Q&A
Enroll in Health Coverage
The California Endowment’s Get Covered campaign has provided an updated overview of the Affordable Care Act and the many options for health coverage now available to Californians. English | Spanish
Use the 2016 Covered California Shop and Compare Tool to see which health coverage options you qualify for.
Additionally, this Health Coverage Eligibility Worksheet can help you.
Covered California, the state’s health coverage marketplace, has answers to key questions about enrolling, including videos explaining the basics of the Covered California marketplace.
Find out more about Medi-Cal, including whether you qualify, on their website.
Yes, if you have DACA status you are eligible for Medi-Cal based on income. View this page.
Yes, you have the right to keep your Covered California health plan even if your household income and pregnancy otherwise qualify you for Medi-Cal. Learn more.
Medi-Cal Access Infant Program (MCAP) provides low-cost coverage for middle-income families who do not have health coverage, but who also do not qualify for no-cost Medi-Cal. MCAP is also available to women whose health coverage does not cover maternity services, or whose maternity services coverage is too expensive. MCAP can also cover your newborn up to age 2. Find out more about MCAP.
Use this network map to find local assistance.
Asegúrate provides Spanish-language information about health coverage options.
Resources for Undocumented Individuals and Families
Your child may soon qualify for Medi-Cal! Starting no sooner than May 2016, undocumented children who would have otherwise qualified for Medi-Cal except for their immigration status will qualify for coverage. Asegúrate provides an explanation of health coverage for immigrants, public charge, and the personal mandate. FAQ for Immigrants – English | Spanish
Yes! In fact, here is a memo (English | Spanish) from ICE confirming that parents can enroll their children and other eligible family members in health coverage under the Affordable Care Act without triggering immigration enforcement activity.
Additionally, Covered California reassures families that information is safe, secure, and confidential for everyone, including undocumented Californians. English | Spanish
My Health LA is a health care program for uninsured people (ages 6 years and up) provided at no cost to those living in Los Angeles County. See their income eligibility. View their English | Spanishflyer. Additionally, here are their English I Spanish presentations.
Actually, no sooner than May 2016, your child may qualify for Medi-Cal coverage. Additionally, Kaiser Permanente Child Health Program (CHP) offers health coverage to children under 19 who do not have health insurance. For more information, choose English or Spanish. For help signing up or renewing in Northern or Southern California, download this flyer and resource list.
Call the NALEO Education Fund’s hotline number, 1(844) – 31 READY.
Asegúrate provides Spanish-language information about health coverage options.
Use this County Contact List for Medi-Cal Assistance for Immigrant Californians. Find your county and call or email the person listed.
Get Care
Covered California has put together a helpful graphic that explains some common insurance terms and walks you through the process of going to the doctor.
Enter your location to find a center nearest you.
Check out this list of services covered by Medi-Cal.
Yes, if your child has Medi-Cal your child also has dental coverage! To find out what services are provided under their dental coverage, view The Children’s Partnership fact sheet for your county. (If you live outside of Sacramento and Los Angeles counties, please use the statewide fact sheet.)
Dental Coverage Fact Sheet | California | English and Spanish
Dental Coverage Fact Sheet | Los Angeles County | English and Spanish
Dental Coverage Fact Sheet | Sacramento County | English and Spanish
To find Medi-Cal dental services near you use the InsureKidsNow.gov search engine.
Yes, if your child is enrolled in Covered California, he or she has dental coverage and should go to the dentist for regular check-ups and care. To find a dentist, contact your health plan. To find out what services are provided under their dental coverage, view The Children’s Partnership fact sheets.
Dental Coverage Fact Sheet | California | English and Spanish
Renew Your Health Coverage
You can renew by phone, mail, fax, or in-person. Check out their renewal flyer.
To transfer your coverage, you must contact your sending (or current) county and request to transfer. Read more about Med-Cal inter-county transfers.
You are automatically enrolled into Medi-Cal. No application necessary! Read more about “Express Lane Enrollment,” which makes this possible.
