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30-Year-Old Medi-Cal Income Limit Leaves Some Seniors Without Critical Care

A doctor with a Medicare patient. Photo courtesy Centers for Medicare & Medicaid Services
A doctor with a Medicare patient. Photo courtesy Centers for Medicare & Medicaid Services

Life in California is expensive. So imagine that you have to make ends meet with $ 600 a month. This is essentially what some seniors and people with disabilities need to do to access Medi-Cal, the state-run low-income health insurance program.

People with significant medical expenses – but whose income is very high qualify for free Medi-Cal – can access the program if they pay part of the cost.

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This cost share works as a monthly discount. Individuals are allowed to keep $ 600 for personal use and must spend the rest of their income on health care expenses before their Medi-Cal coverage begins.

“If you make $ 1,600 a month, $ 1,000 has to go to pay for your care,” said Tiffany Huyenh-Cho, a lawyer at Justice in Aging, an organization that urges state lawmakers to update the income rule. Because people who use this type of Medi-Cal usually have expensive care, for some it is worth paying, but most can not afford it, he said.

In January of this year, the last month for which state data is available, there were about 81,000 people who had enrolled in Medi-Cal but could not use it because it did not cover their share of the cost. The majority are over 65 or have a disability, according to data.

Take San Diego Maxine Wells – She is 91 years old and with the help of her son Keith Wells, she recently applied for Medi-Cal. Her monthly Social Security income of $ 2,000 exceeds the threshold for free coverage. Keith is still waiting to receive official information from the state about his mother’s eligibility status, but it is not certain that they will be able to meet the cost share.

The amount of dollars people can keep, $ 600 for an individual and $ 934 for a couple, has not changed since 1989, when the minimum wage was $ 4.25 one hour.

“It was shocking to hear that he has not been informed since,” said Keith Wells.

Seniors like Wells are also eligible for Medicare, the federal health insurance program for seniors and people with disabilities. But Medicare does not cover all of her needs or home care. Wells, a former beauty shop owner, is suffering from a heart attack, which left her heart muscle damaged. He has chronic obstructive pulmonary disease, dementia and anxiety. Medi-Cal would supplement its Medicare coverage. About 1.4 million Californians are enrolled in both programs.

California has enacted sweeping and groundbreaking policies to extend health insurance coverage to more people. It has one of the lowest rates of uninsured in the country – about 6% of California residents do not have health insurance. However, people’s pockets continue to struggle to afford the coverage and care they need, which means they are left without it.

Advocates of aging say older people tend to live on a steady income, but are sometimes subject to rules that do not keep pace with the current cost of living.

Aging and health advocates now ask legislators and the governor’s office to allow Medi-Cal recipients who have to pay a share of the cost to maintain more than their income. Bill of the Assembly of 1900 by the member of the Assembly Dr. Fresno Democrat Joaquin Arambula is proposing to increase the monthly limit from $ 600 per person, which is about 55% of the federal poverty rate, to $ 1,562 or 138% of the federal poverty rate.

This adjustment would require federal approval, according to the Ministry of Health Services, which oversees the Medi-Cal program.

The Arambula bill was passed by the Assembly last week and is now in the Senate. “This is just a matter of justice for Californians who are struggling to make ends meet and need access to health care,” Arambula said of his bill at a convention health committee hearing earlier this year.

Linda Nguy, a policy advocate at the Western Center for Law and Poverty, said it would be difficult to pass the bill if its funding is not included in this year’s state budget. Funding for this proposal was not included in the governor’s budget review in May.

However, the budget release released Wednesday by the Democratic leaders of the Legislature provides $ 31 million to reduce the cost share for this population. The legislature and Governor Gavin Newsom must now come together and draw up a final budget.

The Office of the Legislative Analyst has considered that this proposal would cost between $ 53 million and $ 151 million, half of which would be paid by the state and the other half through federal funds. Without that funding, the Arambula bill would likely be stuck in the Senate Budget Committee, Nguy said.

At least nine other states and the District of Columbia allow people who pay a share of the cost of Medi-Cal (Medicaid in other states) to keep a higher amount for personal use than California. according to the Kaiser Family Foundation.

“It’s so unfair,” said Naty Chavira, a Los Angeles-based teacher whose parents, Jose and Alicia Chavira, struggled to afford expensive drugs and home help. “Do you know how hard my dad worked? He paid his taxes, he is a good citizen and here he is today in a state of survival. I know that his finances negatively affect his health “.

Jose, 77, a former welder, struggles with a range of health problems and symptoms – diabetes, depression and dizziness, among others. He has spent most of his retirement caring for his wife, Alicia, 78, a former housewife who raised six children and was diagnosed with Alzheimer’s disease a few years ago. But now his health is deteriorating.

Naty would like her parents to get help at home and her father to get the hearing aids he needs, but Medicare will not pay for these expenses, so he helped them apply for Medi-Cal. However, to receive this coverage, the couple could only keep $ 934 out of $ 2,600 monthly Social Security income.

When you deduct $ 500 on bills, they will keep $ 400 on their food and medicine. “It’s crazy,” Tsavira said.

CalMatters is a public interest journalism project committed to explaining how the California State Capitol works and why it matters.

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