Medi-Cal

Medi-Cal is California’s Medicaid program that provides medical services to low-income people at little or no cost. It is administered by the Centers for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (DHCS).

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What Is Medi-Cal?

Each state runs part of the health care program Medicaid, and Medi-Cal is the version available to qualified individuals in California. With Medicaid for California, if you qualify and apply, can help you pay for doctor’s visits, medication, dental screenings, rehabilitation, surgery, visits to the hospital and more.

Who Is Responsible for Medi-Cal?

County human services departments are responsible for administering the Medi-Cal program at the local level. Recent reports state that more than 14 million Californians are eligible for enrollment in Medi-Cal. Approximately one-third of the state’s population is enrolled in Medi-Cal. More than 80% of enrollees have coverage through the managed care plan while the rest use a fee-for-service system to access care.

Getting Started With Medi-Cal Enrollment

If you’re eligible for Medi-Cal, Health for California can help you with your application. We’ll help you apply for a quote online, and our simple application is fast and accurate, so you’ll get the information you need right away. If you need coverage and may qualify for Medi-Cal or would like to compare plans, get a quote from us.

Applying for Medi-Cal

You have several options if you want to apply for Medi-Cal. The first step is usually to determine if you’re eligible for the coverage. To do that, look at your household income or review any other programs you qualify for in California.

If you  meet the income requirements or are eligible because of your health or age, you can apply for coverage in the following ways:

• By mail
• In person
• Online

What Do I Need to Apply?

When you apply, you’ll need to provide information about yourself and your family. Some of the details you’ll be asked for include:

• Social security numbers: You’ll need the Social Security number for each person in your family or those who are part of the application. If you’re an immigrant without a Social Security number, you’ll need to provide your document information instead.
• Employment details: You must provide information about your employment status and income with your application. If more than one person in the household works, provide employment details for each person, as their income can affect your overall eligibility.
• Federal tax information: You’ll also have to provide your federal tax details, such as your filing status and the number of dependents you claim on your return.
• Other health insurance: If you have health insurance through a job or another insurance policy, you’ll be asked to include information about it on your application.

It’s important to provide as much of the requested information as possible when you submit your application. Not having certain details, such as your tax information or employment information, doesn’t mean you shouldn’t apply. It’s often better to send in your application with as much information as you have than not to apply at all. In fact, you can still get coverage for your children even if you are an undocumented immigrant. You can also be eligible for coverage even if you don’t file a tax return.

What Is on the Application?

As you fill out the application, it will ask you to provide personal information about everyone in your home. The application will ask for the following:

• Address
• Preferred language
• Whether you or others in your family have a disability
• Citizenship or immigration status
• Employment and income information
• Race and ethnicity
• Veteran status
• Birthday

If you feel confused about any of the questions on the application or need assistance, Health for California is here to help. If you know you’re eligible for Medi-Cal, it can be worth applying anyway, as you might qualify for a subsidized health insurance plan if you end up not qualifying for Medi-Cal.

Medi-Cal Insurance: Understanding the Basics

California has the nation’s largest Medicaid program. There was a huge increase in Medi-Cal enrollments largely due to the expansion that California opted into after the Affordable Care Act was passed which gives aid to a larger range of people. Now, people with slightly higher income are able to receive Medi-Cal regardless of disability, family status, financial resources, and other factors that were usually taken into account in eligibility decisions.

Medi-Cal for Immigrants

As of May 1, 2016, California’s undocumented low-income children (under the age of 19) have access to full coverage through Medi-Cal.

Most adults who are undocumented do not qualify for Medi-Cal. However, they may qualify for some of the coverage during pregnancy or emergencies.

In most cases, adults who are immigrants and have been legal residents for at least five years or meet other requirements qualify for Medi-Cal. However, even immigrants who are legal residents but do not qualify for Medi-Cal may qualify for assistance in getting insurance if they’re at or below 400 percent of the FPL (Federal Poverty Level).

What May Be Covered by Medi-Cal?

Medi-Cal provides a range of health benefits, including the following 10 “essential health benefits” required by the Affordable Care Act for all health plans:

• Outpatient (ambulatory) services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Programs such as physical and occupational therapy (known as rehabilitative and habilitative services) and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Children’s services, including oral and vision care

 

Understanding Your Medi-Cal Benefits

Your Medi-Cal benefits will depend on how you qualify for Medi-Cal. Some patients get full-scope Medi-Cal, meaning they qualify for all Medi-Cal coverage. Some patients eligible for partial-scope Medi-Cal will be covered only for some services. It’s important to understand what is and what may not be covered for you.

The Medi-Cal Health Benefits Chart provides more details about specific services in the above categories. Medi-Cal also offers certain dental benefits for adults and children, and full-scope Medi-Cal members are offered vison benefits.

Your Medi-Cal benefits will depend on how you qualify for Medi-Cal. Some patients get full-scope Medi-Cal, meaning they qualify for all Medi-Cal coverage. Some patients eligible for partial-scope Medi-Cal will be covered only for some services. It’s important to understand what is and what may not be covered for you.

Medi-Cal also offers certain dental benefits for adults and children, and full-scope Medi-Cal members are offered vison benefits.

To improve its services, the DHCS states that to improve members’ access to services and to ensure they spend tax dollars efficiently, “nearly 80 percent of its members now receive care from a Medi-Cal managed care plan. Under these models access to health care is easier and the quality of care is improved.”*

How You Get Medical Care Under Medi-Cal

Plan options vary depending on the county you reside in. Most counties offer commercial plans including Anthem Blue Cross, Kaiser Permanente, Health Net, and Molina. Other counties offer public plans administered by the community. If a county only administers one plan, then all Medi-Cal members will be enrolled in that plan. Almost all Medi-Cal plans are “managed care plans” which means they function similar to an HMO. Medi-Cal Plans can be found in the Medi-Cal Managed Care Health Plan Directory.

A managed care plan means you’ll have a primary care physician, and they’re the one person you’ll see if you need medical care. If you need to see another doctor or specialist, your primary care physician must refer you to that medical care provider if you want that visit covered by Medi-Cal. In the event of an emergency, however, you are not limited to a specific hospital.

After You Have Selected a Plan

Once the plan is selected, a doctor or doctor’s group must be chosen. Medi-Cal members must use a Medi-Cal doctor and facility that is in the group and plan that they have been enrolled in. Members can search for Medi-Cal Doctors on the Medi-Cal Managed Care Health Care Options Website.

In some areas, only “Fee-For-Service” Medi-Cal is offered – contact Medi-Cal for how Fee-For-Service Medi-Cal works.

The Future is Here

The California DHCS seeks to fulfill its vital role as California’s health care safety net by having the following mission and vision:

“…to provide Californians with access to affordable high-quality health care, including medical, dental, mental health, substance use disorder services, and long-term services and supports…and to preserve and improve the physical and mental health of all Californians.” *

If you’re ready to sign up for Medi-Cal or another health insurance program, get a quote from Health for California today. Our online application is simple and accurate, allowing you to apply for coverage from the comfort of your home or from anywhere you wish.