Jane Dotson
Medi-Cal is California's version of the federal Medicaid health coverage program. It provides free or low-cost health services to eligible Californian residents with limited income and resources. Medi-Cal eligibility is primarily based on income and family size. Individuals who are over a certain age and/or disabled may also qualify for Medi-Cal. Notably, those who are pregnant, residing in a nursing home, or former foster youth may be eligible for Medi-Cal benefits. It is important to note that individuals already possessing medical insurance may still be eligible for Medi-Cal, and in some cases, can receive benefits from both.
| Characteristics | Values |
|---|---|
| What is Medi-Cal? | The name for the Federal Medicaid Program in California. |
| Who is eligible for Medi-Cal? | Californian residents with limited income and assets. |
| How to apply for Medi-Cal? | Apply online on CoveredCA.com, in person at your local county human services agency, or by phone by calling Covered California at (800) 300-1506. |
| What happens after applying for Medi-Cal? | The county will contact you if more information is needed. Within 45 days, the county will mail you a notice telling you if you qualify for Medi-Cal. |
| What happens if you are eligible for Medi-Cal? | You will receive a Medi-Cal Benefits Identification Card (BIC) in the mail. You will also receive an informational packet in the mail that explains the available Medi-Cal health plan options in your county and how to enrol. |
| What happens if you are not eligible for Medi-Cal? | You may qualify for limited health services offered by your county, commonly known as "county indigent health" or "medically indigent adult" programs. |
| What are the benefits of Medi-Cal? | Medi-Cal offers a core set of health benefits, including physical and occupational therapy, and devices. |
| Can you have Medi-Cal with other medical insurance? | Yes, people who qualify for both Medicare and full Medi-Cal are known as "dual eligibles" or "Medi-Medis". |
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What You'll Learn
Medi-Cal eligibility requirements
Medi-Cal is California's Medicaid health care program. It provides free or low-cost comprehensive health coverage to eligible California residents with limited income and resources.
Eligibility Requirements
To be eligible for Medi-Cal, you must meet certain income and asset requirements. Firstly, your monthly income should be up to 138% of the Federal Poverty Level (FPL) for adults and up to 266% FPL for children. Additionally, you can have up to $2,000 in assets as an individual or $3,000 in assets as a couple.
It's important to note that some personal assets are not considered when determining eligibility, and if you meet the asset requirements, your income level will determine the specific Medi-Cal program you qualify for.
If your monthly income is higher than the limits to qualify for SSI or the A&D FPL program but you meet the asset-level requirements, you may still be eligible for Medi-Cal with a share of cost (SOC). An SOC is like a deductible; you pay this amount in any month you incur medical costs, and after the SOC is paid, Medi-Cal covers the remaining amount of your medical bills for that month.
Medi-Cal also offers special eligibility and benefits for specific groups, such as:
- Pregnant individuals: Free or low-cost health care coverage during pregnancy.
- Seniors: Health care assistance for seniors, including help with Medicare premiums, deductibles, and co-insurance fees.
- Individuals in nursing homes or requiring nursing home care: Coverage for all or part of the care and services received.
- Former foster youth: Coverage up to age 26 for youth who were in foster care on their 18th birthday.
- Minors: The Minor Consent program provides eligible minors with temporary confidential Medi-Cal benefits for certain services without parental consent.
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Applying for Medi-Cal
Medi-Cal is the name for the Federal Medicaid Program in California. It provides comprehensive health coverage for those with limited incomes, and it is free or low-cost. You can apply for Medi-Cal at any time throughout the year, either online or through Covered California.
To apply for Medi-Cal, you must first determine your eligibility. Depending on income and family size, you and your family may be eligible for free or low-cost Medi-Cal. Adults aged 19-64 without children may qualify for no-cost benefits, and pregnant women may also be eligible for free or low-cost healthcare coverage during their pregnancy.
You can apply for Medi-Cal in several ways. Firstly, you can apply online through Covered California. Secondly, you can submit a mail-in application. Thirdly, you can apply in person at any of the Family Resource Centers. If you have any questions, you can contact the Access Call Center.
Eligibility can take up to 45 days to determine and up to 90 days if you apply based on a disability. During this time, you will receive a Notice of Action or Request for Information, which informs you of your benefits and lists each eligible individual in your household. If you disagree with the Notice of Action, you can contact the provided phone number. After qualifying for Medi-Cal, you will receive a Benefits Identification Card (BIC) to start getting coverage, and you will then receive a packet by mail with health plans to choose from.
