The Affordable Care Act has dramatically influenced the Medi-Cal program, which provides health insurance to low-income children, parents, and adults. The substantial impacts of the ACA on Medi-Cal, including eligibility, coverage, costs, and transitions, are examined in this article.
The ACA established new protections for people with preexisting conditions and required that plans include essential benefits like prescription drugs. These reforms help ensure that low-income Americans can access the care they need at reasonable prices.
1. Coverage
The Affordable Care Act changes how you get and pay for health insurance. In addition to lowering costs, the Act is also expanding coverage. For example, it extends the range to young adults until age 26, bans lifetime limits on benefits, and makes it illegal for health plans to deny or charge more for people with preexisting conditions.
Medi-Cal, California’s Medicaid program, provides free or low-cost medical and dental services to more than 14 million low-income beneficiaries in the State. You must meet income and health status criteria to be eligible for Medi-Cal.
Most Medi-Cal beneficiaries are enrolled in a managed care plan their county human services department runs. Typically, this kind of plan involves a vast network of medical facilities.
In addition, it is also essential to find a pharmacy that accepts Medi-Cal. With this, members will access a broader network of pharmacies and can avail of the doctor’s prescription anytime.
Many counties also offer fee-for-service Medi-Cal, where you use your doctor and facility. If you wish to avoid becoming a part of a managed care plan or reside in a region without managed care plans, this is a suitable alternative.
While these policies have existed for years, the ACA has expanded them to more Americans. The ACA has also made it harder for employees to lose health care coverage due to strikes or labor disputes.
In the past, those who lost coverage during these times were at risk of being denied health care for several months, which could be very expensive. With the ACA’s expansion of
coverage, workers can no longer face these penalties and receive healthcare coverage immediately after applying.
2. Eligibility
California’s Medicaid program, known as Medi-Cal, covers a variety of medical treatments for children and adults with low incomes and resources. Federal and state taxes fund it. Regardless of gender, ethnicity, religion, color, national origin, sexual orientation, marital status, age, disability, or veteran status, it is accessible to children and adults.
The ACA provides a significant expansion to the number of people who are eligible for Medi-Cal. Starting in 2020, individuals will no longer be required to qualify based on income. In addition, the Affordable Care Act increases the eligibility thresholds for low-income families. This increase will make it easier for more low-income individuals to receive coverage and save money on health care premiums.
Previously, individuals could only be enrolled in Medicaid if they were a child, a pregnant woman, a parent and a caretaker relative, certified disabled, or elderly. The ACA expanded Medicaid to childless adults up to 133% of the Federal Poverty Level. This provision is particularly beneficial for women barred from Medicaid before the ACA since it opens up a large pool of eligible people to the state’s health insurance program.
3. Costs
The Affordable Care Act has changed how health care is provided in the United States. One of the most significant changes is that most Americans must have health insurance or pay the penalty based on their income levels. These changes have been designed to help people afford their coverage.
The ACA also mandated that private insurers cover preventive services, such as cancer screenings and cholesterol tests, at no cost to patients. These benefits are critical to reducing costs and keeping Americans healthy. But if these services were removed, millions of Americans would lose these lifesaving resources.
Despite these gains, the ACA’s high enrollment has also led to a rise in the overall costs of Medi-Cal programs. These increases are partly due to the influx of new high-cost drugs, required payments to primary care providers, and expanded adult coverage.
In addition, many people who lose their insurance will have to pay for care independently. This will strain already underfunded hospitals, which could lead to more closures.
Under the ACA, Medicaid has expanded to serve low-income children, pregnant women, older adults, and people with disabilities. The program is funded by the federal government and state funds, including funds generated from provider fees and transfers from local governments.
As a result, more than half of all California’s eligible adults and children are covered by Medi-Cal. The program pays for doctor visits, hospital stays, prescription drugs, and other medical services.
Some Medi-Cal programs have low monthly costs, and others are more expensive, depending on the plan and the beneficiaries’ income. If you are eligible for Medi-Cal, it is essential to understand your costs to choose a plan that fits your needs and budget.
Another essential factor to consider is your out-of-pocket maximum. This is the total amount you will have to spend each year for covered services before your plan will start paying 100%.
To estimate your out-of-pocket maximum, consider what health and drug services you need and how often you will use them. Enter this information in the tool below to find your estimated yearly costs for different plans.
4. Transition
Those who lose Medi-Cal eligibility due to a change in income may transition to a Covered California plan or another form of health coverage, such as an employer-sponsored plan. The State estimates that this may affect 2 million to 3 million people.
In the past, individuals who lost their Medicaid coverage often could not find an affordable plan to meet their needs. This could result in a gap in care or even lead to uninsured status. However, state officials say they are working to ensure that people will have access to insurance in the future.
The State is moving to a competitive bidding process for Medi-Cal contracts as part of this effort. The new arrangements will include tighter quality standards, financial penalties for providers that don’t meet the goals, and more emphasis on monitoring primary care utilization and identifying patients that may be missing preventive care opportunities.
The move to competitive bidding is expected to improve patient outcomes. Still, it will also mean that more than 1.7 million Medi-Cal patients may get a new insurance provider and experience a disruption in their care. Many providers have said they need to prepare to handle more patients or that the new providers need to be able to meet the requirements.
To help ensure the new providers are prepared for the influx of Medi-Cal patients, the State will launch a secure provider portal for physicians to register as soon as possible. The Portal will allow physicians to manage prescriptions for Medi-Cal patients and submit prior authorizations via fax.
