The federal Medicaid program is known as Medi-Cal in California. This large program provides free or low-cost health care to California residents with limited income and resources. It’s common for household members to be eligible for different health coverage programs. For example, parents may receive premium assistance tax credits through Covered California, and their children qualify for Medi-Cal.
Table of Contents
Online
Medi-Cal (pronounced: me-dee-cal) is California’s version of the federal Medicaid health coverage program. Families with children, retirees, people with disabilities, pregnant women, and former foster youngsters up to 26 with modest incomes can all get services and coverage under the program.
Your eligibility may be determined using the poverty table. Depending on the requirements you satisfy, there are different qualifying levels. Still, if you’re an adult who isn’t pregnant, you must make less than or equal to 138% of the federal poverty threshold.
According to the statute, adults without children whose household earnings do not exceed 138% of the federal poverty threshold are also eligible to participate.
The local County Department of Social Services office determines whether you are eligible for Medi-Cal.
The offices will review your finances, and personal care needs assessment to determine eligibility. You can learn how to qualify for Medi-Cal by completing an application online or in person. The process is simple and free. You must provide your name, address, birth date, and Social Security number.
You must also provide documents showing your income and any countable assets you own, such as bank statements, property tax records, life insurance policies, etc.
Once your application is complete, you will be mailed a letter with information about your health plan options. You will be given 30 days to choose a health plan. If you do not choose a plan within 30 days, your county will automatically select one for you.
Once you have chosen a health plan, your benefits will begin. Your Benefits Identification Card (BIC) will arrive in around 45 days.
Phone
Medi-Cal eligibility is based on income and sometimes “countable property.” Covered California helps determine your family’s income level and can allow you to apply for financial assistance to make health coverage more affordable.
They also can answer questions about changing application information, canceling coverage or changing from a Medi-Cal plan to a private health insurance plan.
Covered California will call you up to five times to help you choose a healthcare plan or to remind you to choose one.
In-Person
Before you apply, learn about the eligibility rules in your state. Then, fill out the application. Some people may need to fill out additional forms.
For example, children who aren’t eligible for Medi-Cal might be able to get coverage through the Children’s Health Insurance Program (CHIP). Most applicants can apply online or by phone.
Some counties have local offices where you can get personal assistance. These offices can help you complete your application and provide information about other benefits you might be eligible for, such as SNAP or child care.
They can also help you find a health plan in the Marketplace. If you’re a current Medi-Cal member and your circumstances have changed, such as losing job-based coverage or having a baby, you’ll need to renew your coverage.
You can contact your county office to check if you need to know whether your situation has changed. If you need to become a Medi-Cal member, you can apply for the program by visiting your county website.
You must have your case number and an access code to create an account. Then, you can sign in and choose a health plan that best meets your needs. If a plan were picked for you by Covered California, the county would send you a mailer with your health plan information.
Eligible residents include adults with low incomes, families with children, people who are elderly or have a disability, and people receiving care under the foster care program. You can apply for Medi-Cal by mail.
The County Department of Social Services will let you know if they need more information from you before processing your application.
A Benefits Identification Card (BIC) will be sent to you within 45 days following the approval of your application.
After you get your BIC, you will receive a letter explaining your health plan options. Medi-Cal will select one for you if you don’t choose a health plan within 30 days.
Each county’s local social services departments decide who is eligible for Medi-Cal. You can challenge the decision if you are refused benefits.
The decision notification you got contains further information regarding your ability to appeal. If you are applying for Medi-Cal, FAMIS or Plan First for more than two people in your household, use this Additional Person Single Page Supplement and the Non-MAGI Medicaid Application (DOH-4520).
This form is needed if any applicant in your family has medical bills that exceed their spend-down liability.
