Medi-Cal’s “Senior Penalty” Ends Dec 1st – Yes!

We’ve got some great news! Medi-Cal’s “senior penalty” ends December 1, 2020 by raising the income limit for Medi-Cal’s Aged & Disabled program from 123% to 138% of the federal poverty level. This change will allow another close to 30,000 older Californians to receive full Medi-Cal.

This change has been a long time coming, as the legislation, AB 715, was signed into law the summer of 2019. In addition, AB 1088, designed to stop what’s known as the “yo-yo effect”, will also be implemented as of December 1, 2020. This legislation will keep seniors and persons with disabilities from losing access to free Medi-Cal due to a confusing Medi-Cal rule that creates fluctuations in how income is counted even though a person’s actual income has not changed (read more on AB 1088 here).

Why ending the “senior penalty” is important
Due to the Affordable Care Act, most adults in California qualify for full Medi-Cal with incomes up to 138% of the poverty level ($1,468/month for an individual). Yet, when someone turns 65, they must get their Medi-Cal through the Aged & Disabled Federal Poverty Level (A&D FPL) program. And to get full Medi-Cal through this program, in the past they could only have incomes up to 123% of the federal poverty level.

This means that if someone’s income was even just $1 above the 123% limit, they would have Medi-Cal with a Share of Cost, and be required to spend hundreds of dollars first before their Medi-Cal coverage would kick in. Having such a large Share of Cost can create significant financial hardship, and, in many cases, forces older adults to chose between health care, rent or food.

As of December 1, 2020, however, with the end of the “senior penalty”, most older adults or persons with a disability won’t need to worry about falling into this situation. A person who qualifies for full Medi-Cal at age 64, can most likely continue on full Medi-Cal through the Aged & Disabled Federal Poverty Level program when turning 65, as long as their assets are no more than $2,000/individual and $3,000 for a couple.

The new income limits for A&D FPL as of December 1st are: $1,468/month for an individual ($17,609/year); and $1,983/month for a couple ($23,792/year). The assets limits are $2,000/individual and $3,000 for a couple.

If you currently have Medi-Cal with a Share of Cost and will qualify for full Medi-Cal with the end of the “senior penalty”, you should automatically receive full Medi-Cal as of 12/1/20. That said, we recommend you contact your county Department of Health Care Services’ eligibility worker to make sure this will happen. If you experience any problems with this transition, contact your local Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222.

Karen Joy Fletcher

Our blogger Karen Joy Fletcher is CHA’s Communications Director. With a Masters in Public Health from UC Berkeley, she is the online “public face” of the organization, provides technical expertise, writing and research on Medicare and other health care issues. She is responsible for digital content creation, management of CHA’s editorial calendar, and managing all aspects of CHA’s social media presence. She loves being a “communicator” and enjoys networking and collaborating with the passionate people and agencies in the health advocacy field. See her current articles.