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Medi-Cal coverage
In California, the Federal Medicaid Program is known as Medi-Cal. It provides comprehensive health coverage for eligible individuals and families at little to no cost. Depending on income and family size, Medi-Cal may offer free or low-cost health services. For instance, adults aged 19 to 64 without children may qualify for no-cost Medi-Cal benefits. Additionally, pregnant individuals, nursing home residents, and former foster youth up to age 26 may be eligible for full or partial coverage.
Individuals can apply for Medi-Cal at any time throughout the year via Covered California, and there are specific programs to cater to different groups. The Former Foster Youth program, for instance, provides Medi-Cal coverage up to age 26 for those who were in foster care on their 18th birthday. The Minor Consent program ensures confidential Medi-Cal benefits for eligible minors without requiring parental consent.
Medi-Cal also assists seniors, children, and adults with disabilities. Medicare Savings Programs help cover Medicare premiums, deductibles, and co-insurance fees. However, it is important to note that the Medi-Cal program may seek repayment from the estates of certain deceased beneficiaries who received benefits after their 55th birthday and owned assets at the time of death.
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Costs of Medi-Cal
The costs of Medi-Cal, California's Medicaid program, depend on an individual's income and family size. For those with a low income, Medi-Cal provides free or low-cost comprehensive health coverage. Adults aged 19-64 without children may qualify for no-cost Medi-Cal benefits.
If your income is higher than the limits to qualify for SSI or the A&D FPL program, but you meet the asset-level requirements, you may still be eligible for Medi-Cal with a share of cost (SOC). An SOC is not a monthly premium but functions like a deductible. It is the amount of medical expense you are responsible for paying before you can get full Medi-Cal coverage for the remainder of the month. For instance, if you have an individual monthly income of $1,300, Medi-Cal subtracts $600 for an SOC of $700. This means you must pay at least $700 in covered medical expenses before Medi-Cal covers any of your healthcare costs for that month.
For those who are pregnant, Medi-Cal may provide free or low-cost healthcare coverage during pregnancy. Additionally, if you reside in a nursing home or require nursing home care, Medi-Cal could pay for all or part of the care and services received.
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Other health services
In California, Medi-Cal is the state's version of the Medicaid health care program. It provides free or low-cost health care coverage to California residents with limited incomes who meet the eligibility criteria, including income guidelines, regardless of their immigration status.
Medi-Cal offers a wide range of health services to its members. Here are some of the key services provided:
- Primary and Specialist Care: Medi-Cal members have access to a diverse network of primary care physicians and specialists, ensuring they can receive timely and comprehensive medical care.
- Care Coordination: This service helps members navigate the healthcare system, providing assistance with referrals, appointments, and coordinating care between different providers.
- 24-Hour Nurse Advice Telephone Services: Members can call a dedicated hotline to receive immediate assistance and advice from registered nurses at any time of day or night.
- Member Services Assistance: A dedicated member services team is available 24/7 to help with any questions or concerns related to their Medi-Cal coverage, benefits, or healthcare needs.
- Pregnancy and Maternity Care: Pregnant individuals may receive free or low-cost health care coverage during their pregnancy, ensuring access to essential prenatal and postpartum care.
- Long-Term Care: Medi-Cal can provide coverage for individuals residing in nursing homes or those who require long-term care services, helping to pay for all or part of the care they receive.
- Former Foster Youth Program: Youth who were in foster care on their 18th birthday are eligible for Full-Scope Medi-Cal benefits up to age 26, ensuring continued access to healthcare as they transition to independence.
- Minor Consent Program: This program provides confidential Medi-Cal benefits to eligible minors without requiring parental consent for certain services, protecting their privacy and ensuring they receive necessary care.
- Medicare Savings Programs: These programs help low-income individuals by paying for Medicare premiums, deductibles, and co-insurance fees, reducing their overall healthcare costs.
These are just a few examples of the additional health services that Medi-Cal offers to its members. Medi-Cal is committed to providing comprehensive coverage and ensuring that its members have access to the care they need.
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Frequently asked questions
Yes, you can apply for Medi-Cal even if you have other medical insurance. Medi-Cal is California's version of the federal Medicaid program, providing health coverage to those with low incomes and limited assets.
You can apply for Medi-Cal online on CoveredCA.com, over the phone, or in person at your local county human services agency.
After submitting your application, the county will contact you within 45 days to inform you if you qualify for Medi-Cal. If you are eligible, you will receive a Medi-Cal Benefits Identification Card (BIC) in the mail, along with information about your Health Plan options.
If you are uninsured and do not qualify for Medi-Cal, you may still be eligible for limited health services offered by your county. These programs are commonly known as "medically indigent adult" programs, and each county has different rules and services.
