Wednesday, March 29, 2017

Medi-Cal Redetermination, Changing to a New Job, and Appeals Hearing

In November of 2016 I received redetermination paperwork from Medi-Cal for my children's coverage. I had changed jobs in August 2015 and they had my old employer on there. I indicated the change and sent it in with a pay stub from my new job.

In January of 2017 I received a letter telling me that my children's coverage was ending because I made too much. They thought our family made $8,000 or so a month. I wish! I immediately filed an appeal so that the coverage would not lapse and so I could present the evidence. Additionally I reapplied for my children through Covered California which, no surprise, told me they were sending it to Medi-Cal.

Prior to the initial cut-off date I received a letter indicating that my request for an appeal had been received and the coverage would continue for now. In February after the cut-off date, I was no longer able to fill my children's prescriptions. I called the state social services who confirmed the coverage should be active. Then I called the insurance company who had not received any notification that the coverage was to be continued. They looked my children up and determined that they were still active, so they sent the information to a different department for manual reactivation of insurance coverage.

I was still unable to fill my children's prescriptions at that point. I called again to find out that while the coverage had been reinstated in the insurer's system, the prescription coverage was not. Fortunately the rep on the phone took care of it while I was on the phone.

Toward the end of February I received a call from Medi-Cal and they told me what the problem was. They were adding the income from my old job to my new job and they needed proof from my previous employer that I was no longer working there. I sent that in. I also received a notice from state social services confirming my telephone hearing date and time. I also provided them with the same information via fax.

In the middle of March I received a notice from Medi-Cal that my children were in fact eligible. I figured when the telephone hearing came up I would simply confirm with the person on the phone.

The date of the hearing came up and all of a sudden I got two voicemails from them about not being able to reach me. As it turns out, these people call from a hidden number. I have hidden numbers blocked because I get overwhelmed with scam calls and telemarketer calls. Fortunately my issue was already resolved or I would have been really upset.

The moral of the story: even though the redetermination paperwork does not say you need to provide it, if the redetermination paperwork lists a job that you no longer have, you need to send in a copy of a signed letter from your previous employer listing the dates you worked. Also if you have a telephone appeals hearing coming up, make sure you aren't blocking hidden numbers.

One more year from now and we won't qualify anymore. I am actually thankful for this. This isn't the first time I've tangled with Medi-Cal. Back when Gov. Brown folded the Healthy Families program into Medi-Cal, Healthy Families cut my kids instead of transitioning them. Then, of course, Healthy Families couldn't correct their mistake because they couldn't accept any enrollments because they were shutting down. I ultimately had to apply again through Covered California to get them on Medi-Cal.

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