Karla Montenegro Gonzalez: Hi everyone, welcome to tonight's session about the introduction to Medi-Cal and Covered California, you will get to learn a little bit more about your health options, but in the meantime, we're going to go ahead and allow participants to start joining the webinar.
Thank you everyone for joining. So we're going to go ahead and start with tonight's session. My name is Karla Montenegro Gonzalez and I am the DREAMers
Support Lead here at Moorpark College. Today we're in partnership with Aurora Ortiz from Human Services Agency in Ventura County, as well as Catherine Pedrosa, who is here, a close partner with the Covered California
health insurance campaign. The focus for the night is on undocumented families. So please,
so we're going to have, we're going to allow you all to ask the questions in the chat here at the Q&A and we will address them at the end of the presentation for each representative,
and then my quick Zoom disclosure for everyone is that the webinar has been configured to have the highest level security for your protection.
You have the option to ask questions and participate with your identity or anonymously. Questions, comments, and any other form of Zoom bombing will not be tolerated. Closed captioning can be found on the
on the toolbar at the bottom of your Zoom and at the moment we are waiting for Spanish interpreter, however, as soon as we have a person that is going to be interpreting for you, we will announce that. Thank you.
So without further ado, I would like to introduce Aurora Ortiz with the Human Services Agency.
Aurora Ortiz: Good evening. My name's Aurora Ortiz as Karla mentioned with the Human
Services Agency, the Medi-cal and the CalFresh programs. So we're going to go ahead and give you a brief overview to the Medi-cal program. Now currently
Medi-cal and Covered California work hand in hand, which you'll learn more information about Covered California from Catherine Pedrosa.
Next slide please?
So what is Medi-Cal? Medi-Cal is California's version of the federal Medicaid program. Anyone can apply any time throughout the year.
It provides health care coverage at no cost, and at low cost to children and adults with limited income and resources. This program is funded by both the state and the federal government.
The Department of Health Care Services oversees the Medi-Cal program and the local county offices manage, most of the Medi-Cal cases for the Department of Health Care Services. Next slide please?
So the general requirements, you must be a California resident, proof of identity needs to be provided, Social Security numbers if applicable,
proof of income and resources, resources are only applicable for certain programs, and an application for Medicare and any unconditionally available income, such as unemployment or Social Security, if an individual may be eligible for these programs.
So next slide?
Karla: Sorry, before moving on to the next slide, I would like to announce that this Spanish interpretation is readily available. So feel free to click on the world icon next to the closed captioning on this Zoom toolbar to join in Spanish. Thank you.
Aurora: Okay.
Thank you Karla. So factors used to determine Medi-Cal eligibility, So we use your income, your age, your family size, the tax household size and tax filing status,
whether an individual is pregnant, blind, or disabled, in some cases, and for some programs property and resource limits do apply, and whether or not the individual is receiving Medicare.
So Medi-Cal Eligibility is determined at an individual level. So, different people in the same family may have different eligibility when it comes to the Medi-Cal program.
Next slide?
So we also have what's known as a Share of Costs. So for those individuals that don't have Medi-Cal
without a Share of Cost, so they are required to pay
a loan or an amount based on their income. So for some individuals, they may have what's known as a Share of Cost. The Share of Cost is a Medi-Cal recipient's monthly
dollar amount they must pay or agree to pay towards their medical expenses before Medi-Cal pays for services.
This function similarly to a deductible and only needs to be met in the months that you get health care services. After you meet your Share of Cost Medi-Cal pays for your covered medical costs for the rest of the month. The Share of Cost starts again the following month.
Next slide?
Okay so information on citizenship.
United States citizens, qualified immigrants, and non qualified immigrants under the age of 26 are entitled to full-scope Medi-Cal benefits.
US citizens must provide proof of citizenship and identity and qualified immigrants must provide an alien number or proof of immigration status.
Non qualified immigrants age 26 and older and US citizens who are unable to provide proof of citizenship are entitled to restricted services. This generally only covers pregnancy, limited emergency care, and long term care.
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So for DACA, this is the Deferred Action for Childhood Arrivals, this is known as a PRUCOL Category.
So on June 15, 2012 the Secretary of Homeland Security declared that individuals who came to the US,
under the age of 16 and met certain criteria could request consideration of deferred action status for a period of two years and it's renewable.
The United States Citizenship and Immigration Services of consider individuals for deferred action status if they have documentation to verify that they meet these guidelines.
