Jane Dotson
California's Medicaid program, Medi-Cal, offers health insurance coverage to millions of people in the state. The application process for Medicaid in California is integrated with Covered California, the health insurance marketplace. There are multiple ways to apply for Medi-Cal, including online, by mail, in person, or by phone. The application requires information about the applicant and their family members to determine eligibility. This information is compared with government data sources to confirm eligibility, and additional documents may be requested if data inconsistencies are found.
| Characteristics | Values |
|---|---|
| Name of California's Medicaid program | Medi-Cal |
| Number of people covered by Medi-Cal as of April 2024 | 15 million |
| Percentage of Californians who rely on Medi-Cal | Over a third |
| Alternative name for the application process for Medicaid in California | Covered California |
| Website for applying for Medicaid in California | Covered California website |
| Postal address for mailing applications | P.O. Box 989725 West Sacramento, CA 95798-9725 |
| Place for applying in person | County social service office |
| Eligibility | Children from birth through age 18 with family income levels up to 266% of FPL; pregnant women with incomes up to 213% of FPL; and nonelderly adults — with or without dependent children — with incomes up to 138% of FPL |
| Eligibility for MCAP | Pregnant women with incomes up to 322% of FPL |
| Number of eligibility categories for Medi-Cal | Over 90 |
| Additional information required for eligibility | Information about family members |
| Other ways to apply | By phone, through Health for California |
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What You'll Learn
Application methods
There are several methods to apply for Medicaid in California. The application process for Medicaid in California is integrated with Covered California, the health insurance marketplace. Firstly, you can apply online on the Covered California website. Secondly, you can apply by mail by completing an application and sending it to Covered California at the following address: P.O. Box 989725 West Sacramento, CA 95798-9725. Seniors and people with Medicare can use a printable application that can be mailed or submitted at a local social services office. Thirdly, you can apply in person at a county social service office. Many county offices have phone numbers listed on their websites if you need more information or assistance.
When applying for Medicaid, you will need to provide information about yourself and your family members to help the local agency determine your eligibility. Covered California will compare the information you enter on your application with government data sources or information you have provided before. If the data is inconsistent, you may be asked to submit additional documents to confirm the new information. After you apply for Medicaid, you should receive a letter in the mail regarding your eligibility within 45 days. If you do not receive this letter, you can call Covered California at 1-800-300-1506 or contact your county social services office for more information.
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Eligibility criteria
To be eligible for Medicaid in California, you must be a resident of the state. California's Medicaid program is called Medi-Cal, and it provides health coverage to people with low incomes and asset levels who meet certain eligibility requirements. The eligibility criteria are based on income and household size. To qualify for free Medi-Cal coverage, you need to earn less than 138% of the poverty level, or the Federal Poverty Level (FPL), based on the number of people in your household. For instance, children from birth through age 18 with family income levels up to 266% of FPL and pregnant women with incomes up to 213% of FPL are eligible.
There are over 90 eligibility categories for Medi-Cal, and you can apply in several ways: online, in person, by mail, or on the phone. The application process is integrated with Covered California, the health insurance marketplace. You can also get a quote for Medi-Cal through Health for California, which will review your income information, family details, age, and health to help determine your eligibility.
If you are enrolled in certain other programs, you may also qualify for Medi-Cal benefits. These include CalFresh, Supplemental Security Income (SSI), and State Supplementary Payment (SSP). Additionally, if you are a refugee living in the U.S. temporarily, you may be eligible for Medicaid assistance.
It is important to note that California no longer has an asset limit for Medi-Cal eligibility as of 2024, and income produced from some assets may count towards Medi-Cal's income limit. However, if you are determined to be eligible for SSI, you will automatically be approved for Regular Medi-Cal.
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Required documents
To fill out information for Medicaid in California, you will need to apply for Medi-Cal, which is California's Medicaid program. There are multiple ways to apply for Medi-Cal, including online, by mail, in person, or on the phone.
The application will require information about you and your family members to help determine eligibility. This includes information such as income levels, as children from birth through age 18 with family incomes up to 266% of FPL, pregnant women with incomes up to 213% of FPL, and non-elderly adults with incomes up to 138% of FPL are eligible. Additionally, California has generous standards for covering various populations, including undocumented immigrants who meet the income requirements.
