Medi-Cal: Aca Insurance Or Not?

Medi-Cal is California's Medicaid program, offering free or low-cost health coverage to Californians with low incomes. It is a state-federal program that, prior to the Affordable Care Act (ACA), served low-income families and children, the elderly, and people with disabilities. Under the ACA, California expanded the program to include low-income adults without children or a qualifying disability. Medi-Cal provides comprehensive health insurance to 12 million Californians, with another 2% of the state population covered by a limited version of the program. The ACA has been instrumental in reducing financial barriers to necessary care and has been linked to improved outcomes, including increased access to care, greater use of prescription drugs, and improved financial well-being.

Medi-Cal is California's Medicaid program

Prior to the Affordable Care Act (ACA), Medi-Cal served low-income families and children, the elderly, and people with disabilities. Under the ACA, California lawmakers expanded the program to include low-income adults without children or a qualifying disability starting in 2014.

To be eligible for Medi-Cal, individuals must be residents of California, have U.S. citizenship or be a permanent resident, and have a low or very low income. They must also be responsible for a child 21 years of age or younger, have a disability or a family member in their household with a disability, or be 65 years of age or older.

Medi-Cal covers a wide range of medical services, including doctor visits, hospital stays, prescription drugs, rehabilitation, and other medical services. It also covers medically necessary health care such as X-ray and laboratory tests, nursing home care, prosthetic and orthopedic devices, and dental services through its Denti-Cal program.

The application process for Medi-Cal can be done online, in person at a local county human services agency, or by phone. Individuals can apply through Covered California, which is the state's health insurance marketplace. Covered California offers a single application that will determine an individual's eligibility for either Covered California or Medi-Cal.

It offers free or low-cost health coverage

Medi-Cal is California's Medicaid health care program. It offers free or low-cost health coverage to eligible Californian residents with limited income and resources. This program is a state-federal initiative that provides comprehensive health insurance to 12 million Californians.

Prior to the Affordable Care Act (ACA), Medi-Cal served low-income families and children, the elderly, and people with disabilities. The ACA expanded the program to include low-income adults without children or a qualifying disability. The ACA's expansion of Medicaid (known as Medi-Cal in California) to most low-income adults in participating states has significantly reduced financial barriers to necessary care.

Eligibility for Medi-Cal is determined by a combination of income and other factors. To qualify for comprehensive Medi-Cal, most adults must have an annual income below about $17,250 for a single adult (138% of the federal poverty level or FPL) and satisfactory immigration status. Pregnant and postpartum women are eligible with incomes up to about $68,700 for a family of three (322% FPL), although women with incomes just under this threshold must make financial contributions. Children under 19 are eligible if their family income is below about $56,750 for a family of three (266% FPL), regardless of immigration status. A more limited version of Medi-Cal covers undocumented adults in certain situations, such as medical emergencies or pregnancy.

Medi-Cal plans typically operate like managed care plans or health maintenance organizations (HMOs). This means that enrollees will have a primary care doctor who helps them manage their health. If they need care from a specialist, their primary care doctor will refer them to one covered under their Medi-Cal plan.

Medi-Cal is an essential component of California policymakers' ongoing efforts to achieve universal health coverage. The state has taken several steps to improve health care coverage among lower-income Californians, including expanding Medi-Cal coverage to low-income children and young adults up to age 26, regardless of immigration status.

Eligibility is determined by income and other factors

Eligibility for Medi-Cal, California's Medicaid program, is determined by a combination of income and other factors. The program offers free or low-cost health coverage to Californians with low family incomes.

Income Requirements

To qualify for comprehensive Medi-Cal, most adults must have an annual income below about $17,250 for a single adult (138% of the federal poverty level or FPL) and satisfactory immigration status. Pregnant and postpartum women are eligible with incomes up to about $68,700 for a family of three (322% FPL). Children under age 19 are eligible if their family incomes are below about $56,750 for a family of three (266% FPL), regardless of immigration status.

Other Factors

In addition to income requirements, there are several other factors that determine eligibility for Medi-Cal. These include:

• Residency in skilled nursing or intermediate care homes
• Refugee status
• Caretaking responsibilities for disadvantaged children under 21
• Diagnosis of breast or cervical cancer
• Enrollment in other assistance programs such as CalFresh, Supplemental Security Income (SSI), State Supplementary Payment (SSP), CalWorks, Refugee Assistance, or Foster Care/Adoption Assistance programs

ACA Insurance Eligibility

Eligibility for ACA insurance is also based on income and other factors. ACA insurance, also known as Obamacare, is available to individuals at varying income levels, with a focus on making healthcare more affordable and accessible. Household income between 100% and 400% of the FPL may qualify for a premium tax credit or special subsidies.

