If you are interested in applying for Medicaid in California (Medi-Cal), you’ve come to the right place. In this post, we will provide information about California Medi-Cal eligibility criteria for the children and family, pregnancy, the elderly, the blind, and the disabled.
We will explain in detail everything you need to know to successfully apply for California Medicaid.
In addition, we will show you the various ways you can apply, including how to log in to the CoveredCA.com website, and how to contact California Medi-Cal.
Finally, we will answer some of the most frequently asked questions about California Medi-Cal Eligibility.
This article on California Medi-Cal Eligibility will cover:
- What is California Medi-Cal?
- Who is Eligible for Medicaid in California?
- California Medi-Cal Eligibility Guidelines
- 2021 California Medicaid Income Limit
- How to Apply for Medicaid in California
- What does California Medi-Cal Cover?
- California Medicaid Phone Number
- Medicaid Expansion in California
- California Medi-Cal Benefits Identification Card (BIC)
- Emergency Medical Assistance for Non-citizens
- FAQs about Medicaid in California
What is Medicaid?
Medicaid is a federal and state health insurance program for people with a low income.
It provides free or low-cost health coverage to millions of Americans, including families and children, pregnant women, the elderly, and people with disabilities.
The Children’s Health Insurance Program (CHIP) offers health coverage to children in families with incomes too high to qualify for Medicaid, but who can’t afford private coverage.
California Medicaid (Medi-Cal)
The California Medicaid program provides medical coverage to low-income individuals and families.
As of 2020, the program, along with the Children’s Health Insurance Program (CHIP) covered about 12.3 million people as shown by the image below.
In California, Medicaid (Medi-Cal is managed by the California Department of Health Care Services (DHCS).
The DHCS is the backbone of California’s health care safety net, helping millions of low-income and disabled Californians.
DHCS funds health care services for about 13 million Medi-Cal beneficiaries.
About one-third of Californians receive health care services financed or organized by DHCS, making the Department the largest health care purchaser in California.
Who is Eligible for California Medi-Cal?
You can get Medi-Cal if you are:
- 65 or older
- Blind
- Disabled
- Under 21
- Pregnant
- In a skilled nursing or intermediate care home
- On refugee status for a limited time, depending on how long you have been in the United States
- A parent or caretaker relative of an age eligible child
- Have been screened for breast and/or cervical cancer
If you are enrolled in one of the following programs, you can also get Medi-Cal:
- CalFresh
- SSI/SSP
- CalWorks (AFDC)
- Refugee Assistance
- Foster Care or Adoption Assistance Program
California Medi-Cal Eligibility Guidelines
To qualify for Medicaid in California, an individual must meet the eligibility requirements of the program.
There are several Medicaid programs that people in California can be eligible for. Each program has its own income and asset requirements.
However, all applicants must meet the general requirements below in order to qualify for California Medicaid.
Proof of Identity
Identity can be verified by a driver’s license, state identification card or another piece of identification.
Social Security Number (SSN)
A SSN must be provided for each person applying for Medicaid.
Your county Medicaid Office staff can help you apply for an SSN for anyone who does not have one.
Residency
Medicaid assistance is available to individuals who are residents of California if all other eligibility requirements are met.
There is no requirement regarding the length of time that a person must live in California in order to be eligible.
Citizenship
Medicaid is available to United States citizens, refugees, and certain lawfully admitted aliens. Other aliens may be eligible for limited Medical Assistance benefits if an emergency medical condition exists.
Additionally, U.S. citizens, refugees and legal aliens must submit documentation proving U.S. citizenship or legal alien status.
Household Composition
County Assistance Office staff will determine who are mandatory or optional budget group members in the Medical Assistance application based upon household relationships and individual needs for Medical Assistance.
Income limit
The income requirements for California Medicaid is perhaps the most important eligibility criteria. See below for details about Medicaid income limits by group. and household size.
2021 California Medi-Cal Income Limit
The California Medicaid eligibility income limit charts are divided by groups.
