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Guide to Medicaid in California

The Medicaid program for California, known as Medi-Cal, provides coverage for a number of necessary medical services as well as some prescription medications

The Medi-Cal program in California serves a significant portion of the state’s population, with enrollment exceeding one-third of its residents. This staggering figure amounts to approximately 15 million people, highlighting the program’s critical role in providing essential healthcare services to a substantial portion of California’s populace. This comprehensive guide is expertly designed to enhance your understanding of the intricacies of Medicaid in California to empower you to make well-informed decisions.

We have simplified the complexities surrounding the program’s coverage, eligibility requirements, and other crucial details. Our aim is to equip you with the necessary information to confidently navigate the Medi-Cal program, ensuring you can access the healthcare services you need with ease and assurance.

What is Medi-Cal?

Each state has its own version of the Federal Medicaid program, and California’s is called Medi-Cal. The program, administered by the Department of Health Care Services (DHCS), is designed to offer low-cost and sometimes even no-cost health coverage to those in California who qualify.

Difference between Medicaid and Medi-Cal

In the state of California, Medicaid and Medi-Cal are the same thing. Medi-Cal is the name given to California’s specific Medicaid program. People living in California who qualify for Medicaid are covered by the Medi-Cal program.

Eligibility for Medi-Cal

Not everyone will qualify for low or no-cost healthcare coverage through the Medi-Cal program. Eligibility depends on income, age, residency, and other requirements.

Income requirements

How much an applicant earns has an effect on their Medi-Cal eligibility. 

To determine eligibility, MAGI Medi-Cal uses the Modified Adjusted Gross Income (MAGI) of the applicant and household size, along with tax filing and qualified countable income information. There are no property limits.

Those who don’t meet the income limit may qualify for non-MAGI Medi-Cal. There are some countable asset limits, including houses and banking account balances.

The Covered California website offers a calculator to see if you may qualify for Medi-Cal or the state health insurance marketplace.

Age requirements

Medi-Cal offers access to individuals of all age groups, contingent upon a range of factors such as age, disability, pregnancy, and more. Eligibility criteria vary according to specific categories. MAGI Medi-Cal extends its coverage to qualifying pregnant individuals, children, young adults up to 19 years old, adults aged 19 to 64, as well as caregivers of children under 19. Additionally, 

Non-MAGI Medi-Cal welcomes further applicants, including adults aged 65 and above, along with Medicare recipients.

Disability requirements

Those who qualify for Supplemental Security Income (SSI) automatically qualify for SSI-linked Medicaid in California.

Some Medi-Cal benefits may be available to adults or children in a long-term care facility, as well as those who are blind or have a disability.

Citizenship or immigration status

California residents qualify for Medi-Cal. To apply for the program, you must share your immigration or citizenship status, but this information is confidential and won’t be shared with immigration enforcement unless the applicant commits fraud through the program.

Adults aged 19 and above, who are unable to present a Social Security card or establish their immigration status, can still access limited benefits through Medi-Cal. These encompass services like long-term care, pregnancy assistance, and emergency care. Moreover, there are specialized provisions such as the Young Adult Expansion (YAE) and Older Adult Expansion, which may extend benefits to individuals lacking formal immigration status. For children under 19 years of age, full benefits can be considered, irrespective of their immigration status.

Medi-Cal benefits

Medi-Cal covers a variety of essential and medically necessary services, as well as some prescription drugs. The benefits vary, depending on the program you qualify for. To see the full terms and conditions of what’s covered and what’s not, ask to see the coverage limits of the Medi-Cal program before seeking treatment.

Medical services covered

Any services that are medically necessary should be covered by Medi-Cal. This includes the following:

  • Abortions
  • Acupuncture
  • Allergy services
  • Emergency room visits 
  • Hospitalization and surgical procedures
  • In-home health care
  • Mental health and substance abuse disorder services
  • Newborn care
  • Physicals and well checks
  • Prenatal and infant delivery services
  • Therapy services, such as occupational, physical, and speech
  • X-rays and imaging services

Prescription drug coverage

The Medi-Cal Rx program handles prescription drug coverage for covered members. The list of prescriptions covered by the program can be found on the official website and changes periodically. If you don’t see your prescription covered, you may need prior authorization from the Medi-Cal program to get it paid for. It’s also important to find a participating pharmacy that accepts Medi-Cal coverage before you have your prescription filled.

