Jeffrey Wade
Medi-Cal is California's implementation of the federal Medicaid program, providing health insurance for low-income individuals and families. The program covers a range of medical services, including hospitalization, mental health treatment, dental and vision care, and long-term care. Eligibility for Medi-Cal is based on income, with individuals and families up to a certain percentage of the federal poverty level qualifying for coverage. As of September 2022, approximately 15.28 million people, or about 40% of California's population, were enrolled in Medi-Cal.
| Characteristics | Values |
|---|---|
| Type | California's Medicaid health care program |
| Administered by | Covered California, California's health insurance marketplace |
| Aim | To provide medical services for children and adults with limited income and resources |
| Eligibility | Family incomes up to 138% of the federal poverty level; lawful permanent residents (green card holders) regardless of their date of entry if they meet other eligibility requirements; individuals with incomes below 266% FPL for children may also qualify |
| Cost | $73.9 billion ($16.9 billion in state funds) in 2014-15 |
| Benefits | Ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental (Denti-Cal), vision, and long-term care |
| Enrollment | Approximately 15.28 million people as of September 2022 (about 40% of California's population) |
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What You'll Learn
Medi-Cal eligibility
Medi-Cal is California's implementation of the federal Medicaid program. It provides free or low-cost health services for eligible low-income individuals, including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults. Eligibility is determined by several factors, including income level and residency status.
To be eligible for Medi-Cal, individuals must have an income below 138% of the federal poverty level. This threshold is higher for children, at 266% of the federal poverty level. Lawful permanent residents, or green card holders, are eligible for full-scope Medi-Cal if they meet the income requirements and other eligibility criteria. This has been the case since 2024, regardless of their date of entry into the country.
Those with higher incomes or small businesses may choose a plan in Covered California, the state's health insurance marketplace, and may still be eligible for government subsidies. Covered California offers a range of plans, and applicants will find out if they are eligible for Medi-Cal after applying for coverage.
Medi-Cal has open enrollment year-round, and applicants can apply in person, over the phone, or online. To maintain coverage, beneficiaries must renew their enrollment once a year and report any household changes within 10 days to their local county social services office.
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Health benefits
Medi-Cal is California's implementation of the federal Medicaid program, which provides health coverage for low-income individuals and families. It offers a comprehensive set of health benefits, including:
Doctor Visits and Hospital Care
Medi-Cal covers doctor visits and hospitalisation costs, ensuring that enrollees can access necessary medical care without incurring out-of-pocket expenses.
Emergency Services
Emergency services are also covered by Medi-Cal, providing peace of mind for enrollees in case of unexpected accidents or urgent medical situations.
Maternity and Newborn Care
Pregnant women enrolled in Medi-Cal can receive free or low-cost maternity care, ensuring access to prenatal and postnatal healthcare services. This includes pregnancy-related services and newborn care, promoting the health and well-being of both mother and child.
Mental Health and Substance Use Disorder Treatment
Medi-Cal recognises the importance of mental health and provides coverage for mental health services, including treatment for substance use disorders. This benefit addresses the need for accessible and affordable mental healthcare, which is crucial for overall well-being.
Dental, Vision, and Long-Term Care
California is one of the few US states offering Medicaid dental benefits to adults through the Denti-Cal program. Medi-Cal also covers vision care for children and long-term care services, including support for the aged, blind, or disabled. This comprehensive approach ensures that enrollees can maintain their overall health and well-being.
Prescription Drugs and Preventive Care
The program includes coverage for prescription medications, ensuring access to necessary pharmaceuticals. Additionally, Medi-Cal emphasises preventive care, providing services such as immunisations, rehabilitative therapies, laboratory tests, and chronic disease management to help enrollees maintain their health and avoid potential health complications.