Tax Information
Your 1095-A shows what Covered California paid to your insurance company over the previous year to help you with the cost of your health coverage. You will need this form when filing your taxes. See Covered California’s 1095-A instructions.
Some Californians with Medi-Cal may receive a 1095-B tax form to show that they had coverage during the previous year. You will not need the form to file your taxes in 2015, but you should keep the form for your records. Anyone with coverage through Medi-Cal will be able to check a box on their tax forms saying that they had health coverage in 2015. Visit the Medi-Cal 1095-B form page to learn more.
You are NOT required to pay the tax penalty for being uninsured if your immigration status makes you ineligible to buy health coverage through Covered California. If you have Deferred Action for Childhood Arrivals (DACA) or are undocumented, you are also EXEMPT from the requirement to pay the tax penalty for being uninsured, even if you have a Social Security number.
Visit the National Immigration Law Center to get further details and forms that you need to claim exemption when filing taxes.
And review the Immigrants & Exemptions from the ACA Individual Mandate fact sheet.
Covered CA can provide a detailed list of their exemptions.
The Volunteer Income Tax Assistance (VITA) program offers free tax help to people who generally make $53,000 or less, persons with disabilities, the elderly and limited English-speaking taxpayers who need assistance. IRS-certified volunteers provide free, basic income tax return preparation with electronic filing to qualified individuals.
The California Earned Income Tax Credit (EITC) is a new cash back tax credit for California’s working families and individuals. The California EITC means more money in the pockets of working families that can be used to help pay for the costs of health coverage and care. Use this infographic and chartto see if you qualify.
Help Others Get Covered
We have provided a LCFF Fact Sheet, LCAP Talking Points and LCAP Sample Language for your use. Help create a “culture of coverage in your district. Please contact us directly for more inquiries.
Care Glossary
- Eligibility: Some health plans, such as those through Medi-Cal, require you to prove that you are eligible based on how much money you make and where you live.
- Employer-Sponsored Insurance (ESI): Depending on your employer and how many hours you work per week, you may be eligible for health insurance through your job. If your employer offers health insurance, they may cover some of your health care expenses.
- Federal Poverty Level (FPL): The federal poverty level is the federal government’s definition of poverty. It is an amount of money that a household makes in dollars. The government uses that level to determine whether people qualify for certain programs, including Medi-Cal and premium subsidies in Covered California. You can qualify for different health coverage options based on how your income compares to the FPL. This is always given as a dollar amount. For example, adults are eligible for Medi-Cal if they make 138 percent or less of the federal poverty level. That means that adults qualify for Medi-Cal if yearly household income is less than $33,465 for a family of four. (2016 Federal Poverty Guidelines)
- Health Insurance: A health insurance company promises to pay for specific medical services in exchange for your monthly payment.
- Health Plan: A package of medical service benefits offered to members by an insurer. Typically, each insurer offers multiple health plans to choose from.
- Individual Mandate: Under the Affordable Care Act (Obamacare), most Americans have to have health insurance—it’s the law. If you don’t have health insurance, you will be required to pay a tax fine (also called a tax fee or a tax penalty) for not having health insurance when you pay your taxes. You will be fined for the amount of months you didn’t have health insurance, and the amount you owe increases every year that you don’t have health insurance.
- Medicaid: In California, Medicaid is known as Medi-Cal. It is a partnership between the US government and the state of California in which California gets money from the US government to provide health coverage to low-income people.
- Medicare: Medicare is a program run by the US government to provide health coverage to Americans age 65 and older and some Americans with disabilities.
- Copayment: A set dollar amount that you pay when you go to a doctor or other health provider visit. The amount you pay depends on what kind of provider you are seeing, what health concern you are seeing them for, and the health plan you have.
- Cost Sharing: Where you or your family members have to pay some of the costs of the care you get. An example of cost sharing is a copayment.
- Cost Sharing Subsidies: Some people who buy health insurance through Covered California can get money from the government to help pay for cost sharing (see Cost Sharing). This is in addition to the financial help many people can get in Covered California to help pay monthly premiums (see Premium and Premium Subsidies).