DACA individuals are considered to be lawfully present in the US and they are eligible to state funded full-scope Medi-Cal
under the PRUCOL rules. However these individuals are not considered lawfully present for the purposes of purchasing insurance, through the health benefit exchange or Covered California.
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So we also have what's called a Retroactive Medi-Cal. As I previously mentioned, Medi-Cal, you can apply throughout the year. So if you apply in January and you just
find that you had medical bills in the month of December, you may be eligible to apply up to three months prior to your date of application.
So Medi-Cal may provide retroactive coverage for health care services received by an applicant during any of the three months immediately prior to the initial month of application. A Retroactive Medi-Cal request must be submitted within one year of the retro month being requested.
Next slide?
Now there are different ways that you can apply. You can apply through My Benefits CalWIN, which is the county portal. You can apply through Covered California.
You can apply through our community service centers throughout Ventura County. Currently due to COVID 19 our offices are closed,
but once they reopen, you can certainly come in and apply in person. All our offices do have applications available to pick up paper applications outside of our offices.
So if you'd like to pick up a paper application, complete it, and drop it off, we do have drop boxes outside of each of our offices as well during COVID 19.
You can also apply over the phone by calling our customer service line,
by mail and via fax.
So next slide?
So what's covered? What is covered by Medi-Cal. So Medi-Cal covers most medically necessary care. This includes doctor and dentist appointments, prescription drugs, vision care, family planning, mental health, and drug or alcohol treatment. Medi-Cal also covers transportation to these services.
Next slide?
So what is managed care? Ventura County has managed care system with a single plan, which is Gold Coast health care plan.
This functions just like an HMO for Medi-Cal beneficiaries, most of you who are automatically enrolled.
Most Gold Coast Health Plan members must choose a primary care physician under contract with Gold Coast Health Plan,
and only pharmacies under contract with Gold Coast Health Plan Optum Rx will provide coverage to members for medications and pharmaceutical products. This will change effective January 1, 2021.
Next slide?
So what is fee for service or Gold Coast admin members?
Medi-Cal fee for service are individuals that are not enrolled in Gold Coast, they can change to any provider who accepts Medi-Cal and health care providers are paid for each service.
Gold Coast health administrative members are individuals that have a Share of Cost, or long term care, or have other health insurance, in addition to Medi-Cal. They're not required to select a primary care physician and they can go to any provider who accepts Medi-Cal. Next slide?
So these are some important resource numbers for the Gold Coast Health Care Plan. So we have our member services number, we have the Optum Rx number, we have
Beacon Health Options, and if you have Medi-Cal full-scope Medi-Cal, Denti-Cal is also part of that program. And then we have the Vision Services Plan, you would contact VSP for any vision.
And that brings me to the end of my presentation. Does anyone have any questions?
Karla: Although there are no questions at this time, we can go ahead and move forward with the next part of the presentation with Catherine Pedrosa.
Whenever we're ready to move forward with the second presentation, we'll go ahead and start. [Catherine Pedrosa]: Great.
So if we can pull up the Covered California slides? Good evening, everybody. My name is Catherine Pedrosa and I'm with United Way Ventura County.
I am the Covered California Navigator, and so what that means is I help people understand our kind of confusing healthcare system,
whether it's Medi-Cal, or Covered California, or even private insurance and help people navigate through the different systems to try and find the health care that is the right health care for them. Next slide please?
So what is Covered California, and what does Covered California offer? So
about a dozen, not even a dozen a decade ago, Congress passed and the President signed into law the Affordable Care Act, and as a result Covered California was born shortly after.
Covered California is California's version of the Affordable Care Act's marketplace. So through Covered California people who don't get health insurance from their employer,
who don't get who are no longer eligible for health insurance coverage through their family members, or who may not qualify for Medi-Cal they can buy health insurance through Covered California.
So it's health insurance that's affordable, because Covered California offers federal financial assistance, so a subsidy based on your income to help
buy health insurance. It also reduces in some cases co-pays. That's the amount that you pay out of pocket when you go visit a doctor or if you have a service like a surgery or a hospital visit
and it also reduces deductibles. Deductibles are the amount of basically your out of pocket expense, if you have a certain type of health plan, it's what you have to pay out of pocket before the health plan kicks in.
But as a result, Covered California does have some things that it makes sure all health plans, regardless of which health plan you choose, offer, it makes them offer these benefits like preventive care.
