Medi-Cal, the California version of Medicaid, was expanded by the Affordable Care Act. Medi-Cal is available for those that qualify, regardless of affordable health insurance offered through an employer. This makes Medi-Cal an important option for low-wage earning employees to consider when evaluating their health insurance options, and an important benefit educational item for their employers.

Because Medi-Cal expansion has such an impact on employees, employers can expect to be solicited by consulting firms offering to handle Medi-Cal enrollments for employees for a fee.

Here is a quick list of do’s, don’ts and best practices when considering these services:

1. Qualification of Medi-Cal Service Providers

Do make sure the organization is Certified by Covered CA (or the exchange in your State), either as a Certified Enroller or Certified Agent.

Don’t use a service that is not a licensed AND certified insurance agent or certified enroller.

WHY? Organizations that are not certified cannot establish accounts, complete enrollment or follow up on delays for employees. They will merely “coach” the employee on how to apply for Medi-Cal. Given the technical glitches of Covered CA and the volume of Medi-Cal applications being processed, enrollment and follow up could be overwhelming for employees on their own. Best Practice – Hire a certified enroller or agent that can establish accounts and assist employees with application follow up.

2.  Necessity of Pre-Qualification Fees

Do ask for a detailed list of necessary information for any “pre-qualification” BEFORE paying any fee.

Don’t pay any fee to “pre-qualify” employees if it requires you, as the employer, to gather information from the employee that you do not currently ask them to provide.

WHY? Any pre-qualification for Medi-Cal will only be an estimate until the employee provides income and household size for his or her ENTIRE family, not just from his or her job. As an employer, you do not have access to his or her tax returns, which list spousal income and a complete list of dependents (including those that do not reside with the employee). Employers should not violate an employee’s privacy by asking him or her to provide tax returns, nor can an employer require him or her to do so. Best Practice – Pay one fee for educational materials and presentations, and a per employee fee when enrollment is complete, based on information volunteered directly to the service provider by the employee.

3.  Immigration Considerations

Do make sure that all options for undocumented residents are presented to employees.

Don’t ask for information regarding immigration status.

WHY? Employees may have family members that are not here legally, and they may be sensitive to providing that information. Legal immigration is a necessity to obtain full Medi-Cal enrollment, however, limited Medi-Cal services are available to people without the appropriate documentation. Best Practice – Provide employees with resources for filing directly with the County, should they want to keep such information private.

4.  Educational Forum

Do provide an educational meeting and/or material for employees ahead of open enrollment.

Don’t require employees to discuss their eligibility or single out those expected to be Medi-Cal eligible.

WHY? Employers should remain objective and impartial regarding the health care choices of employees. Best Practice – Provide educational resources that will allow employees to independently evaluate their choices.

What to know more about our Medi-Cal services? Email Kelley Jensen,