{"id":59963,"date":"2023-08-30T09:45:42","date_gmt":"2023-08-30T13:45:42","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=59963"},"modified":"2026-01-05T15:23:03","modified_gmt":"2026-01-05T20:23:03","slug":"california-medicaid-guide","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/california-medicaid-guide\/","title":{"rendered":"Guide to Medicaid in California"},"content":{"rendered":"

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 translates to approximately 15 million people, underscoring the program’s crucial role in delivering essential healthcare services to a substantial portion of California’s population. 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.<\/span><\/p>\n

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.<\/span><\/p>\n

What is Medi-Cal?<\/b><\/h2>\n

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.<\/span><\/p>\n

Difference between Medicaid and Medi-Cal<\/b><\/h3>\n

In the state of California, Medicaid and Medi-Cal are the same thing. Medi-Cal is the name given to California\u2019s specific Medicaid program. People living in California who qualify for Medicaid are covered by the Medi-Cal program.<\/span><\/p>\n

Eligibility for Medi-Cal<\/b><\/h2>\n

Not everyone will qualify for low or no-cost healthcare coverage through the <\/span>Medi-Cal program. Eligibility<\/span><\/a> depends on income, age, residency, and other requirements.<\/span><\/p>\n

Income and asset requirements<\/b><\/h3>\n

How much an applicant earns has an effect on their Medi-Cal eligibility.\u00a0<\/span><\/p>\n

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.<\/span><\/p>\n

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.<\/span><\/p>\n

The <\/span>Covered California website<\/span><\/a> offers a calculator to see if you qualify for Medi-Cal or the state health insurance marketplace.<\/span><\/p>\n

Starting in 2026, adults 65 and older, people with disabilities, and those who are in a family that exceeds income limits under federal tax rules will need to meet asset requirements to receive Medi-Cal. Countable assets include bank accounts, cash, and properties such as more than one house or vehicle.<\/span><\/p>\n

Age requirements<\/b><\/h3>\n

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 younger than 19. Additionally,\u00a0<\/span><\/p>\n

Non-MAGI Medi-Cal welcomes further applicants, including adults aged 65 and older, along with Medicare recipients.<\/span><\/p>\n

Starting in January 2024, eligibility for full Medi-Cal benefits was<\/span> expanded<\/span><\/a> to low-income adults aged 26 to 49, some people with disabilities, and some people older than 64.<\/span><\/p>\n

Disability requirements<\/b><\/h3>\n

Those who qualify for Supplemental Security Income (SSI) automatically qualify for SSI-linked Medicaid in California.<\/span><\/p>\n

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.<\/span><\/p>\n

Citizenship or immigration status<\/b><\/h3>\n

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\u2019t be shared with immigration enforcement unless the applicant commits fraud through the program.<\/span><\/p>\n

Through 2025, adults aged 19 and older who had been unable to present a Social Security card or establish their immigration status could still access benefits through Medi-Cal. Moreover, there are specialized provisions such as the <\/span>Young Adult Expansion<\/span><\/a> (YAE) and <\/span>Older Adult Expansion<\/span><\/a>, which may extend benefits to individuals lacking formal immigration status. Full benefits can be considered for children younger than 19 years of age, irrespective of their immigration status.<\/span><\/p>\n

Starting in 2026, adults 19 years or older who are not pregnant, undocumented, or without satisfactory immigration status will no longer qualify for full-scope Medi-Cal coverage if they apply for benefits on or after January 1, 2026. They may only qualify for restricted-scope Medi-Cal, which covers emergency, pregnancy-related, and nursing home care.<\/span><\/p>\n

This rule applies to new enrollments only; individuals who already have full-scope Medi-Cal will not lose their coverage, but must fill out their renewal form on time to keep their benefits.<\/span><\/p>\n

New work requirements<\/b><\/p>\n

As a result of legislation enacted in the summer of 2025, some Medicaid recipients will need to prove that they are working or volunteering in order to receive coverage. <\/span>The new requirement applies to certain low-income childless adults between 18 and 64 without disabilities, and certain parents of older teenagers. With some exceptions for people with substance use disorders, disability, or those who are caring for a sick relative, these individuals will likely need to show that they worked or volunteered at least 80 hours monthly in order to continue receiving benefits. This process is likely to start in January 2027.<\/span><\/p>\n

Medi-Cal benefits<\/b><\/h2>\n

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.<\/span><\/p>\n

Medical services covered<\/b><\/h3>\n

Medi-Cal should cover any medically necessary services<\/span><\/a>. This includes the following:<\/span><\/p>\n