For example, the first chart is focused on income limits for children who qualify for Medicaid.
Similarly, the second chart below focuses on the Medicaid income limits for adults in California who qualify for Medicaid.
California Medicaid Income Limit for Children
Below is the income limit for children by age category. Find the age category your child falls into and you will see the income limit by household size.
| California Medicaid Income Limit – Children | ||||||
| Children Medicaid Ages 0-1 | Children Medicaid Ages 1-5 | Children Medicaid Ages 6-18 | Children Separate CHIP | |||
| % FPL | 100% | 261% | 261% | 261% | 312% | |
|
Household Size
|
1 | $12,880 | $33,617 | $33,617 | $33,617 | $40,186 |
| 2 | $17,420 | $45,466 | $45,466 | $45,466 | $54,350 | |
| 3 | $21,960 | $57,316 | $57,316 | $57,316 | $68,515 | |
| 4 | $26,500 | $69,165 | $69,165 | $69,165 | $82,680 | |
| 5 | $31,040 | $81,014 | $81,014 | $81,014 | $96,845 | |
| 6 | $35,580 | $92,864 | $92,864 | $92,864 | $111,010 | |
| 7 | $40,120 | $104,713 | $104,713 | $104,713 | $125,174 | |
| 8 | $44,660 | $116,563 | $116,563 | $116,563 | $139,339 | |
Next is the income limit for adults by category. Find the category you fall into and you will see the income limit by household size.
California has expanded Medicaid to include adults without dependents.
Therefore, adults without dependents can apply for Medicaid in California.
For an update on the Medicaid expansion debate and timeline in California, see our California Expansion update below.
California Medicaid Income Limit for Adults
| California Medicaid Income Limit – Adults | ||||||
| Pregnant Women Medicaid | Adults (Medicaid) Parent/ Caretaker | Seniors & People w/ Disabilities (Medicaid) | Adults (Medicaid) Expansion to Adults | |||
| % FPL | 100% | 208% | 109% | 100% | 133% | |
|
Household Size
|
1 | $12,880 | $26,790 | $14,039 | $12,880 | $17,130 |
| 2 | $17,420 | $36,234 | $18,988 | $17,420 | $23,169 | |
| 3 | $21,960 | $45,677 | $23,936 | $21,960 | $29,207 | |
| 4 | $26,500 | $55,120 | $28,885 | $26,500 | $35,245 | |
| 5 | $31,040 | $64,563 | $33,834 | $31,040 | $41,283 | |
| 6 | $35,580 | $74,006 | $38,782 | $35,580 | $47,321 | |
| 7 | $40,120 | $83,450 | $43,731 | $40,120 | $53,360 | |
| 8 | $44,660 | $92,893 | $48,679 | $44,660 | $59,398 | |
How to Read the California Medicaid Income Limits Charts Above
You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid.
Similarly, when you identify the income group that applies to you, the income limit you see refers to the maximum level of income you can earn to qualify for benefits.
For example, if you are pregnant, to qualify for Medicaid, you cannot have an income higher than 206% of the Federal Poverty Level – which for a family of two is $36,234 as shown in the chart above.
How to Apply for California Medicaid (Medi-Cal)
There are 3 ways you can apply for Medicaid in California.
Option 1 – Apply online
You can apply online through the CoveredCA.com website, as shown by the image below.
CoveredCA.com is a joint partnership between Covered California and the Department of Health Care Services.
If you have an account, you can log in or create your CoveredCA.com account. Click here to be taken to the website.
Option 2 – Apply at CDSS Office Near You
You can apply in person at the California Department of Social Services (CDSS) office near you. Click here to locate a CDSS office.
Option 3 – Download Application
The Department of Health Care Services (DHCS) and Covered California have partnered to create a Single Streamlined Application for affordable health care coverage.
You can use the Single Streamlined Application to apply for a range of affordable health care coverage options, including free or low-cost Medi-Cal.