Other Factors

In addition to income, other factors that determine eligibility for ACA insurance include:

• Citizenship or legal presence in the U.S.
• Incarceration status
• Medicare coverage
• Age, with young adults up to age 26 allowed to remain on their family's health insurance plan

It provides comprehensive health insurance

Medi-Cal is California's implementation of the Medicaid program, a state-federal initiative that provides free or low-cost health coverage to Americans with low incomes. The Affordable Care Act (ACA) has expanded the program to include low-income adults without children or a qualifying disability.

Medi-Cal provides comprehensive health insurance to 12 million Californians. This means it covers a wide range of healthcare services, including inpatient and outpatient treatment, consultations, hospital stays, and medical testing. It also covers physician visits, hospitalization, and emergency room visits.

Range of Coverage

Medi-Cal covers essential health benefits, including ambulatory patient services, behavioral health treatment, maternity and newborn care, and rehabilitation services. It also includes inpatient hospitalization expenses, such as room rent, nursing fees, and ICU charges. Additionally, it covers pre- and post-hospitalization costs, such as diagnostic tests, follow-up treatments, and medication.

Financial Support

The program offers financial support by providing free or low-cost health coverage. It is designed to reduce out-of-pocket healthcare costs and has been linked to improved financial well-being, including reduced debt and bankruptcies.

Accessibility

Medi-Cal is accessible to eligible Californian residents with limited incomes, and its eligibility is determined by a combination of income and other factors. It serves low-income families and children, the elderly, people with disabilities, and, under the ACA, low-income adults without children.

Protection from Pre-Existing Conditions

Medi-Cal cannot be dropped or denied if you have a pre-existing medical condition. This means that individuals with pre-existing illnesses are protected and can receive coverage for their medical expenses.

Additional Benefits

Medi-Cal also offers benefits such as coverage for alternative treatments, emergency ambulance services, and daily hospital allowances. It provides coverage for specific treatments at home (domiciliary procedures) and covers a range of common critical illnesses, including heart attacks, paralysis, and cancer.

In summary, Medi-Cal is considered comprehensive health insurance as it covers a broad range of healthcare services, provides financial support, and offers protection from pre-existing conditions. It is an essential program that ensures Californians with low incomes have access to the healthcare they need.

Enrollment has increased rapidly in recent years

Medi-Cal is California's Medicaid program, which offers free or low-cost health coverage to Californians with low family incomes. It is a state-federal program that, prior to the Affordable Care Act (ACA), served low-income families and children, the elderly, and people with disabilities. Under the ACA, California lawmakers expanded the program to include low-income adults without children or a qualifying disability starting in 2014.

Enrollment in comprehensive Medi-Cal has increased rapidly in recent years. The program served about 8 million people at the end of 2013, and this number grew to more than 12 million (31% of the state) in August 2018. This increase in enrollment is likely due to the state's decision to pause disenrollment during the public health emergency. Additionally, the limited version of Medi-Cal covers about 900,000 low-income undocumented adults, which is approximately 2% of the state's population. In some counties, about half of the residents are covered by either comprehensive or limited Medi-Cal.

The expansion of Medi-Cal under the ACA has significantly reduced financial barriers to necessary care. In California counties with high uninsured rates in 2013, which stood to gain the most from Medi-Cal expansion, families have been less likely to delay needed care due to cost compared to those in other areas. Between 2014 and 2018, this translated to about a 25% reduction on average in delaying needed care, and this effect has grown over time.

The state of California has taken several additional steps to improve health care coverage among lower-income residents. For example, it has expanded Medi-Cal coverage to low-income children and young adults up to age 26, regardless of immigration status. Additionally, low-income adults aged 50 and over who lack satisfactory immigration status will be eligible for Medi-Cal starting May 1, 2024.

The state is also launching its ambitious CalAIM plan to integrate Medi-Cal with social services to improve care for vulnerable low-income individuals. These initiatives build on the success of the ACA expansion in reducing financial barriers to care and improving access to affordable health care for Californians.

Frequently asked questions