- Deductible: A deductible is an amount of money you pay out of pocket on covered health care services before the insurance company begins to pay for those services. For example, if you are enrolled in a health plan with a $1,000 deductible, you must pay the first $1,000 of costs for health care services before insurance will begin to pay for your care.
- Out-of-Pocket Costs: These include health care costs, such as deductibles (See Deductibles), copayments (See Copayments), and co-insurance, that are not covered by insurance. This does not include monthly premium costs (even though those costs also come out of your pocket).
- Out-of-Pocket Max: This is the most that you have to pay for health care costs in a given year. This also does not include monthly premiums.
- Premium: The amount you pay each month for health insurance. If you have Medi-Cal, you may not have to pay a premium.
- Premium Subsidies/Tax Credits: A premium subsidy is money you can get from the US government to help pay for health coverage. If you purchase health insurance through Covered California, you can get financial help in the form of premium subsidies to help lower your monthly costs. The amount that you get is based on the amount of money you make (See FPL). The federal government pays for the subsidies. Premium subsidies are also known as tax credits.
- COBRA: If you lose your job, you can continue your health insurance plan from your employer for up to 18 months through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).
- Renewal: You must update enrollment in your health insurance every year in order to stay covered. You can choose to continue with the health coverage you have or make changes to your coverage, which can mean switching health plans.
- Benefits Package: The services, such as provider visits, hospital stays, medications, and tests, that are covered by your health insurance plan. The benefits package will also explain any cost sharing for services and limits on how much of a service you can get.
- Child Health and Disability Prevention (CHDP): This program delivers periodic health assessments and other services to children under 21 who are enrolled in Medi-Cal, or children under 19 with a family income less than or equal to 200 percent of the Federal Poverty Level. CHDP can help with medical appointment scheduling, transportation, and access to diagnostic and treatment services.
- Early and Periodic Screening, Diagnostic & Treatment (EPSDT): States are required to provide complete health care services for children under 21 who are enrolled in Medi-Cal. This includes preventive, dental, mental health, developmental, and specialty services.
- Fee-for-Service: A way of paying for health services where doctors, hospitals, dentists, and other providers are paid for each service they perform. They are paid a fee for every service they perform, which is why it is called fee-for-service.
- Managed Care: In Medi-Cal, most people are enrolled in managed care plans. The managed care plan is paid by the state to find doctors and other health care providers who will care for you and your family.
- Medical Home: A medical home is the name for a primary care doctor or other care provider who sees you for yearly physicals and routine care. That person is then responsible for helping you with all of your health care needs, including connecting you to specialists when you need them, and makes sure you get the care you need.
- Preventive Care: Preventive care is the routine care that you get when you are not sick. This can include exams and checkups. It is one of the biggest advantages of having health coverage; preventive care can help you not get sick.
- Primary Care Provider (PCP): Your primary care provider is your main doctor or other health care provider who you go to for checkups or when you get sick or have a health concern. For children, pediatricians are usually the best primary care providers.
- Specialty Care: Medical care that requires you to go to a physician specialist (such as a cardiologist for heart conditions or a dermatologist for skin conditions) rather than your primary care or family doctor.
Connect Your School to Certified Enrollment Counselors
Research has demonstrated that 7 out of 10 of those applying for health coverage see receiving one-on-one help as critical to their enrollment. Certified Enrollment Counselors (CECs) can educate families about their eligibility for health coverage options and walk them through the enrollment process to get them enrolled. This is especially important for helping families with newly eligible children apply for Medi-Cal.
Below are three ways that schools can offer regular appointments with CECs to enroll children and families in Medi-Cal or Covered California health coverage.
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Find a certified agency near you. Use the CCHI Directory and connect with a CEC in your county.
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Set a regular date and time for a CEC to visit your school to enroll students and families.
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Provide CEC’s contact information to families or ask families for permission to have CECs contact them so they can meet at a time and place that’s most convenient for them.