First, download the application, complete it, You can mail your completed and signed application to:
Covered California
P.O. Box 989725
West Sacramento, CA 95798-9725
Additionally, you can mail it to your local County Social Services Office.
Resources Limits
Medicaid eligibility for some is also determined using resource and household size in comparison to resource limits.
However, the resource limits do not apply to the following groups:
- Adults Age 19-64
- Pregnant women
- Families with children in the household – under their care and control
- Children under the age of 21
- CHIP
Examples of resources counted in determining eligibility include:
- Cash
- Checking accounts
- Savings accounts and certificates
- Christmas or vacation clubs
- Stocks and bonds
- Some trust funds
- Life insurance
- Vehicles
- Revocable burial funds
- Non-resident property
Examples of resources not counted in determining eligibility include:
- Your home
- Revocable and irrevocable burial reserves subject to specified limits
- Burial space and marker
- One motor vehicle
As mentioned above, some Medicaid eligibility groups have resource limits. This includes:
- Seniors ages 65 and above
- People with Disabilities
- SSI Recipients
For details on California Medicaid resources limits for these group of applicants, check with your county Medicaid office.
Documents you need to apply
During the application process for Medicaid in California, you will need to have various documents to support your application.
Here’s the list of documents you may have to provide:
- Information about household members (name, date of birth and Social Security number)
- Rent or mortgage information
- Expenses (utilities, daycare, etc.)
- Vehicle information
- Bank statements
- Income (pay stubs)
- Proof of disability or medical records showing a lasting medical condition
- Recent medical bills
- Proof of citizenship
- Additional information as requested
What happens after I apply for California Medi-Cal?
After you submit your Medi-Cal application, here’s what happens after:
- Receive a Notification of Likely Eligibility by mail
- Your county’s social services office may contact you by mail or by phone to request paper verification of income, citizenship, and other criteria that cannot be verified electronically.
- Receive Final Notice of Action notifying you of whether or not you can receive Medi-Cal
- Receive your BIC – when you receive your BIC in the mail, you are able to use the many Medi-Cal benefits available to you.
What does Medi-Cal Cover in California?
Medi-Cal covers a variety of medical expenses. This includes:
Primary Medical Care
- Doctor visits
- Diagnostic testing
- Emergency services
- Surgery
- Hospitalization
- Prescription drugs
- Dental services
- Health screenings for kids
Ongoing Care & Recovery
- Personal care services (IHSS)
- Occupational & physical therapy
- Outpatient drug abuse services
- Nursing facility stays
- Adult day health care
Other medical-related costs
- Medical supplies
- Durable medical equipment
- Transportation to doctor visits
- Transportation costs for children with disabilities
Depending on how you qualify for Medi-Cal, the program may pay for all of these services (full-scope Medi-Cal) or just some of them (partial-scope Medi-Cal).
Also, Medi-Cal only pays for prescriptions that are on its list of accepted drugs.
Additionally, Medi-Cal it may refuse to pay for certain procedures like cosmetic surgery and may require that you get prior authorization for some services.
However, if Medi-Cal decides not to pay for a service and you think they should, you can appeal the decision.
When you have more than one Health Insurance
Depending on your situation, you might get employer-sponsored coverage, Medi-Cal, and Medicare all at the same time.
The rules about how your different types of coverage pay for things are very complicated.
To be on the safe side, it is best to check with your health coverage plans when you have questions about which plan will pay for what expenses.
However, Medi-Cal will only pay for expenses that it covers and that your other coverage won’t pay for.
California Medi-Cal Phone Number
Here’s how to contact Medi-Cal:
Call 1- (800) 541-5555
If you are outside of California, please call (916) 636-1980) for the Telephone Service Center.
The Service Center can help with:
1. Learning how to apply for Medi-Cal
2. Learning about Medi-Cal services
3. Finding a health care provider
4. Filing a complaint
For questions specific to Mental Health Services call 1-800-896-4042. TTY Line: 1-800-896-2512.
