What is Medi-Cal?
Medi-Cal is California’s Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources. Medi-Cal is supported by federal and state taxes. You can apply for Medi-Cal benefits regardless of sex, race, religion, color, national origin, sexual orientation, marital status, age, disability, or veteran status. If you are found (or determined) eligible, you can get Medi-Cal as long as you continue to meet the eligibility requirements.
Your local County Welfare/Social Services Department manages Medi-Cal eligibility determinations. If you have questions, you can find the addresses and telephone numbers under County Social Services Office Listing.
How Can Medi-Cal Help You?
The Medi-Cal program assists Californians in various family and medical situations. When you apply, the information you provide on your Medi-Cal Application and any required verification (proof) will be used to determine which program(s) you qualify for, and which program is best for you and your family.
Who Can Get Medi-Cal?
People in many different situations qualify for Medi-Cal. They are listed below. If you are not in one of these groups, call your county social service agency to determine if you qualify for a county-operated medical assistance program.
You may automatically be eligible for Medi-Cal if you receive cash assistance under one of the following programs:
- SSI/SSP (Supplemental Security Income/State Supplemental Program)
- CalWORKs (California Work Opportunity and Responsibility to Kids). Previously called Aid to Families with Dependent Children (AFDC).
- Refugee Assistance
- Foster Care or Adoption Assistance Program.
- Even if you don’t receive cash assistance, you may be eligible for Medi-Cal if you are one of the following:
- 65 or older
- Under 21
- Diagnosed with breast or cervical cancer
- In a skilled nursing or intermediate care facility.
- Refugee status during a limited period of eligibility. Adult refugees may or may not be eligible depending upon how long they have been in the U.S.
- Parent or caretaker relative of a child under 21 and
- The child’s parent is deceased or does not live with the child, or
- The child’s parent is incapacitated, or
- The child’s parent who is the primary wage earner is unemployed or underemployed.
Do I have to Live in California to Get Medi-Cal?
Yes, you must be a resident of California to get Medi-Cal. A California resident is someone who lives here and plans to stay here, or someone who is working or looking for work in California.
How Do I Apply for Medi-Cal?
- Call or visit your local county social services office and ask for a Medi-Cal application.
- If you need help filling out the forms, call the county social services agency. Mail or take your application with the required verifications (proof) to the nearest social services office in your county. If you do not have all your verifications, or are not sure of what you need, please send what you have. You can send the rest later. The sooner the social services agency receives your application, the sooner your case may be processed and your Medi-Cal benefits can begin.
- If you get SSI/SSP payments, your Social Security administration office automatically sets up Medi-Cal for you. No separate application for Medi-Cal is needed. You will get your Medi-Cal card (BIC) in the mail.
If you get CalWORKs payments, the county social services agency automatically sets up Medi-Cal for you. No separate Medi-Cal application is needed. You will get your Medi-Cal card (BIC) in the mail.
How Is My Application Processed?
- When the county receives your application the eligibility worker will review your application. If additional information is needed, the worker may ask you for information by mail or by phone. If you want to meet with your worker to discuss your application, call your worker to set up an appointment.
- Once the eligibility worker has all of the necessary information, he or she will determine if you are eligible for Medi-Cal. You will get a letter in the mail telling you if your Medi-Cal application is approved or denied. If you do not understand this letter or do not agree with the information in this letter, contact the eligibility worker at the county social services office. If you still disagree with the county’s action, you may file for a State Hearing by completing the back of the Notice of Action the county sends you or by calling the toll free number.
- If your child(ren) is not eligible for free Medi-Cal, they may be able to get health coverage through the low-cost Healthy Families Program (HFP). Make sure you indicate on your application that we can send your information to the HFP if your child(ren) is found ineligible for free Medi-Cal.
Anyone can help you with the application process – a family member, friend, or anyone else of your choice.
How Long Does It Take?
Forty-five (45) days are allowed to process a Medi-Cal application not involving a disability. If you are applying for Medi-Cal based on a disability, your application process may take up to 90 days depending on how quickly you complete the disability information and when your doctors and hospitals submit your medical records. To avoid processing delays, submit all information requested of you as soon as possible. Ask your eligibility worker for help if you cannot get the information. If you have an immediate medical or dental need, such as pregnancy or a severe illness, indicate this need on your application and your application may be processed more quickly.
Do I Have To Pay For Medi-Cal?
- If your income is less than Medi-Cal limits for your family size, you will receive Medi-Cal services at no cost to you.
- If your income is more than Medi-Cal limits for your family size, you will have to pay a certain amount only in the month you have medical expenses. The amount that you pay is called your share of cost (SOC). When you pay or promise to pay that amount, we say that you have met your SOC. Once you have met your SOC, Medi-Cal will pay the rest of your covered medical bills for that month. For example, if your SOC is $50, you must first pay or obligate (obtain your providers agreement to make payments on the SOC) $50. Your provider will enter the amount you paid or obligated into the Department’s database. Your case will certify when the amounts you paid or obligated equal the amount of your share of cost. Once your share of cost is certified; providers checking your eligibility will advised that you are eligible and covered services may now be billed to the Medi-Cal program. Please note, expenses incurred by ineligible members of your family may be used to meet the share of cost of eligible members.
- If one spouse lives in a nursing home, Medi-Cal allows the spouse remaining in the home to keep all of the income he/she receives in his/her name regardless of the amount. If that amount is below $2,541per month, then the spouse in the nursing home can give income to the spouse at home to bring the spouse at home up to $2,541 per month. Be sure to ask your county social service agency for an MC Information Notice 007 for more information on income.
What If I’m Pregnant?
Many health care providers can offer you immediate, temporary, pregnancy related Medi-Cal services under a program called Presumptive Eligibility for Pregnant Women. If you are pregnant or think you are pregnant, ask if your health care provider participates in this program. If you would like further information, please call 1 (800) 824-0088.