For families seeking affordable health insurance, the state’s health insurance marketplace, Covered California, can provide major relief. But if they’re not careful, they can get hit by an unexpected federal tax bill.

As CalMatters health reporter Ana B. Ibarra explains, enrollees can sometimes unknowingly receive too much aid if they underestimate their income the following year, or if they fail to report that they lost a dependent. This “excess” aid is connected to the federal Affordable Care Act, and is collected by the federal government when people file their taxes.

In 2021, about 415,000 California households owed the Internal Revenue Service close to $690 million in charges related to the Covered California subsidies, or an average of $1,662 per person or family. About half of these households in 2021 earned less than $50,000.

So how do you avoid paying this tax bill? First, declare changes in income and dependents to Covered California or an enrollment counselor as soon as possible. Report all taxable income, including any extras, such as salary bonuses. And to remain really up-to-date, find an insurance agent and check in with them every so often. They often provide services for free, since agents get commissions from insurance companies.

If you’re thinking about skipping out on health insurance altogether than owe the IRS, keep in mind that California requires residents to have coverage, and you could still end up paying a penalty. And remember: The repayment process works the other way around too. If you overestimate your income and receive less subsidies than you’re eligible for, you could get money back.

For more on repaying health care subsidies, read Ana’s story.

Speaking of health care challenges in California: A significant number of homeless individuals on the street have mental health issues. There’s a new tactic becoming more common — shots to prevent psychotic episodes, writes CalMatters homelessness reporter Marisa Kendall.

These antipsychotics, which can ease symptoms for a month or longer, are administered by street medicine teams wherever patients reside. Unlike oral pills, the medication can’t be lost or stolen off an unhoused resident, nor does it require a pharmacy refill.

Treatment is voluntary and doctors say the goal of administering these shots is to get someone living in an encampment to begin thinking clearly, so they can engage with social workers, sign up for benefits and get on housing waitlists.

There are some side effects, such as dizziness and decreased mobility, which can be severely dire for someone living on the street. For doctors, their main challenge is following up with patients who can be difficult to track. Some wary patients also don’t want the shots.

But for others, such as Ricardo Fonseca Jr., the medication can be a godsend. Before becoming homeless, he worked as a welder. After a sudden mental breakdown, he started hearing voices. Two months ago, Fonseca started taking a monthly shot of an antipsychotic drug.

• Fonseca: “Everything’s changed … I can finally hear the birds and the crickets. I couldn’t hear them before.”

Read more about the antipsychotic treatment in Marisa’s story.

Read More at Cal Matters.