Covered California Q&A's

Medi-Cal Clawback or Penalty?

Question: My daughter is 26 and thinks that she will make about $17,000 in 2014 so if she gets coverage through covered California and then she does not make $16,000 (meaning she is not eligible for premium assistance and is then eligible for Medical) in 2014 will there be any penalty or will she have to pay back any of the premium assistance?

Answer: Actually, the answer to this question is that there is NO claw back. The law sets the schedule (with the $300 max) but the regulations have a special exception written in for people who retrospectively would have qualified for Medicaid — called, appropriately, the “Special rule for taxpayers with household income below 100 percent of the Federal poverty line for the taxable year.”

You can find that here - in paragraph 6: http://www.law.cornell.edu/cfr/text/26/1.36B-2

Essentially it says that if the person’s income was estimated to be between 100 and 400 percent of the FPL “at the time of enrollment” — and the taxpayer would be eligible for a subsidy but for their income falling below 100% FPL - then the taxpayer is treated as eligible and their credit is determined in accordance with their actual year end income (paragraph 7)