Orlando Harmon
Medi-Cal is California's Medicaid health care program, providing comprehensive health coverage for children and adults with limited incomes and resources. It is jointly administered by the Centers for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (DHCS). Medi-Cal covers a range of medical services, including emergency services, hospitalization, maternity and newborn care, mental health treatment, dental, vision, and long-term care. Eligibility for Medi-Cal is based on income, with individuals earning up to 138% of the Federal Poverty Level (FPL) for adults and up to 266% FPL for children qualifying for benefits. California was one of the first US states to provide Medicaid dental benefits to adults.
| Characteristics | Values |
|---|---|
| Name | Medi-Cal |
| Description | California's Medicaid health care program |
| Administered by | Centers for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (DHCS) |
| Local Administration | County welfare department in each of the 58 counties in California |
| Eligibility | Family incomes up to 138% of the federal poverty level, lawful permanent residents, individuals with higher incomes, and small businesses |
| Cost | $73.9 billion ($16.9 billion in state funds) in 2014-15 |
| Coverage | Comprehensive health coverage for children and families, including ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental, vision, and long-term care |
| Application | Online, in-person, or over the phone |
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What You'll Learn
Medi-Cal is California's Medicaid program
Medi-Cal provides comprehensive health coverage for children and adults with limited incomes and resources. It offers a range of health benefits, including 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.
Eligibility for Medi-Cal is based on income and family size. Individuals with incomes up to 138% of the Federal Poverty Level (FPL) for adults and up to 266% FPL for children may qualify for Medi-Cal. Lawful permanent residents (green card holders) are eligible for full-scope Medi-Cal in California if they meet the eligibility requirements. Beginning in 2024, people without lawful immigration status who meet the requirements will also be eligible for full-scope Medi-Cal.
Medi-Cal has open enrollment year-round, and individuals can apply online, in-person, or over the phone. Those who no longer qualify for Medi-Cal can explore other options through Covered California, the state's health insurance marketplace.
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$14.95
Eligibility and enrollment
Eligibility for Medi-Cal is based on income, household size, age, and county of residence. Individuals with higher incomes enrolled in Share of Cost Medi-Cal must incur certain healthcare costs before Medi-Cal will pay for medically necessary goods and services.
Pregnant women may be eligible for free or low-cost healthcare coverage during their pregnancy. Medi-Cal also provides coverage for individuals who reside in or need nursing home care. Adults without children between the ages of 19 and 64 may qualify for no-cost benefits. Individuals who were in foster care on their 18th birthday are eligible for full-scope Medi-Cal benefits up to age 26.
To enroll in Medi-Cal, individuals can apply online, over the phone, by mail, in person, or through a community health center. Enrollment navigators are also available to help individuals apply for Medi-Cal. To apply, individuals will need to provide records verifying their identity, income, residence, and other details. Once approved, individuals will receive a packet in the mail with information on how to choose a Medi-Cal health plan.
To maintain Medi-Cal coverage, individuals must renew their coverage once a year on their original sign-up date and report any household changes within 10 days to their local county social services office.
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Comprehensive health coverage
Comprehensive health insurance, also known as major medical health insurance, refers to health insurance plans that cover a wide range of healthcare services. These services include physician visits, hospitalization, prescriptions, emergency room visits, and preventive care. Comprehensive coverage policies are typically more expensive than limited-benefit plans but provide significantly more protection in the event of a medical claim. They are designed to be supplemental to a major medical plan rather than a replacement.
Comprehensive health insurance provides coverage for most medical services and procedures, including routine health check-ups, critical illnesses, and recognized and unknown diseases. It also covers medical emergencies, such as surgery for major complications, treatment for critical illnesses, and hospitalization due to sickness or injuries. Comprehensive plans allow for customization of the coverage amount to suit specific healthcare needs, which is especially important for individuals with a high risk of certain critical diseases.
In the context of employer-based health insurance, comprehensive coverage typically includes prescription drugs, specialist visits, and mental health and addiction treatment. The extent of coverage can vary depending on the specific plan, with some plans requiring a copayment or referral from a primary care provider for specialist visits.
In the United States, Medi-Cal is a form of comprehensive health insurance provided by the state of California. It offers a range of health benefits, including ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental, vision, and long-term care. Medi-Cal is available to individuals with family incomes up to 138% of the federal poverty level, with open enrollment year-round.
Overall, comprehensive health insurance provides broad coverage for a wide range of healthcare services, offering financial protection against medical emergencies and providing peace of mind for individuals and families.
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Medi-Cal costs
In California, Medi-Cal is the state's version of Medicaid, the federal-state program that provides health coverage to low-income households across the US. California law has required counties to provide healthcare services to the poor since 1933.
In 2014, under the Patient Protection and Affordable Care Act (PPACA), those with family incomes up to 138% of the federal poverty level became eligible for Medi-Cal. Lawful permanent residents (green card holders) are also eligible for full-scope Medi-Cal in California if they meet the other requirements, and, as of 2024, people without lawful immigration status who meet the requirements are also eligible for full-scope Medi-Cal.
The Medi-Cal program covers almost 15 million people, which is more than state officials expected. This has resulted in the state spending more than anticipated on the program. In 2014-2015, Medi-Cal costs were estimated at $73.9 billion, with $16.9 billion in state funds. The state's Medi-Cal expansion for undocumented immigrants costs about $8.5 billion from the state general fund annually. In 2025, the Newsom administration borrowed $3.4 billion from the state's general fund to cover unexpected cost increases, with the state spending $2.7 billion more than planned due to coverage expansions for immigrants without legal status.
For those with HPSM Medi-Cal and Medicare, there is the option to join the CareAdvantage plan, which offers $0 premiums and low or no co-pays for prescription medicines. If you have a SOC (share-of-cost amount), you pay a monthly amount for your medical expenses, similar to a deductible in private insurance. These payments are made to Medi-Cal providers when they specify that a SOC payment is due.
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Medi-Cal 2020 initiative
The Medi-Cal 2020 initiative refers to the extension of the Bridge to Reform program, which was approved by CMS in 2011 as a Section 1115 Medicaid waiver. The program included an expansion of the patient-centred medical home primary care approach, an expansion of coverage with the Low-Income Health Program (LIHP), and the implementation of the Delivery System Reform Incentive Pool (DSRIP). The DSRIP program showed improvements in quality of care and population health, although cost-of-care improvements were less significant.
The waiver was renewed in 2015, extending the program to 2020 and resulting in the Medi-Cal 2020 initiative. This initiative introduced additional programs, including alternative payment systems, the Dental Transformation Initiative, and the Whole Person Care program. The latter was focused on high-risk, high-utilizing recipients.
Since 2020, California has added several new benefits and services for Medi-Cal enrollees. These include the CalAIM initiative, new non-specialty mental health services (NSMHS), and the establishment of new billable provider types.
Medi-Cal is the California implementation of the federal Medicaid program, serving low-income individuals, including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of the federal poverty level. 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 support.
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Frequently asked questions
Medi-Cal is California's Medicaid health care program.
Eligibility for Medi-Cal is based on income and family size. Individuals with a family income of up to 138% of the federal poverty level are eligible. Lawful permanent residents (green card holders) are also eligible if they meet the requirements.
Medi-Cal provides comprehensive health coverage, including ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health services, dental, vision, and long-term care.
You can apply for Medi-Cal anytime throughout the year online, over the phone, or in person. Applications can be submitted through Covered California, California's health insurance marketplace.
If you are notified that you no longer qualify for Medi-Cal, you can contact the service center within 60 days to discuss your options with Covered California.