Monday through Friday 8 a.m. – 5 p.m. ( Except State Holidays and CA only)
Medicaid Expansion in California
California’s Medicaid program (Medi-Cal) covers nearly 12.5 million people as of March 2020.
Of that total, nearly 3.7 million were eligible due to the ACA expansion of Medicaid, which took effect in 2014.
Undocumented immigrant children gained access to California Medicaid starting in May 2016.
Furthermore, as of January 2020, that eligibility applies to young adults through the age of 25.
As long as they qualify based on household income, children and young adults can enroll in Medicaid in California regardless of their immigration status.
Additionally, Gov. Jerry Brown signed SB4 into law in October 2015, and it eliminated the immigration status requirement for Medicaid eligibility for California residents 18 and under.
California Medi-Cal Benefits Identification Card (BIC)
The California Benefits Identification Card (BIC) has been redesigned. The new BIC design, featuring the California poppy, will be provided to newly eligible recipients and recipients requesting replacement cards.
Most people on Medicaid must enroll in a health plan. If you are one of those people, you will get a letter telling you the names of Medicaid providers in the state.
You will be given a timeframe to choose a health plan.
Additionally, once you are approved for Medicaid in California, you will be issued a permanent Medi-Cal card, like the image below.
Furthermore, If you are enrolled in a health plan, you will also receive a membership card from your plan.
FAQs about California Medi-Cal
Here are the most frequently asked questions about Medicaid in California:
What health plans are available through Medi-Cal?
Medi-Cal managed care offers a selection of 21 health plans. Your health plan options will vary depending upon the county in which you live.
Additionally, most counties offer commercial plans, which also operate in Covered California including Anthem Blue Cross, Kaiser, Health Net, and Molina.
Other plans are public plans administered by the community.
Also, every county’s Medi-Cal plans provide the same high-quality care at the same low or no cost to Californians, no matter where you live.
To see the directory of health plans available through Medi-Cal managed care click here.
How much does Medi-Cal cost?
For many individuals who enroll in Medi-Cal, there is no premium, no co-payment, and no out-of-pocket cost.
However, for some households, there is a low monthly premium to pay.
Additionally, for some Medi-Cal children, the monthly premiums are $13 per child up to a family maximum of $39 per month.
In general, individuals in Medi-Cal will get the same health benefits available through Covered California at a lower cost.
What is the difference in coverage between Medi-Cal and Covered California?
Medi-Cal offers low-cost or free health coverage to eligible Californian residents with limited income.
Covered California is the state’s health insurance marketplace where Californians can shop for health plans and access financial assistance if they qualify for it.
Health plans available through Medi-Cal and Covered California both offer a similar set of important benefits, called essential health benefits.
Essential health benefits consist of:
- 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 & Habilitative Services) and devices
- Laboratory services
- Preventive and wellness services & chronic disease management
- Children’s (Pediatric) services, including oral and vision care
Can I change my Medi-Cal health plan?
Yes. If you are in a Medi-Cal health plan and want to choose another health plan for any reason, you may leave your current health plan and join a different health plan.
To change your Medi-Cal health plan, call Health Care Options (HCO), toll-free, at 1-800-430-4263 (TTY 1-800-430-7077).
Customer service is available from 8 a.m. to 6 p.m. PT, Monday through Friday, except holidays.
Additionally, you can visit an HCO presentation site for help changing your health plan.
Also, you may also complete and mail an Enrollment Choice Form to Health Care Options.
California Medi-Cal Eligibility Summary
We hope this post on California Medi-Cal Eligibility was helpful to you.
If you have any questions about Medicaid in the state of California, you can ask us in the comments section below.
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Be sure to check out our other articles about Medicaid.
Difference between Medicare and Medicaid Programs
How to Apply for Coverage by State
Medicaid Income Limits by State
Medicaid Phone Number for Florida