So all preventive care is free. So if you go for your well person visit,
once a year, or if you have a child and your child goes in for a well child checkup once a month, or I'm sorry, once every few months or once a year, that is a free visit. There's no co-pay or no fees associated with that visit.
And just like Aurora was saying with Medi-Cal the,
how much you pay,
how much financial assistance you get is based on how old you are, where you live, your household size and income, it's the same formula with Covered California. Next slide please?
Okay, so I just wanted to step back for a moment and also give you an idea of what the improvements are with the under the Affordable Care Act.
So the Affordable Care Act guarantees coverage for everyone. So that means, and you've probably heard a lot about pre-existing conditions,
that means anyone with a pre-existing condition is is able to get health care coverage. So, doesn't matter if you have diabetes, or if you have high blood pressure,
or if you've had a surgery, maybe when you were a child, anything like that in the past those might have been barriers for you to get health insurance to buy health insurance on the private market, it can no longer be a impediment to you getting health insurance now.
There's no annual limits. So in the past there have been limits to how much healthcare you could use. So if you had cancer, for example, and you
the health plan spent a lot of money on your cancer care, you could come across a limit as to what the health insurance plan would pay out on your behalf. So those limits, no longer exist under the Affordable Care Act.
Rates are not based on your health status. So whether you have diabetes, or whether you're a smoker, that doesn't, those are those factors are not taking into consideration
with the rate that you pay for your health insurance coverage. It also requires large employers to offer coverage to their employees. So really important to know if your company that you work for
covers or has employees have more than 50, then that company is required to offer health insurance coverage to its employees if it's under 50, then it's not required.
And again, affordable coverage, based on your financial circumstances.
Next slide please?
Okay, so this is gonna, this chart is going to give you little bit of an idea of how
your financial assistance works based on your income level and it's a little confusing, but keep in mind that Medi-Cal and Covered
California work hand in hand. They work together. So if you qualify for Medi-Cal then you don't qualify for Covered California.
And vice versa, if you qualify for Covered California you may not, you don't qualify for Medi-Cal. However, as Aurora spoke about earlier,
you can have one family where some family members qualify for Medi-Cal and other family members qualify for Covered California.
For example, if you have a family of two adults and two children, if that family make $60,000 a year, the adults will qualify for Covered California with financial assistance,
but the children will qualify for Medi-Cal so with medical they'll qualify for full-scope, meaning they don't have to the everything's covered and they don't have to pay for the kids,
but the parents have Share of Costs. So they pay a monthly premium to the health plan that they choose and they pay co-pays and deductibles, that kind of thing. So it's when
you apply either through the county, or through the Covered California website, or through a certified enrollment counselor, like myself, this is basically
the chart that we look at or this is how it's calculated as to whether you qualify for one program or the other and how much financial assistance you qualify for.
Next slide please?
Okay, so there are 10 essential health benefits and it's
Aurora covered most of this already, but just to reiterate, whether or not you have Medi-Cal, or Covered California, or even private insurance through an employer,
all health insurance plans have to cover these 10 essential health benefits in order to be considered, you know, compliant with the Affordable Care Act.
So things to know is that all emergency services, if you go into the emergency room that's a covered benefit if you have to be hospitalized or admitted into the hospital, of course, that's the covered benefit. Any maternity newborn care.
Prescription drugs, lab services, and pediatric services. So if you're under 18 or
you haven't yet reached your 19th birthday, then any services, whether it's doctor visits are included, but they're also including dental and vision for children. So unlike with adults,
dental and vision are not part of the 10 essential health benefits only for children.
Next slide please?
Okay. So the big question is, are you eligible for Covered California? So
you have to be in order to be eligible for Covered California, you have to be a lawful permanent resident, so a green card holder.
You can also be a non immigrant status holder, so people with worker visas or student visas are able to purchase health insurance through Covered California.
Lawful temporary residents and they're very specific categories of these folks, and then people who are considered refugees or a asylees again, they're very specific
categories of immigrants as well as those who have, who've been granted temporary protected status. So I think
like folks from Haiti, they are part of a temporary protected status. So they would fall under this. So those are the folks that are eligible for Covered California. So at this point,
people who are in the DACA program are not eligible for Covered California, but are eligible for Medi-Cal.
Next slide please?
Okay, so I spoke about this a little bit already. If you're not lawfully eligible or lawfully in California, then you are eligible for Medi-Cal and you may qualify for full-scope Medi-Cal until age 26, or if you have a pregnancy.
