Pib xyoo 2014, Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau ua haujlwm nrog cov neeg koom tes los siv Txoj Haujlwm Affordability and Benefit Program rau Cov Poj Niam Cev Xeeb Tub uas Muaj Nyiaj Tsawg, raws li Senate Bill 857, (Tshooj 31, Statutes of 2014) Welfare and Institutions (W & I) Code Sections, 14148.65 thiab 14148.67, raws li kev pom zoo ntawm tsoomfwv. Cov rooj sib tham no kuj tau ua rau muaj kev koom tes nrog Covered California los siv Full-Scope kev pov hwm kev noj qab haus huv los ntawm Qualified Health Plans (QHPs), raws li kev pom zoo los ntawm tsoomfwv. Xyoo 2015, cov rooj sib tham tau raug tso tseg vim DHCS nrhiav kev taw qhia los ntawm tsoomfwv txog kev pabcuam ntsig txog kev cev xeeb tub kom ua tau raws li Minimum Essential Coverage (MEC). DHCS txuas ntxiv ua haujlwm nrog cov neeg koom nrog ua ib feem ntawm Assembly Bill 1296 thiab Eligibility Expansion stakeholder stakeholder workgroup, suav nrog Pregnancy Workgroup subgroup. Kev pab them nqi Medi-Cal rau cov poj niam cev xeeb tub tau piav qhia hauv qab no.​​ 

Raws li W&I Code Seem 14102, DHCS tam sim no ua haujlwm ze nrog Covered California los tsim kom muaj QHP pub dawb rau Cov Neeg Tsiv Teb Tsaws Chaw Tshiab (NQIs) uas raug txwv tsis pub nkag tebchaws tsib xyoos thiab lwm tus yuav tsim nyog tau txais cov txiaj ntsig Medi-Cal raws li pawg neeg laus tshiab raws li W&I Code Seem 14005.60. Cov NQIs yuav muaj peev xwm xaiv rau hauv txoj kev npaj tsis them nqi thiab tau txais lawv cov kev kho mob los ntawm cov kws kho mob QHP. DHCS yuav them tus nqi them txhua hli thiab txhua tus nqi sib koom them, suav nrog cov nqi deductible, coinsurance, copayments lossis cov nqi zoo sib xws sawv cev rau NQI. Cov NQIs uas tsis xaiv rau hauv Covered California QHP uas tsis muaj nqi yuav tsim nyog rau Medi-Cal uas muaj kev txwv xwb. DHCS xav tias yuav siv tau rau lub Ib Hlis Ntuj xyoo 2017. Cov ntaub ntawv hais txog NQIs thiab QHP kev them nqi tuaj yeem pom ntawm Assembly Bill 1296 thiab Eligibility Expansion stakeholder workgroup uas teev nyob rau hauv nplooj ntawv web Immigration Workgroup.​​ 

Medi-Cal kev pab them nqi rau cov poj niam cev xeeb tub muaj xws li:​​ 

Medi-Cal kev pab them nqi rau cov poj niam cev xeeb tub ntawm 0 feem pua txog 138 feem pua Federal Poverty Level (FPL)​​ 

Txij li Lub Yim Hli 1, 2015, DHCS tau txais kev pom zoo los ntawm tsoomfwv kom nthuav dav kev pabcuam rau cov poj niam cev xeeb tub uas muaj cov nyiaj tau los ntawm 0 feem pua txog 138 feem pua ntawm FPL. Cov poj niam cev xeeb tub uas tsim nyog yuav tsum tau sau npe rau hauv Medi-Cal txoj kev npaj kho mob tshwj tsis yog tias lawv xaiv nyob nrog lawv tus kws kho mob hauv Fee-for-Service thoob plaws lawv cev xeeb tub thiab tom qab yug menyuam. Kev nthuav dav ntawm kev pab them nqi yuav ua kom cov poj niam cev xeeb tub tau txais txhua yam kev pabcuam kho mob uas tsim nyog.​​ 

Medi-Cal kev pab them nqi rau cov poj niam cev xeeb tub siab dua 138 feem pua FPL​​ 

