What happens if I forgot to report an income change to Medi-Cal?
Asked by: Edyth Grimes | Last update: November 6, 2025Score: 4.5/5 (72 votes)
What happens if I don't report an income change to Medi-Cal?
Your Medi-Cal coverage will end if you don't turn in your renewal form or you are missing proof of things like income that the county asked you to send. Your local Medi-Cal office will mail you a letter (Notice of Action) to let you know if you didn't turn in your renewal form or are missing information.
Does Medi-Cal check your income?
Most people who apply for Medi-Cal can find out if they qualify based on their income. For some types of Medi-Cal, people may also need to give information about their assets and property.
Does Medicaid know when your income changes?
Yes, income and assets have to be verified again for Medicaid Redetermination. After initial acceptance into the Medicaid program, redetermination is generally every 12 months.
Do you have to repay Medi-Cal after your income increases?
If your income is more than what you told us on your application, you may have to repay some or all of the advanced premium tax credits that you got. There are limits to the amount you may need to repay, depending on your income and if you file taxes as “Single” or another filing status.
What Happens If You Don't Report Income Changes To Medicaid? - CountyOffice.org
Can Medi-Cal ask for money back?
Involuntary Provider Reimbursement/Recoupment: If the provider does not voluntarily agree to reimburse the entire payment you made for a service that should have been covered by Medi-Cal. In this case, the payment of the entire expense you paid for that service will be recovered/recouped from the provider by Medi-Cal.
How can I avoid paying back my premium tax credit?
Report any changes in your income during the year to the Marketplace, so your credit can be adjusted and you can avoid any significant repayments at the end of the year.
What disqualifies you from Medi-Cal?
To qualify, you must: Meet the medical requirements of Social Security's definition of disability. Be working and earning income (this can be part-time work). Have countable income less than 250% of the federal poverty level (in 2024, this equates to $3,158/mo.
What happens if I make too much money while on Medicaid?
If your income is too high for Medicaid, a spend down will let you use extra money on medical expenses until you qualify. Not all states have a spend down program for Medicaid eligibility. Those that do often have different income limits and rules. Not all states offer a spend down option.
Do you have to pay back Medicaid if you get a job?
No. Unlike employer-sponsored plans, Medicaid is not tied to your job. You'll still have it even if you lose your job because of COVID-19 or for any other reason. If you find a job, your new financial situation will determine whether you qualify for Medicaid.
What are the new rules for Medi-Cal 2024?
Basic Information. Beginning January 1, 2024, a new law in California will allow adults ages 26 through 49 to qualify for full-scope Medi-Cal, regardless of immigration status. All other Medi-Cal eligibility rules, including income limits, will still apply.
Does Medi-Cal report to IRS?
DHCS will only report a person's coverage to the IRS and FTB if that person receives coverage from Medi-Cal. Every person in the home enrolled in Medi-Cal will get their own Form 1095-B. If you have family members enrolled in Covered California, they should receive Form 1095-A.
How much can you make before you lose Medi-Cal?
Most single individuals will qualify for Medi-Cal if there income is under $1,676 per month. Most couples will qualify if their income is under $2,267 per month. If you have disabilities, your income can be slightly higher. You can qualify for Medi-Cal even if you have assets.
What happens if you lie to Medi-Cal?
And the felony penalties for this form of Medi-Cal fraud include: Felony probation; Two (2), three (3) or five (5) years in county jail; and/or. A fine of up to fifty thousand dollars ($50,000) or double the amount of the fraud, whichever is greater.
What happens if you don't report some of your income?
Criminal Penalties for Underreported Income
Willful tax evasion, such as underreporting income or filing a false tax return can be penalized with criminal charges – typically a felony tax evasion charge and sometimes even jail time.
Does Medi-Cal verify income?
In order to determine your eligibility for Medi-Cal benefits, you may be required to submit information verifying your identity, income and/or property.
Why was I kicked off Medicaid?
Some are still eligible for Medicaid but may lose coverage for administrative reasons, including not having a current address on file, submitting an incomplete renewal application, not applying for a renewal, or submitting a late application.
What happens if you make too much money while on Medicare?
If you have a higher income, you'll pay an additional premium amount for Medicare Part B and Medicare prescription drug coverage. We call the additional amount the “income-related monthly adjustment amount.”
Does Medi-Cal look at your bank account?
Starting on January 1, 2024, Medi-Cal applications will no longer ask for asset information.
What if my income is too high for Medi-Cal?
Yes. If you make too much to qualify for Medi-Cal, you can apply for Covered California. Covered California is a state-run health care insurance exchange that offers financial assistance to reduce your premiums payments.
How often does Medicaid check your income?
They will check when you submit an application and on an annual basis, but checks can occur at any time. While agencies can look at account balances, they can't view your personal bank statements. Other information used to determine Medicaid eligibility often comes from public records.
What happens if I underestimate my income for Covered CA?
They will inquire about your tax return from the IRS and other databases. If you underestimated your income for that year and received a subsidy, you will need to pay the entire subsidy back the next time you file your taxes. You must report income changes to Covered California within 30 days.
What happens if I don't report my 1095-A?
You can use Form 1095-A to reconcile any advance premium tax credits you received during the year with the amount of credits you were eligible to receive. If you fail to file a tax return reconciling those payments, you will not be eligible for premium tax subsidies in the next year.
What is a tax clawback?
A tax clawback agreement is an arrangement whereby the tax benefits received from a given venture are reinvested into that venture to cover cash shortages. A tax clawback is just one of many similar arrangements that cover various distributions such as profits, dividends, or even stock distributions.