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).Medi-Cal

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. Medi-Cal, 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 12 million Californians are enrolled in Medi-Cal. This means about 1 in 3 Californians have Medi-Cal.

Getting Started With Medi-Cal Enrollment

If you’re eligible for Medi-Cal, you should know that Health for California will soon be taking applications. 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.

Why Do I Need Medi-Cal California Medicaid?

Medi-Cal is an insurance for low-income individuals. There are more than 90 eligibility categories, and each one has its own rules and requisites. For example, SSI-Linked Medi-Cal automatically gives Medi-Cal coverage to those who receive SSI benefits. Income-Based Medi-Cal is for those who meet certain low-income requirements. Those who are disabled may qualify for Aged, Blind, and Disabled — Medically Needy Medi-Cal, California’s Working Disabled Program, or Aged & Disabled Federal Poverty Level Medi-Cal.

How Do I Apply for Medi-Cal?

First, determine whether you’re eligible. If you are, you can apply through BenefitsCal or, soon, Health for California.

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.

Your Status and Medi-Cal

Effective May 1, 2016, California’s undocumented low-income children will now have access to full coverage through Medi-Cal. California is the largest state with more immigrants than any other, will now provide options to approximately 170,000 undocumented children.

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.

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 their 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.

*All references and quotations from the DHCS can be found on the California Department of Health Care website by clicking here.