And next slide?
I think that's...is that
my last slide. Yes, that is. So,
I think Aurora covered pretty well, how you can access either Medi-Cal Covered California. There's no wrong way to apply for coverage. You can apply for coverage
directly to the county to Human Services Agency. You can apply to on the Covered California website yourself, or through a navigator or a
Certified Enrollment Counselor, like myself.
You can call or you can, not walk in, you can call or you can talk to somebody who is also like a community, there are community
reps out there who also do enrollment for Medi-Cal and Covered California. So there's no wrong way to go and and everybody's here to help you figure out which program is going to be the right program for you.
So hopefully that makes sense.
Karla: Yes, thank you Catherine and Michael, can I ask you to put up that's live from Aurora Ortiz, who had the contact information, so our participants can refer back to it and take a picture, so they can get in contact with
either Catherine or in moving forward with
how to apply?
Aurora: I believe that's slide number nine, Michael.
Thank you. [Karla]: Perfect. Thank you. So for all our participants, please take a picture of this.
Catherine: And I'm going to add in the chat,
my contact information, as well because I forgot to include that in the slide.
Karla: Thank you.
Aurora: I'm sorry, Michael, I think it's slide number nine.
There you go.
Karla: Oh, there we go.
Aurora: Thank you. Thank you.
Karla: Okay, so I'm gonna go ahead and just re-share Catherine's information for all attendees here too.
So once again, if you have any questions please feel free to drop them in the Q&A,
but if you just happened to join us, we just wanted to reiterate that Aurora can be contacted by the information that you find on this slide that you find in front of you, and then if you would like to contact Catherine, then you can find her information in the chat section.
Alright everyone, so this concludes the presentation for today. I really want to thank Catherine and Aurora for their time.
This information is really necessary at this time, I feel, you know, many people are wondering when it's a good time to apply and the right time to apply is now. So getting contact with them...
Catherine: Oh I oh I completely forgot one other thing to mention,
that I don't think Aurora or I covered, is that Medi-Cal enrollment is year round.
So there's no
deadline or, you know, you have to apply on this date, however, with Covered California open enrollment is when people
can apply and get into coverage and that starts November 1. So November 1 through January 31 is Covered California is open enrollment time period and only once a year
are people allowed to get into Covered California, unless you have some sort of change during the course of the year, like you lost your health insurance,
or you move into the county, that kind of thing. Those are very specific circumstances to get into Covered California, otherwise it's limited to open enrollment.
Anything to add there Aurora, did I get that?
Aurora: Nope, you covered it.
Catherine: Okay, great.
That's an important one. Sorry about that.
Aurora: One thing I do want to mention that on this screen here. It's our customer service line. So you wouldn't actually speak to me,
but the eligibility staff do monitor that line. So if you do contact our customer service line, you will be placed in queue to actually speak to an eligibility staff.
Karla: Okay, good to know.
Aurora: Thank you.
Karla: Okay, so we do have a question in the Q&A.
Let's see.
Can you send us your question?
Okay, we'll wait for the
student to send in the question.
Catherine: Karla, did we cover everything as far as you are concerned? Is there anything you wanted to us to cover some more of?
Karla: Um...
I think that you covered pretty much everything. I think that maybe what we're going to do to make this a little bit more accessible is enabled that feature for hand raising.
So if participants want to ask their question out loud, and they can raise their hand and then I can mute them and bring them up to ask their questions, that may be easier.
Okay, so we have
for the attendees, can you please raise your hand again, so I can allow you to talk?
Thank you everyone for your patience. I have a feeling that we are experiencing some technology issues, but,
we're going to give it a couple more minutes because I did see the participant attempt to participate again.
Okay everyone, so we're going to go ahead and conclude this webinar tonight. I just want to reiterate that, please take an take a picture of the information that is on your screen as well as
look over to the chat for Catherine's information, and get in contact with them, and get that health insurance applications going, and see what you qualify for, see what your family qualifies for as they mentioned, you may be different, but they're happy to help you figure that out.
Catherine: And you can also use the health center on campus. Obviously can't go in, but if you call the health center on campus they also have that information, as well. They have my information and they have,
you know, Human Services' information as well.
Karla: Okay, perfect. Thank you everyone for joining. Thank you Catherine.
Catherine: Course, thank you everybody.
Aurora: Thank you. Thank you.
Karla: Alright everyone, good night.
[Catherine]: Goodnight. [Aurora]: Night.