If you are applying online, you will need to fill out the application on the Covered California website. If you are applying by mail, you can complete the application, available in 12 languages, and mail it to Covered California at the specified address. Seniors and people with Medicare can use a printable application. If you are applying in person, you can visit a county social service office, and if you are applying by phone, an operator will guide you through the steps.
After submitting your application, you should receive a letter within 45 days confirming your eligibility. If you do not receive this letter, you can contact Covered California or your county social services office for more information.
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Application processing
California's Medicaid program is called Medi-Cal. The application process for Medicaid in California is integrated with Covered California, the health insurance marketplace.
The application process for Medicaid in California can be done in four ways: online, in person, by mail, or on the phone. Here is a detailed description of each of these methods:
- Online: The Covered California website offers an online application process that is inclusive, quick, easy, and free of charge. Agents are available to answer questions and guide applicants through the steps.
- In person: Applicants can apply in person at a county social service office. The directory includes phone numbers for each county office if more information or assistance is needed.
- By mail: Applicants can complete the application, available in 12 languages, and mail it to Covered California at the following address: P.O. Box 989725 West Sacramento, CA 95798-9725. Seniors and people with Medicare can use this printable application.
- On the phone: When applying by phone, an operator will guide the applicant through the steps.
After submitting an application, Covered California compares the information provided with government data sources or previously provided information. If the data is inconsistent, additional documentation may be requested to confirm the new information.
Once an application is submitted, applicants should receive a letter within 45 days confirming their eligibility for Medi-Cal. If this letter is not received, applicants can call Covered California at 1-800-300-1506 or contact their county social services office for more information.
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Additional services
As a Medi-Cal member, you have access to a range of additional services to help you get the most out of your coverage. Firstly, you can access member services similar to those offered by private insurance plans. These services are provided through your plan, and many plans have similar offerings. Additionally, Covered California also provides online member services that you can access through your account. Here are some specific additional services available:
- Multiple Plan Options: Depending on the county you reside in, you may have multiple Medi-Cal plan options to choose from. You can switch your plan at any time by calling Medi-Cal Managed Care Health Care Options at 1-800-430-4263 or by completing a Medi-Cal Choice Form.
- Continuity of Care: If you need to change your Medi-Cal plan, you are guaranteed to be able to keep your current provider for up to 12 months after enrolling in the new plan. This applies to individuals whose Medi-Cal health plans were inactive as of January 1, 2024, those 25 years old or younger who are currently or previously in foster care, and those who were receiving Medi-Cal services from Kaiser Permanente and were automatically enrolled in their plan at the beginning of 2024.
- Federally Qualified Health Centers (FQHC): These non-profit clinics provide primary care services in underserved areas and work on a sliding scale fee to serve those with limited budgets.
- Children's Health Insurance Program (CHIP): This program provides assistance to low-income children who don't qualify for Medicaid coverage.
- Coverage for Former Foster Youth: Individuals who were in foster care on or after their 18th birthday are eligible for free Medi-Cal coverage until the age of 26.
- Maternity Services: Individuals with other health insurance plans that do not cover maternity services or have a high deductible may apply for MCAP.
- Undocumented Immigrant Coverage: Undocumented children can qualify for Medi-Cal coverage, and California is using state funds to cover undocumented immigrants.
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Frequently asked questions
You can apply for Medicaid in California through Covered California, the health insurance marketplace. You can apply online, by mail, or in person at a county social service office. Seniors and people with Medicare can also apply using a printable application.
You can apply for Medi-Cal online, by phone, in person, or by mail. The application requires information about you and your family members to determine your eligibility. After applying, you should receive a letter regarding your eligibility within 45 days.
California has generous standards for covering various Medicaid populations. Children from birth through age 18 with family income levels up to 266% of FPL, pregnant women with incomes up to 213%-322% of FPL, and non-elderly adults with incomes up to 138% of FPL are eligible. California no longer has an asset limit for aged, blind, or disabled enrollees, and undocumented immigrants who meet income requirements can also qualify.
Medi-Cal covers most medical services, from maternity to substance use. Federally Qualified Health Centers (FQHC) are also available to fill in some gaps in coverage, providing primary care services on a sliding scale fee.
