Medi-Cal is a public health care program for people with low incomes. Medi-Cal insurance is free or at a very low cost depending on your eligibility. It offers plans that are similar to the Covered California marketplace plans but it is its own program.
Medi-Cal can be complex to navigate. There are quite a few steps, and it is a longer process than a typical Covered California plan. While enrolling in Covered California plans is like shopping on a marketplace, Medi-Cal is a government program where you work with a social services office in your county. If you’d like to learn more about Covered California health plans you can find information here.
Free Resource: Certified Enrollment Counselors
There is a free resource that United Way provides that can be very helpful in understanding the process and going through the steps: Certified Enrollment Counselors. These counselors can answer complex questions, help you sort through documents, resolve hang-ups and understand your unique situation, as well examine why you may or may not get certain benefits. You can reach out to a Counselor directly here.
What is Medi-Cal and What Does Medi-Cal Cover?
Medi-Cal is California’s Medicaid program. It is a public health insurance program financed by the state and federal government. Medi-Cal provides healthcare services for low-income individuals, including families with children, seniors, persons with disabilities, foster care, pregnant women and those with specific diseases such as tuberculosis, breast cancer or HIV/AIDS. Medi-Cal plans offer benefits that are similar to Covered California plans, but the insurance comes at little or no cost to you, if you are eligible.
Medi-Cal Insurance Coverage
There are two levels of Medi-Cal coverage: restricted scope and full-scope. Restricted scope Medi-Cal covers emergencies only. Full-scope Medi-Cal provides medical, mental health, dental and vision care. It also covers alcohol and drug use treatment and many prescriptions. You will learn your level of eligibility from your county social services agency once you begin the process of enrolling in Medi-Cal.
Essential Health Benefits
All the health plans in the Medi-Cal program and the Covered California program include the same comprehensive set of “essential health benefits.” These benefits are:
- Outpatient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Children’s dental care
- Children’s vision care
- Exams and X-rays
- Fluoride treatments
- Anterior root canals
- Prefabricated crowns
- Full dentures
- Other medically necessary dental services
- Routine eye exam once every 2 years
- Glasses coverage for members under 21 and for nursing home residents
- Contact lens testing for specific conditions
- Low-vision testing for specific conditions
- Artificial-eye services for those who have lost an eye or eyes
You can also view the full list of Medi-Cal benefits.
If you have specific medical needs or are confused about any of your coverage options, definitely reach out to a Certified Enrollment Counselor.
How to Qualify
You can apply for Medi-Cal if you live in California, regardless of your sex, race, religion, color, national origin, sexual orientation, marital status, age, disability or veteran status. Your local county office will determine if you are eligible and what level of coverage you can get based on a few key factors, including:
- Your income
- Your age
- Your children’s age (if you would like to include them)
- If you are pregnant, blind or have a disability
Medi-Cal coverage is primarily determined based on the Federal Poverty Level (FPL), which means that your income will need to fall under a certain range. You can view the U.S. Federal Poverty Guidelines for more information.
You might also be awarded Medi-Cal if you are:
- 65 or older
- Under 21
- In a nursing home or intermediate care home
- On refugee status for a limited time, depending how long you have been in the U.S.
- A parent or caretaker relative of an age eligible child
- Have been screened for breast and/or cervical cancer
Additionally, you are eligible Medi-Cal if you are enrolled in one of the following programs:
- CalWorks (AFDC)
- Refugee Assistance
- Foster Care or Adoption Assistance Program
Learn more about Medi-Cal eligibility.
Available Medi-Cal Programs
There are two ways that California offers Medi-Cal insurance: Fee-for-service and Managed Care. In a fee-for-service arrangement, the state pays your doctor or medical provider directly for whatever services you use. For managed care, the state pays your insurance plan for the coverage that it provides to you.
Most Medi-Cal members are enrolled in a managed care plan, which works like a private insurance plan. Medi-Cal offers a selection of 21 health insurers, and the plans available to you will depend upon the county you live in. Most counties offer Anthem, Blue Cross, Kaiser, Health Net and Molina. Every plan provides the same level of care at the coverage level you have been approved for.
Not sure what Medi-Cal programs are near you? Look up the plans available in your county.
How to Apply for Medi-Cal
If you have specific questions or run into any issues with your county office or the overall process, be sure to reach out to one of the United Way Certified Enrollment Counselors. It’s not always easy to navigate! You can find direct contact information for a counselor at United Way.
Here is the general process for enrolling in Medi-Cal.
- You can begin the process of applying for any of these ways. Unlike Covered California health insurance, there is no deadline to enroll in Medi-Cal. Go to covercalifornia.ca to fill out an application on CoveredCA.com
Send an application via mail
Visit your local county social services office in-person
Call your local county social services office
Call a Covered California representative at (800) 300-1506
- You will receive a “Notice of Action” eligibility notice and you will be connected to your local county office to finish the application process. Note: It may take up to 45 days to receive your notice, and if you apply based on disability, it may take up to 90 days. If you aren’t approved or you don’t hear back within that time frame, you can request a “State Fair Hearing” to request reconsideration.
- Once you are approved, you will be able to access your Medi-Cal benefits right away using a Medi-Cal Benefits Identification Card (BIC) that you’ll get in the mail. Initially you will get your benefits as a Fee-for-Service setup, until you have enrolled in a managed care health plan.
- You will get an information packet in the mail about managed care health plans if they are available to you. The packet will feature the plans in your area, along with instructions on how to enroll. If you don’t not choose a plan within 30 days, the state will assign a plan to you.