Medi-Cal Eligibility Requirements

Medi-Cal is California’s Medicaid program. It gives people with low incomes access to health services, including medical and dental care. The program is available for adults, children, pregnant women, older adults and people with disabilities. People who have certain conditions, such as tuberculosis and HIV, might also qualify for Medi-Cal.

This guide explains how to qualify for Medi-Cal, the program’s benefits and some recent updates. Contact Health for California to learn more or find the best plan for you and your family.

Who Qualifies for Medi-Cal?

You may qualify for Medi-Cal if you are a resident of California and meet the household or income eligibility requirements. Alternatively, you may qualify if you are a California resident and are one of the following:

• Over the age of 65
• Pregnant
• Blind or disabled
• In a nursing or intermediate care home
• A refugee living in the U.S. temporarily
• Under the age of 21

A parent or guardian relative of a child below 21 years old may also be eligible for Medicaid assistance when caring for a child due to:

• The death of their parent
• The parent not living with the child
• The parent being incapacitated
• The parent being unemployed

You may also qualify for Medi-Cal benefits if you are already enrolled and receiving benefits from one or more of the following programs:

• CalFresh: CalFresh is California’s food stamp program. The federal version is called the Supplemental Nutrition Assistance Program (SNAP). Eligibility for CalFresh is based on your income level and monthly expenses.
• Supplemental Security Income (SSI) and State Supplementary Payment (SSP): The SSI program provides supplementary income monthly to adults who meet specific requirements, such as being blind, over the age of 65 or disabled. SSP is California’s version of SSI.
• CalWorks: This program provides cash assistance to families with children. Eligible families receive cash monthly to help them pay for food, housing and other needs. Eligibility is based on income, age, resources and citizenship status.
• Refugee Assistance: California’s Refugee Assistance program is designed for refugees who don’t have children and who don’t have any other form of assistance. The program provides employment assistance to help people gain self-sufficiency.
• Foster Care or Adoption Assistance Program: The foster care and adoption assistance program in California is designed to help people adopt a child. The children who are eligible for the program would otherwise have remained in long-term foster care.

If you think you might be eligible for any of the above programs but haven’t yet applied or started receiving benefits, you can do so through BenefitsCal. Health for California can help you through the Medi-Cal application process.

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Medi-Cal Income Eligibility Requirements

Generally, you must stay within an income threshold to qualify for an assistance program. Benefits programs typically require you to provide proof of income when you apply, such as your paystub or W-2 Form. Those income requirements also apply to Medi-Cal. In some cases, you might be eligible for Medi-Cal based on your income alone, even if you’re not signed up for another assistance program.

Medicaid income eligibility in California is based on household size. To qualify for free Medi-Cal coverage, you need to earn less than 138% of the poverty level, based on the number of people who live in your home. The income limits based on household size include:

• One person: $20,783
• Two people: $28,208
• Three people: $​​35,632
• Four people: $43,056
• Five people: $50,481

The list continues until you reach a household with 12 people, after which point you must add $7,425 for every extra person. Visit the California Department of Health Care Services to view the complete income levels.

What Benefits Are Covered Under Medicaid in California?

When you go without health insurance, any cough, cold or injury can be a cause for concern. You might worry about how you’ll pay for health care when you need it. Fortunately, Medi-Cal takes the worry out of affording health coverage. The program provides coverage for preventive medical care and treatment when sick or injured.

The Affordable Care Act requires qualified health plans, including Medicaid plans, to offer coverage of essential health benefits, which include:

• Outpatient or ambulatory services
• Hospitalization
• Emergency services
• Maternity and newborn care
• Prescription medications
• Mental health and substance abuse treatment services
• Physical and occupational therapy (or rehabilitative and habilitative services)
• Preventive and wellness services and chronic disease management
• Dental and vision care

If you’ve been putting off seeing a doctor or getting a treatment you need out of concern about its cost, getting coverage from Medi-Cal can help you take care of your health.

What Is the Medi-Cal Access Program in California?

The Medi-Cal Access Program (MCAP) offers covered health services at no cost for individuals who are pregnant, with no copayments or deductibles. It is designed for middle-income families whose income exceeds the no-cost Medi-Cal threshold and who do not hold health insurance. Individuals with other health insurance plans not covering maternity services or those with a copayment or maternity-only deductible above $500 may also apply for MCAP.

In general, the following people may apply for MCAP:

• Pregnant individuals aged 18 and above
• Legal partners of the pregnant individual
• Natural parents or guardians, foster parents or stepparents with whom a pregnant child lives
• Emancipated minors living outside the home of a natural or adoptive parent, foster parent, legal guardian or stepparent

The individual’s newborn may qualify for the Medi-Cal Access Infant Program, getting coverage for two years maximum, except where the child is:

• Enrolled in an employer-sponsored insurance
• Enrolled in no-cost Medi-Cal
• Disqualified because you exceed the income threshold by the child’s first birthday

Medi-Cal Updates for 2024

Since January 1, 2024, more people have become eligible for Medi-Cal due to certain changes. Immigration status restrictions have been removed, allowing more income-eligible Californians to apply for full-scope coverage. Full-scope Medi-Cal differs from Emergency Medi-Cal. Full-scope plans cover all medical, mental health, vision, dental and other essential services. On the other hand, Emergency Medi-Cal is limited and only covers emergency medical services.

Additionally, Medi-Cal managed care plans (MCP) now have additional requirements to advance quality, accessibility, equity, transparency and accountability. This development has caused some members to change plans, and the Department of Health Care Services (DHCS) is monitoring the transition process. Affected members have a Continuity of Care, which means they can keep the current provider for a maximum of 12 months after enrolling into the new Medi-Cal plan. Members will continue receiving Medi-Cal covered services.

The Continuity of Care applies to the following individuals:

• Those whose Medi-Cal health plans have been inactive as of January 1, 2024.
• Those 25 years old or younger who are currently or previously utilizing foster care and are enrolling in MCP from a regular fee-for-service Medi-Cal.
• Those who were receiving Medi-Cal services from Kaiser Permanente and were informed they would be automatically enrolled into the Kaiser Permanente Medi-Cal Plan at the beginning of 2024.
• Those who had a Medi-Cal health plan with Health Net in Los Angeles County in 2023 and were informed mid-November 2023 that they would automatically be re-assigned to Molina Healthcare on January 1, 2024.

The Federal Poverty Level (FPL) that determines the income threshold for Hospital Presumptive Eligibility (HPE) has been updated. HPE providers can use this requirement to determine program eligibility for the 2024 calendar year. HPE improves access to Medi-Cal by allowing hospitals to obtain reimbursement for services provided as if the individual were enrolled in standard Medi-Cal.

How Do I Know If I Qualify for Medicaid Services?

Not sure whether you meet the Medicaid qualifications and income requirements? A Health for California agent can help you determine your eligibility. Our agents will review your income information, family details and other relevant factors, such as your age and health, and help you put together your application.

Health for California is here to help you determine your Medi-Cal eligibility. Our free agents are always available to answer your questions. If you want to enroll yourself or your family in Medi-Cal, get your free quote today.