Medicaid Eligibility & Requirements in California
Medi-Cal is California’s Medicaid program. Medi-Cal 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.
Who Is Eligible for Medicaid in California?
Medi-Cal is available to California residents who are U.S. citizens, permanent residents, legal aliens or U.S. nationals. There are several ways to qualify for the program. Some individuals qualify based on their household income level. Other nights qualify because they meet certain requirements concerning their health status or age. You are eligible to receive benefits if you are:
- Over the age of 65
- Blind or disabled
- In a nursing or intermediate care home
- Under the age of 21
- A refugee living in the U.S. temporarily
As a parent or guardian relative of a child who is under the age of 21, you may be eligible for Medicaid assistance if you’re taking care of the child because the parents:
- Have died
- Do not live with the child
- Are incapacitated
- Are not employed
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: California’s food stamp program is called CalFresh. The federal version of the program is called the Supplemental Nutrition Assistance Program (SNAP). Eligibility for CalFresh is based on income level and your monthly expenses.
- Supplemental Security Income (SSI) and State Supplementary Payment (SSP): The SSI program gives adults who meet certain requirements, such as being blind, over the age of 65 or disabled, supplement income monthly. SSP is California’s version of SSI.
- CalWorks: This program provides cash assistance to families that have children. Eligible families receive cash monthly to help them pay for food, housing and other needs. Eligiblity 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.
Medicaid Income Eligibility Requirements
Usually, if you’re eligible for the programs above, you meet certain income requirements. 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 for the Medi-Cal program. 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 are:
- One person: $17,609
- Two people: $23,792
- Three people: $29,974
- Four people: $36,156
- Five people: $42,339
For every person in a household above five people, add $6,183 to the income limit. Visit the California Department of Health Care Services to view additional 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 preventative medical care and treatment when you’re sick or injured.
The Affordable Care Act requires qualified health plans, including Medicaid plans, to offer coverage of Essential Health Benefits, which include:
- Outpatient (ambulatory services)
- Emergency services
- Maternity and newborn care
- Mental health and substance abuse treatment services
- Prescription medications
- 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.
How Do I Know If I Qualify for Medicaid Services?
If you’re unsure whether you meet the Medicaid qualifications and income requirements, you can use a Medicaid calculator. Simply enter your information, including your state/zip code, income, household size and the number of adults and children you want to enroll. A Health for California agent can also 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 question. If you want to enroll yourself or your family in Medi-Cal, get your free quote today.
Not sure how Obamacare affects your health care plans in California? Learn how the ACA works in California, including benefits, costs and enrollment.
Covered California is the Golden State’s official health exchange marketplace where individuals, families and small businesses can find high-quality, low-cost California government health insurance.
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Learn about the Covered California website. Find easy online enrollment. Set up your account, log in, buy insurance and more on the California health marketplace website.