Medi-Cal: Your Insurance Carrier?

Medi-Cal is California's Medicaid health care program. It provides free or low-cost health care services to children and adults with limited income and resources. The program is administered by the Centers for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (DHCS). County human services departments are responsible for administering the program at the local level. Medi-Cal offers a range of health benefits, including outpatient services, maternity and newborn care, mental health services, and prescription drug coverage.

Income requirements for Medi-Cal

Medi-Cal is California's Medicaid program, providing health services—including medical and dental care—to people with low incomes. Eligibility for the program is primarily determined by income, with households needing to earn less than 138% of the Federal Poverty Level (FPL). The income limit depends on household size; for instance, a single person earning $21,000 or a family of five earning over $49,000 in 2024 would exceed the limit. To qualify for free Medi-Cal coverage, you need to earn less than 138% of the poverty level, based on the number of people who live in your home.

• Three people: $29,974
• Four people: $36,156
• Five people: $42,339
• For every person in a household above five people, add $6,183 to the income limit.

Pregnant women are also eligible for Medi-Cal if their family's income is above 138% of FPL but at or below 213% of FPL ($43,537 if single and pregnant with the first child, $66,456 per year for a family of four). This is called 'Medi-Cal for Pregnant Women' and covers pregnancy-related services, including prenatal care, labour, delivery, postpartum care, and family planning services.

Children under 19 years of age can qualify for Medi-Cal if their family's income is 266% or less of FPL ($82,992 per year for a family of four).

Additionally, adults aged 65+ without Medicare can qualify for Medi-Cal if they have less than $1,732 in countable monthly income ($2,351 for a couple).

Medi-Cal for immigrants

Medi-Cal is California's Medicaid program, which provides medical services to low-income people at little to no cost. It is jointly administered by the Centers for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (DHCS). County human services departments are responsible for implementing the program at the local level.

As of 1 May 2016, undocumented low-income children in California (under the age of 19) have been able to access full coverage through Medi-Cal. Undocumented adults may also qualify for some coverage during pregnancy or emergencies.

From 1 January 2024, adults in California between the ages of 26 and 49 will be eligible for Medi-Cal, regardless of their immigration status. All other eligibility rules, including income limits, will still apply.

Under the Affordable Care Act, most immigrants qualify for health coverage, including the following groups:

• Lawful permanent residents (green card holders)
• Lawful temporary residents
• Persons fleeing persecution, including refugees and asylees
• Other humanitarian immigrants, including those granted temporary protected status
• Non-immigrant status holders (including worker visas and student visas)

Both lawfully and unlawfully present individuals can apply through Covered California to see if they are eligible for a health plan through Covered California or Medi-Cal. There is no "waiting period" or "five-year bar".

Medi-Cal member services

Medi-Cal is California's Medicaid program, which provides medical services to low-income people at little or no cost. It is administered by the Centers for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (DHCS). County human services departments are responsible for administering the program at the local level.

As a Medi-Cal member, you have access to member services, which you can receive through your plan. Many plans have similar member services, and you can also get help through Covered California. These additional resources and information will help you get the most out of your Medi-Cal coverage.

Changing or Cancelling Your Plan

Depending on the county where you live, you may have multiple Medi-Cal plan options. If you want to try another plan available in your county, you can change it at any time. To switch your plan, you can call Medi-Cal Managed Care Health Care Options at 1-800-430-4263, or complete a Medi-Cal Choice Form, which can be found on the Health Care Options download page.

If you need to cancel your Medi-Cal coverage, call your local county office. Once you are released from Medi-Cal, you can get a quote online to view rates and enrol in a Covered California plan. It is important to note that there are different income limits for Medicaid/Medi-Cal and Covered California.

Accessing Member Services

You can access your member services online through your plan's website and the Covered California website. Your local county office will also take care of specific parts of your Medi-Cal membership.

Your health insurance company handles:

• Premium payments
• ID cards
• Benefits and eligibility
• Claims
• Covered medical providers

Meanwhile, Covered California takes care of:

• Enrollment
• Application information
• Eligibility
• Coverage cancellation
• Changing to a private plan

Member Services Contact Information

To access member services, most insurance plans offer online member assistance, and many companies also allow you to call them for direct help. Covered California also has online member services that you can access through your account.

If you have general questions about Medi-Cal, members and medical providers can call the official helpline at 1-800-541-5555. You may also call Covered California at 1-800-300-1506 or your county's Medi-Cal office, depending on the situation.

Paying Premiums and Finding Renewal Forms

Your health insurance company will receive all premium payments. After enrolling in a plan, you should receive a bill with online payment instructions. Most companies require you to set up an online account and provide information about your payment method. Covered California has information about each plan's payment options on their member information website.

County organizations handle Medi-Cal renewals, and they will typically use your existing information to renew your membership. However, if your information doesn't match your records, they may need to send you a renewal form.

Checking Your Medicaid Status

To learn about your Medi-Cal status and eligibility, contact your local county social services office. The California Department of Health Care Services has a full directory of each county's agency.

Medi-Cal application process

Medi-Cal is California's Medicaid health care program. It provides free or low-cost health coverage to eligible persons with limited income and resources. The program is supported by federal and state taxes.

Any California resident can register for Medicaid through Medi-Cal and other Medi-Cal programs. There are over 90 eligibility categories, and the application process will determine if you fall under one of them. The people who qualify for Medi-Cal can include:

• Families with children
• People with disabilities
• Pregnant women
• Children who don't qualify for Medicaid coverage
• Former foster youth

The application process for Medi-Cal is straightforward. You can apply online on CoveredCA.com, in person at your local county human services agency, or by phone. The application requires information about you and your family members, including:

• Social Security numbers
• Immigration documents
• Income and employment information
• Federal tax information

The application process typically takes around 30 minutes to complete. After submitting your application, you should receive a response within 45 days. If you are deemed eligible, you will receive a letter of determination outlining the benefits you qualify for.

Medi-Cal coverage and costs

Medi-Cal is California's Medicaid program, providing medical services to low-income individuals and families at little to no cost. The cost of Medi-Cal coverage depends on your income and household size. If you meet the income requirements, you can get free or low-cost health care services.

The program is administered by the Centers for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (DHCS). County human services departments manage the program at the local level.

Coverage

Medi-Cal covers a range of health benefits, including:

• Outpatient (ambulatory) services
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioural health treatment
• Rehabilitation and habilitative services, such as physical and occupational therapy
• Preventive and wellness services, and chronic disease management
• Children's services, including oral and vision care
• Prescription drugs
• Ambulance and emergency room services
• Doctor visits for sickness, injuries, or other concerns
• Dental services through its Denti-Cal program
• Counseling, screening, and family-planning services

Costs

The cost of Medi-Cal coverage depends on your income and family size. If you meet the income requirements, you can receive free or low-cost health care services.

To qualify for full Medi-Cal coverage, individuals must have an income of up to $954.72 per month, while couples can earn up to $1,598.14 per month. These limits are higher for individuals who are blind.

For those with higher incomes, Medi-Cal offers a "share of cost" (SOC) option, which functions like a deductible. With the SOC option, you pay a certain amount each month towards your medical expenses, after which Medi-Cal covers the remaining costs for that month. The SOC amount is determined based on your monthly income.

Enrollment and Application

To apply for Medi-Cal, you must provide information about yourself and your family, including:

• Social security numbers or, for immigrants without a Social Security number, document information
• Employment details and income information for all working household members
• Federal tax information, such as filing status and the number of dependents
• Details of any other health insurance coverage you have

You can apply for Medi-Cal anytime throughout the year online or through Covered California.

Frequently asked questions