Everything You Need to Know About Medi-Cal

Medi-Cal is California’s public health care coverage program for low-income people. It provides health benefits to children, seniors, people with disabilities, and others.

The program operates through a network of managed care plans, each with a distinct structure that has evolved. These different models reflect individual counties’ unique healthcare delivery and financing systems.

What is Medi-Cal?

People who are underprivileged or have little finances can receive free or inexpensive healthcare coverage through Medi-Cal, the state Medicaid program of California. It includes children, pregnant women, older adults and individuals with disabilities.

Medi-Cal has several different programs that each offer additional benefits and services. Some of these programs are free, while others have a monthly cost that depends on the program and your income.

The program covers inpatient and outpatient medical care, emergency room visits and prescription drugs. It also covers vision and dental care.

You must meet certain income or health status requirements to qualify for Medi-Cal. For example, to be eligible for the program, you must have an income below 138% of the federal poverty level or $31,055 a year for an individual or a family of four.

Many low-income people, such as seniors or individuals with disabilities, are dually enrolled in Medicare and Medi-Cal. It is done because Medicare has no income or residency requirements, while Medi-Cal requires you to meet specific eligibility rules.

To qualify for the program, you must apply. The application is available online or at your county social services office.

Who is eligible for Medi-Cal?

Medi-Cal is a health insurance program that helps low-income people pay for medical costs. The state and the federal government run it. So what does Medi-Cal cover? It covers doctor’s visits, medication, dental screenings, rehabilitation, surgery and more.

You are eligible for Medi-Cal if you are a California resident and your income is below certain limits. You must generally earn less than $1,564 for a single individual and $2,196 for a couple to qualify for Medi-Cal.

If you have a child under 19 and your income is below the Medi-Cal income limit, you are eligible for Children’s Health Insurance Program (CHIP) coverage with a low monthly premium. Your children can also get free services like well-baby checkups; doctor visits for sickness and injuries, teeth cleanings, fillings and eye exams.

Many families that qualify for a health plan with financial help through state funding will find out their children are also eligible for Medi-Cal. These parents often want to decline Medi-Cal and add their children to their plan, but unfortunately, this isn’t an option.

If you are a senior and your income is above the Medicaid income limit, you may be able to enroll in a Medi-Cal program called “Medi-Cal with Share of Cost.” Your countable income will be deducted to determine your “Share of Cost” (SOC). Once you meet this SOC, Medi-Cal will start paying for your medical care.

How do I apply for Medi-Cal?

Medi-Cal is a health insurance program for Californians with low incomes and resources. Federal and state taxes support it. You can apply for Medi-Cal online or at your local county social services office. Your eligibility depends on how much you earn and other factors, such as your countable property. Use the income guidelines chart to find out if you and your family may qualify for Medi-Cal. To apply, you must complete a single streamlined application, available in English and Spanish. Send completed and signed applications to your local county social services office, where you will receive personal assistance.

Additionally, you’ll need to provide evidence of your income. It could be a check stub or a recent employer statement. If you have Medicare, you must also submit your award letter.

You can choose from various Medi-Cal managed care plans depending on your income. These plans will have a doctor or group of doctors you can see. You must ask your primary care physician for a referral if you need to see a specialist or other medical doctor.

You can also apply for Fee-for-Service Medi-Cal, which is a type of Medi-Cal that does not require you to enroll in a managed care plan. This plan is only available in some areas of the state.

What happens if I don’t qualify for Medi-Cal?

If you or someone in your household does not qualify for Medi-Cal, you can get a health plan through Covered California, the state’s marketplace. It offers programs from private companies and federal subsidies that help lower monthly premiums. However, you can only apply for a Medi-Cal plan if your income is below the cutoff level. The cutoff is 138% of the federal poverty line. However, people with income above that cutoff are not eligible for subsidies to help them pay their monthly premiums. It’s called “The Subsidy Cliff.”

It is especially true for undocumented immigrants. And it’s a big reason why unauthorized immigrants have difficulty accessing Medi-Cal.

Another way that undocumented immigrants can get coverage is through Medicaid, which provides free or low-cost health care to Californians with limited incomes. Most undocumented people do not qualify for Medicaid based on income, but they can apply. In addition, under a new law signed last summer, about 235,000 undocumented immigrants who are 50 and older will be eligible for full Medi-Cal, regardless of their immigration status. The state has also proposed extending Medi-Cal to cover 700,000 illegal people between the ages of 26 and 49 if approved in this year’s budget.