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Costs
The costs of Medi-Cal insurance are dependent on an individual's income and family size. Medi-Cal is the name for the Federal Medicaid Program in California and provides comprehensive health coverage for those with limited incomes. Depending on your income, you may be eligible for free or low-cost health care. Adults aged 19-64 without children may qualify for no-cost Medi-Cal benefits.
For adults, if your income is up to 138% of the Federal Poverty Level (FPL), you may be eligible for Medi-Cal. For children, the limit is higher, with eligibility up to 266% FPL. Medi-Cal also offers a mixed-program for families, so costs can be tailored to the specific needs of the family unit.
Pregnant women may also receive free or low-cost healthcare coverage during their pregnancy. This coverage can be started right away and provides peace of mind for expectant mothers. Additionally, if an individual resides in a nursing home or requires nursing home care, Medi-Cal could pay for all or part of the care and services received.
To maintain your Medi-Cal coverage, renewal is required once a year on your original sign-up date. Any household changes must be reported within 10 days to your local county social services office. This ensures that your coverage remains up-to-date and reflective of your current situation.
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Enrollment
Medi-Cal is California's Medicaid health care program. It provides free or low-cost health care for children and adults with limited income and resources.
There are four ways to apply for Medi-Cal: online, by phone, by mail, or in person.
Online
You can apply online at Covered California's website, your local county social service office website, or BenefitsCal.com. Applying online takes about half an hour, and you can save your application and return to it later. Have the necessary documents on hand before starting your application for a seamless enrollment process.
By Phone
You can apply over the phone by calling your local county services office or Covered California.
By Mail
You can mail your completed and signed application to Covered California or your local county social service office.
In Person
You can apply in person at your local county human services office.
Once you apply for Medi-Cal, your application will be reviewed by the county to determine if you qualify. This review process can take up to 45 days. If you qualify for Medi-Cal, the Department of Health Care Services (DHCS) will mail you a Medi-Cal Benefits Identification Card (BIC). You can use your BIC to access fee-for-service (regular Medi-Cal) until you are enrolled in a health plan.
Health Care Options (HCO) will also mail you an enrollment packet that includes a Medi-Cal Managed Care Choice Enrollment Form. You will need to choose a health plan and a doctor within 30 days of receiving your packet. If you do not choose within 30 days, a plan and doctor will be assigned to you.
Special Enrollment
You can apply for Medi-Cal outside of the open enrollment period if you have experienced certain major life changes, usually within the last 60 days. These life changes include losing coverage after leaving active duty or becoming a citizen, national, or permanent legal resident. You can also apply outside of open enrollment if you experience changes to your dependents or lose your status as a dependent due to divorce, legal separation, dissolution of domestic partnership, or death.
Transferring Plans
If you are already enrolled in a Medi-Cal plan, you can transfer to a different plan at any time. For example, you can transfer from your current plan to Blue Shield Promise Medi-Cal by calling their enrollment team or mailing a completed Medi-Cal Choice Form.
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Covered California
Under the PPACA, those with family incomes up to 138% of the federal poverty level are eligible for Medi-Cal. Individuals with higher incomes and some small businesses may choose a plan in Covered California, with potential government subsidies.
Health plans available through Covered California and Medi-Cal offer a similar set of benefits, called essential health benefits. These include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental (Denti-Cal), vision, and long-term care and support.
You can apply for both programs at the same time using a single application. If you no longer qualify for Medi-Cal, you can contact the service centre within 60 days to discuss your options with Covered California. You can enrol in person, by phone or online, and help is available in over a dozen languages.
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Frequently asked questions
Medi-Cal is California's Medicaid health care program. It provides medical services for children and adults with limited income and resources.
Eligibility for Medi-Cal is based on several factors, including income level. As of 2024, individuals without a lawful immigration status who meet the requirements are eligible for full-scope Medi-Cal. Lawful permanent residents are also eligible for full-scope Medi-Cal if they meet the requirements.
Medi-Cal health benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental (Denti-Cal), vision, and long-term care and supports.