Dental coverage

The Medi-Cal Dental health plan covers various dental and oral health services based on age and stage of life. Covered adults will qualify for regular dentist visits and some or all of the following:

  • Cleanings
  • Fillings
  • Fluoride varnish
  • Dentures
  • Root canals
  • Scaling
  • Extractions
  • X-rays

Crowns may be covered in some situations, as well as sedation if it’s medically necessary. Children may qualify for even more dental care services.

Vision coverage

California Medicaid offers some vision services at low or no cost to covered children and adults. Services include an eye exam every 24 months and may also include eyeglasses or contact lenses.

How to apply for Medi-Cal

It’s free to apply for Medi-Cal, and you can use the same form you use to apply for the state health insurance marketplace. California offers a few methods to apply, including:

  • In person at your local county social services office
  • By mail
  • Over the phone
  • Online at CoveredCA.com 

Applicants who need additional guidance can call a Certified Enrollment Counselor (CEC) at 1-800-300-1506. All of your sensitive information will be handled discreetly during the call. 

Cost of Medi-Cal

A significant number of individuals who join Medi-Cal enjoy the advantage of zero premiums, co-payments, and out-of-pocket expenses. Starting from July 1, 2022, all monthly premiums were lowered to $0.00.​ In essence, those enrolled in Medi-Cal receive equivalent health benefits as those accessible through Covered California, but at a more affordable expense.

Additional Medi-Cal resources

California continually updates its guidelines, benefits, and resources to help those in California get access to quality health care.

California Medi-Cal FAQ

What is the difference between Medi-Cal and Medicaid?

In California, the Medicaid program is called Medi-Cal. There is no difference.

When can I apply for Medi-Cal?

There is no deadline to sign up for Medi-Cal. If you need health insurance, you can apply at any time of the year, including after you lose existing healthcare coverage, have a baby, or become a resident of California.

How long does it take for my Medi-Cal application to be processed?

While the exact time varies, expect your application to be reviewed within 45 days. It may take longer, and there are steps you can take to avoid delays, including applying online and verifying your residency or income information ahead of time. If you are approved, your healthcare coverage will go back to the month you started the application process. Because California charges a penalty for not having health insurance coverage, you should try to get coverage as soon as possible.

Can I keep my doctor under Medi-Cal?

If your physician accepts Medi-Cal coverage, you can continue to see them and have their services paid for by the health coverage. Not all healthcare providers accept Medi-Cal, but there are around 130,000 physicians, dentists, and other providers in the state of California that do.

What if I don’t have a ride to a doctor’s appointment?

Medi-Cal covers transportation for covered individuals, depending on their needs. Non-medical transportation (NMT) works for those who can easily use a car, bus, or other vehicle to get around. Non-emergency medical transportation (NEMT) is available for those who need assistance with transportation, such as with a litter van or wheelchair van. Emergency vehicle services, such as ambulances, are used for life-threatening and emergency situations.

How do I get a replacement medical benefits card?

Those in the Medi-Cal program receive a Benefits Identification Card (BIC) that must be shown when receiving covered services. If you lose it, notify your county office right away so that they can issue a replacement. Once your new card is issued, your old card won’t be valid.

If your card is stolen, you should notify your county office and local law enforcement so they can follow up on the crime. Share as much information as possible about the theft.

Can I receive interpreter or translation services under Medi-Cal?

Both language interpreter assistance and American Sign Language (ASL) translation are available to Medi-Cal members. You won’t pay for this service. To access this benefit, let your provider know as soon as possible about your request. You can also have the healthcare provider or someone at the office call the service phone number, especially if you are hard of hearing or need assistance making the call. This service is available for medical, dental, and vision appointments and services.

What do I bring to an appointment?

In addition to your Benefit Identification Card (BIC), you should bring one additional piece of identification. This may be your driver’s license or Social Security Number. The office will match the ID to your BIC to ensure it is you receiving benefits and to prevent fraud. You may still be seen for services without a BIC in some cases. They may also take your photo to make it easy to be verified at future visits.