Tsis tas li ntawd, cov poj niam cev xeeb tub uas cov nyiaj tau los tshaj 138 feem pua txog 213 feem pua ntawm FPL tau txais kev pab them nqi kho mob ntsig txog Medi-Cal. Cov kev pabcuam cev xeeb tub yog cov kev pabcuam uas yuav tsum tau ua kom muaj kev noj qab haus huv ntawm tus poj niam cev xeeb tub thiab tus menyuam hauv plab. Cov no suav nrog, tab sis tsis txwv rau, kev saib xyuas ua ntej yug menyuam, kev pabcuam rau lwm yam mob uas yuav ua rau muaj kev xeeb tub, kev ua haujlwm, kev yug menyuam, kev saib xyuas tomqab yug menyuam, thiab kev pabcuam npaj tsev neeg. Cov kev pab cuam rau lwm yam mob uas yuav ua rau muaj teeb meem xeeb tub, suav nrog cov kev kuaj mob, kev mob nkeeg, lossis kev kho mob uas yuav ua rau muaj kev phom sij rau tus menyuam hauv plab mus rau tag nrho lub sijhawm lossis kev nyab xeeb ntawm tus menyuam hauv plab. Cov kev pabcuam cev xeeb tub tuaj yeem muab ua ntej yug menyuam txij hnub uas cev xeeb tub raug kho mob thiab tom qab yug menyuam mus txog rau thaum kawg ntawm lub hli uas 365 hnub tom qab yug menyuam. Cov kev pab them nqi tshuaj, uas tau sau tseg rau cov kev pabcuam ntsig txog kev xeeb menyuam thiab muab faib rau lub sijhawm tsim nyog no, suav nrog tag nrho cov peev txheej ntawm Medi-Cal cov txiaj ntsig tshuaj. Tsis muaj Medi-Cal cov kev pab cuam uas tsis suav nrog kev pab cuam txog kev xeeb tub yog tias qhov kev pab cuam tsim nyog kho mob. Cov kws kho mob Medi-Cal yuav tsum sau ib tsab cai kuaj mob cev xeeb tub rau hauv daim ntawv thov kev them nqi thiaj li yuav tau them rov qab rau cov kev pab cuam ntsig txog cev xeeb tub. Hauv California ob qho tag nrho-scope thiab kev tiv thaiv kev xeeb tub muaj feem tau txais kev pab them nqi tsawg kawg nkaus (MEC).​​ 

Kev Pabcuam Medi-Cal lossis Kev Npaj Khomob uas tsim nyog​​ 

Tsis tas li ntawd, cov poj niam cev xeeb tub uas cov nyiaj khwv tau los siab dua 138 feem pua txog 213 feem pua ntawm FPL tuaj yeem xaiv los ntawm Medi-Cal ntsig txog kev xeeb tub, piav qhia saum toj no, lossis rau npe rau hauv Daim Phiaj Xwm Muaj Peev Xwm (QHP) los ntawm Covered California thiab tau txais cov nqi se them se siab tshaj ( APTC) kom txo lawv cov nqi them txhua hli. Cov poj niam cev xeeb tub uas tau cuv npe hauv QHP ua ntej cev xeeb tub thiab tsim nyog tau txais Medicaid tuaj yeem tso npe rau hauv Medi-Cal lossis nyob rau hauv lawv QHP thiab txuas ntxiv tau txais APTC thiab txo cov nqi sib faib. Txawm li cas los xij, cov poj niam cev xeeb tub hauv cov nyiaj khwv tau los no yuav tsis raug rau npe hauv Medi-Cal thiab QHP tib lub sijhawm.​​ 

Medi-Cal Access Program​​ 

Cov poj niam cev xeeb tub uas muaj cov nyiaj tau los ntau dua 213 feem pua txog 322 feem pua ntawm FPL yuav tsim nyog rau Medi-Cal Access Program (MCAP). Cov poj niam cev xeeb tub uas tsis tsim nyog tau txais kev pab them nqi kho mob tag nrho lossis kev pab them nqi kho mob ntsig txog cev xeeb tub yuav tsim nyog tau txais MCAP, txawm tias yog pej xeem thiab kev nkag tebchaws los xij. MCAP muab kev pab them nqi dav dav, tsis muaj kev them ua ke, kev them ua ntej, thiab kev koom ua ke pov hwm. Cov poj niam cev xeeb tub yuav tsim nyog tau txais Covered California thiab MCAP, tab sis tsis tuaj yeem sau npe rau hauv ob qho kev pab cuam thiab yuav tsum xaiv ib qho kev pab cuam.​​