Medi-Cal Update 2025-2 FPL, CSIA, APPR Values

Medi-Cal 2025 FPL, CSIA, APPR Value Changes

Date References Clerical Implementation
03/5/2025 ACWDL 25-01, 24-14, 25-02 N/A January 1, 2025

Background

The 2025 value changes for the Federal Proverty Levels (FPL), Community Spouse Income Allocation (CSIA), and the Statewide Average Private Pay Rate (APPR)have been published by the Department of Health Care Services (DHCS) and updated accordingly.

Changes

The following topics have been revised in the Charts Handbook:

  • Federal Poverty Level Programs Monthly Income Comparison Chart
  • Community Spouse Income Allocation Chart
  • Statewide Average Private Pay Rate Chart

Implementation

The 2025 FPL amounts are effective as follows:

  • January 1, 2025- Modified Adjusted Gross Income (MAGI) coverage groups, Medicare Savings Programs (MSP) coverage groups who do not receive Title II Retirement, Survivors, and Disability Insurance (RSDI) income.
  • March 1, 2025- MSP coverage groups who do receive Title II RSDI.
  • April 1, 2025- Aged, Blind, and Disabled (ABD) FPL programs, 250% Working Disabled Program (WDP), and all other Medi-Cal programs.

Note: Eligibility will need to be run back to the specified effective date for individuals in these groups whom the FPL increase may positively impact their level of Medi-Cal benefit.

Upon request from the beneficiary (or parent/legal guardian, AR), the EW can retroactively change eligibility for the following: 

  • Advanced Premium Tax Credit (APTC) individuals- eligibility can only be changed retroactively for those individuals who did not enroll in a Qualified Health Plan (QHP), did not pay a premium, or who did enroll in a QHP and pay a premium but have MC covered medical or dental expenses that were not covered by their QHP during the retroactive period- in this case, they may be eligible for retroactive MC out-of-pocket expense reimbursements (Conlan), but cannot be reimbursed for premiums paid to Covered CA QHPs.
  • Individuals with a Share-of-Cost (SOC)- if redetermined eligible for zero or lower SOC, may be eligible for retroactive MC out-of-pocket expense reimbursements. (Conlan)

 

The CSIA and APPR values are effective January 1, 2025. 

Data Systems

CalSAWS and CalHEERS were updated with the 2025 above referenced values in March 2025. The Department of Health Care Services (DHCS) will send notices to individuals who may potentially be impacted by the new FPL values.

Forms

"Medi-Cal Budget Chart" (SCD 1470) and "CW-CF-MC Limits Chart" (SCD 2338) have been updated to reflect the 2025 FPL amounts. 

 

 

Department of Employment & Benefits Services

Contact Person(s): Manuel Garcia, SSA BPIS, 408-755-7540