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Can people with low incomes qualify for free medical care (Medi-Cal) in California regardless of their liquid assets?

A document on the Department of Health Care Services site (pdf) notes off-hand:

Note: Medi-Cal disregards property for individuals whose eligibility is determined utilizing your Modified Adjusted Gross Income (MAGI).

But on the other hand, calhealthadvocates.org says:

To find out if you qualify for one of Medi-Cal’s programs, look at your countable asset levels. You may have up to $2,000 in assets as an individual or $3,000 in assets as a couple.

Is there a basis for this policy in law, and do high-asset / low-income people qualify for free medical care in California?

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+500

Can people with low incomes qualify for free medical care (Medi-Cal) in California regardless of their assets?

For some programs, but not others. The main exception, discussed below, is the Medicaid expansion component of Obamacare (a.k.a. the Affordable Care Act).

One of the exceptions to the general rule considering property is as follows:

The Affordable Care Act introduced a new methodology – Modified Adjusted Gross Income (MAGI) – to define a family’s size and count income in order to determine eligibility for insurance affordability programs. 42 U.S.C. § 1396a(e)(14).

As a result, household determination and income counting rules are largely aligned among Medi-Cal, the Medi-Cal Access Program (MCAP, the low-cost health insurance for moderate income pregnant women), and Covered California, with some exceptions.

For Medi-Cal, the MAGI rules apply to the following programs: Expansion Adults (adults aged 19 through 64); Parents and Caretaker Relatives; Pregnant Women; and Children.

Medi-Cal’s Tuberculosis Program and the Refugee Medical Assistance program also now use the MAGI income methodology. See Welf. & Inst. Code 14005.20(b)(2) and ACWD 15-16 (Mar. 20, 2015), http://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/ACWDL2015/ACWDL15-16.pdf. These programs, however, are not considered MAGI Medi-Cal in the Medi-Cal hierarchy because they are limited in scope or duration and should only be used when an individual is not eligible for any other form of free Medi-Cal.

In general, unless an individual gets Medi-Cal through a linked program such as SSI or CalWORKs, or due to former foster youth status, Medi-Cal eligibility is reviewed for the MAGI programs before looking to the Non-MAGI programs.

Outside that Obamacare program, someone can have significant assets of types that are exempt from consideration (e.g. in the Medicaid nursing home program), but they cannot qualify regardless of their assets. The exact extent to which assets are disqualifying varies by subprogram, with ordinary Medi-Cal, the nursing home program, and the CHIP program for children, having different requirements.

The key language is "countable asset levels". This is defined in a combination of state statutes and regulations which in turn are enacted in order to comply with federal Medicaid program requirements.

Only some assets count for purposes of Medi-Cal eligibility. In particular, a personal residence, a single motor vehicle, certain household goods, certain retirement assets, certain cash value in life insurance policies, and investment assets that don't generate current cash income and are impracticable so sell in a timely manner at anything approaching their true value because they are illiquid for some reason or other, don't count. Exactly what does and does not count as a countable asset for purposes of Medi-Cal eligibility is a rather technical and detailed matter because there are some many different kinds of assets out there and the rules address them on a type by type basis. The most common exemptions are set forth here:

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The main regulations for the Department of Health Services that govern this are found here and here. More legal sources are found here. These primary sources, alas, aren't organized in a very user friendly way. In part, this is because the Medicaid Rules incorporate by reference (with modifications) the rules for the Aid To Families With Dependent Children (AFDC) and Supplemental Security Income (SSI) rules, rather than restating them with the modifications include in full. So the chart on the form is assembled from a mishmash of state and federal regulations in multiple locations.

I didn't find a chapter and verse citation for a few kinds of non-countable assets but know they exist from continuing education classes and practicing in the area.

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  • Thanks for replying, but isn't that the same link I posted? It starts with "Note: Medi-Cal disregards property for individuals whose eligibility is determined utilizing your Modified Adjusted Gross Income" (Presumably "all property", but I'd like to find the text of the law that governs this)
    – MWB
    Dec 30, 2021 at 23:30
  • @MWB This official government form is derived from the State of California regulations of the agency that administers the program (the California Department of Healthcare Services), but it contains the substance of the answer.
    – ohwilleke
    Dec 30, 2021 at 23:43
  • Thanks for the links, but I must say that I don't understand if your answer is "yes" or "no". If "no", how should the DHCS "Note:..." be interpreted?
    – MWB
    Dec 31, 2021 at 0:30
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    @MWB the answer to the question "Can people with low incomes qualify for free medical care (Medi-Cal) in California regardless of their assets?" is "no, their assets will be considered." The answer to the question "Do high-asset / low-income people qualify for free medical care in California?" will depend on the specific assets held by the individual. If the assets are entirely illiquid, there's a good chance of qualifying. If the assets are entirely liquid, there's a poor chance. Most people will fall somewhere in between.
    – phoog
    Dec 31, 2021 at 14:32
  • +500 since there are no other answers, but I think there must be different ways to qualify. One takes into account your property, and the other one doesn't. This would explain both the lists of exemptions and the remark saying "Note: Medi-Cal disregards property for individuals whose eligibility is determined utilizing your Modified Adjusted Gross Income"
    – MWB
    Jan 17, 2022 at 5:53

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