What is Adult Expansion / MAGI Medi-Cal?

Publications
#5551.01

What is Adult Expansion / MAGI Medi-Cal?

The Affordable Care Act (ACA) (also known as Obamacare) has increased the number of people who can get Medicaid (Medi-Cal in California). “Adult Expansion Medi-Cal” or Medi-Cal for “childless adults” is part of what is now being called “MAGI” Medi-Cal under the ACA. “MAGI” Medi-Cal means any Medi-Cal program that uses MAGI (modified adjusted gross income) to determine financial eligibility for Medi-Cal. 

The Affordable Care Act (ACA) (also known as Obamacare) has increased the number of people who can get Medicaid (Medi-Cal in California). “Adult Expansion Medi-Cal” or Medi-Cal for “childless adults” is part of what is now being called “MAGI” Medi-Cal under the ACA. “MAGI” Medi-Cal means any Medi-Cal program that uses MAGI (modified adjusted gross income) to determine financial eligibility for Medi-Cal. 

Who is Eligible for Adult Expansion Medi-Cal?

You can get Medi-Cal under the new Adult Expansion Medi-Cal program if: 

  • You are between the ages of 19 and 64; 
  • Your MAGI income is below 138% federal poverty level (FPL);1
  • You are not pregnant; 
  • You do not get Medicare; 
  • You do not have Medi-Cal without a Share of Cost already. 

How do I know if my MAGI income is below 138%?2

You don’t have to figure it out yourself. You can file a “single streamlined application” for MAGI Medi-Cal through Covered California, the county Medi-Cal office, or a number of other places. You can file the single streamlined application online on the Covered California website. If you file for benefits on the county Medi-Cal website, it will redirect you to the Covered California website so you can apply for MAGI Medi-Cal.

Are there rules about how much money or property I can have and still get Adult Expansion Medi-Cal? 

Yes, but they are different from pre-ACA Medi-Cal. Pre-ACA Medi-Cal has very strict limits on how much income and how many assets you can have. MAGI Medi-Cal uses a different way to calculate income, and allows a single person to have up to $16,242 year of MAGI income. That’s 138% of the federal poverty level. However, under MAGI Medi-Cal, there are no income exclusions or deductions other than a few deductions used to determine the amount of your MAGI. And, unlike pre-ACA Medi-Cal there is no asset test for MAGI Medi-Cal.3 This means you can have more than the $2,000 per person/3,000 per couple resource limits of pre-ACA Medi-Cal.4

What if I have a Medi-Cal Share of Cost Now? Can I switch to Adult Expansion Medi-Cal? 

Yes. You can contact your local County Medi-Cal office and ask them to check whether you are now eligible for MAGI Medi-Cal with no share of cost. The County will also check if you are eligible for MAGI Medi-Cal at your annual redetermination. The county will give you MAGI Medi-Cal if you are eligible for it. 

What Services can I Get with Adult Expansion Medi-Cal? 

You can get all of the services available under regular Medi-Cal, including nursing facility, In-Home Supportive Services (IHSS), and other long-term care services, without an asset test.5 In addition, you can get substance use and mental health services from Medi-Cal managed care plans and from county mental health/behavioral health.6 If you want home and community-based waiver services (HCBS) you can apply for pre-ACA Medi-Cal through the county Medi-Cal office. You can do this by filling out a SAWS 2 Plus form.7

What Resources Are Available if I Have More Questions? 

At the bottom of this document, we have listed Internet resources that may be helpful to do further research. In addition, your county Medi-Cal agency, http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx, and Covered California, www.coveredca.com, 1-800-300-1506, can answer questions.

The following organizations can help with advocacy: 

 

Disclaimer: This publication is legal information only and is not legal advice about your individual situation. It is current as of the date posted. We try to update our materials regularly. However, laws are regularly changing. If you want to make sure the law has not changed, contact DRC or another legal office.

 

 

Click links below for a downloadable version.