabled populations. www.seniormedi- or 888.789.4589 A grateful former client

Medi-cal became unaffordable when I got a raise

August 2008

I am at the end of my rope and I'm wonder if anyone out there can help. I am a single mom of a ten year old girl and ever since she was born I have had Blue Cross Medi-cal. Suddenly because I started to make slightly more a month (maybe $100. more), medi-cal has given me a ''share of cost'' of 1100. a month. I went in to bring pay stubs to show my income had not gone up that much and recieved a notice in the mail that since it had gone up by $2000. or so dollars(huh?)now my share of cost is around $2500. a month. That is more than I have ever made per month, I sometimes make less because I am in education and seasonally my income goes down or disappears altogether.

From this I can only come to the conclusion that my worker is either crazy, drunk, or even worse discriminating against me for an unknown reason. Meanwhile my daughter's asthma is getting worse and I cannot afford her medications or even take her to the doctor. Since kids can die of asthma, that is a big concern. I am stressed to the limit and don't know how much longer I can hold up. To top it up my income goes up and down to the point that I am afraid of being evicted and becoming homeless. I am seeing a therapist but that is paid by, you guessed it, Medi-cal. I have no real supportive family. I am a paraeducator (7 years experience) and the only jobs I can get are seasonal (summer) or part time school district jobs plus seasonal after school program jobs.I have 2 bachelor's degees. I am close to getting my teaching credential and consider myself good at what I do but I do not have the time or babysitting to go back to finish school.

Communicating with the medi-cal people is next to impossile because they have an automated phone system and I have to take off work to go in there and wait to see a very unhelpful person. My daughter's father is not helping and it would take six months to a year to get a fair amount of child support. I beleive it would involve court. I am applying for Healthy Families for my daughter but it won't cover me and I am on meds too. Help, my life has become unliveable. Any advice would be appreciated. anonymous

I'm not sure if you received other replies to your post. I saw yours a few weeks late. I just wanted to share my experience with Medi-Cal (Alameda County). It was a nightmare. I had Kaiser Medi-Cal in Oakland for my (then) 1-year-old daughter, but moved to SoCal and needed Alameda County to officially change my address and transfer the file. I couldn't enroll in a plan in SoCal until that happened, so even though I officially had Medi-Cal for my daughter, we really only had emergency coverage at the VERY overburdened county hospital.

After NINE MONTHS of calls and letters to my case worker, the Medi-Cal coverage was cancelled because I didn't send in certain forms, which of course I never received because my address STILL hadn't been changed in the system. At that point I filed for a hearing, and finally things moved forward. The file was transferred and coverage was restored (although even that took about 4 months). My advice to you is to file for a hearing so that your case worker receives some oversight. I think (but I'm not completely sure on this) there are also low- or no-cost Medi-Cal attorneys who can help.

Good luck! Survivor of Medi-Cal hell

Urologist who accepts Medicaid for Paralyzed Friend

April 2005

Do you know a UROLOGIST who accepts Medicaid or who provides pro-bono services to the handicapped? A friend recently became paralyzed from the waist down. He's a young man and has limited financial means and he can't locate a urologist who accepts Medicaid. thanks so much

Your friend would likely need to go to the county hospital in his area; they generally have specialty clinics, like urology. At San Francisco General Hospital, if the patients needs can not be met by the specialist there, the patient is usually referred on to UCSF; so that might be another option for your friend. eve