Misconceptions about Medi-Cal
- Medi-Cal is only for unemployed people: This is not true. Many employed individuals with low income are also eligible for Medi-Cal.
- Medi-Cal only offers limited health services: Medi-Cal actually provides a comprehensive set of services, including preventative care, chronic disease management, and emergency services.
- Only U.S. citizens can apply for Medi-Cal: Non-citizen legal residents, including permanent residents, refugees, and asylees, can also qualify for Medi-Cal.
Income Limits for Adult Medi-Cal 2024
What does it cover: preventative care, primary care, family planning, mental health and substance abuse, emergency services, dental and vision, and prescription?
| Family Size | Gross Income Threshold (138% FPL) |
|---|---|
| 1 | $20,783 |
| 2 | $28,208 |
| 3 | $35,632 |
| 4 | $43,056 |
| 5 | $50,481 |
| 6 | $65,330 |
| 7 | $72,754 |
| Each Additional Person | Add $7,425 |
Income Limits for Pregnant Individuals in 2024
Full-Scope Medi-Cal: Offers complete health coverage, including prenatal, labor, delivery, and postpartum care, plus dental and mental health, before, during, and after pregnancy. The Medi-Cal Access Program (MCAP) extends coverage for a year post-pregnancy.
Coverage: Provides essential health services, including dental and mental health, for pregnant individuals without legal residency in California, during pregnancy and for a year after.
Presumptive Eligibility: Allows immediate access to health coverage for pregnant individuals while their Medi-Cal application is being processed.
| Family Size | Gross Income Threshold (213% FPL) |
|---|---|
| 1 | $32,078 |
| 2 | $43,538 |
| 3 | $54,997 |
| 4 | $66,456 |
| 5 | $77,916 |
| Each Additional Person | Add $11,460 |
Coverage Eligibility for 0-18 Kids & Adolescents
California offers very generous coverage for kids, separate from adult coverage. If you and your partner are not eligible for Adult Medi-Cal, your kids might still be eligible for CCHIP.
The CCHIP program has a much higher income threshold than adult Medi-Cal. It is common for parents to be covered under ObamaCare and for kids to be covered under Medicaid (Medi-Cal CCHIP).
IMPORTANT: I am eligible for Covered California (subsidized plan), can I decline Medi-Cal for my kids and keep them under the same plan? Unfortunately, in California, if your kids are eligible for CCHIP, that would be their option. If you decline CCHIP, you can still add them onto your current plan, but at the full cost.
| Family Size | Gross Income Threshold (266% FPL) |
|---|---|
| 1 | $40,060 |
| 2 | $54,371 |
| 3 | $68,682 |
| 4 | $82,992 |
| 5 | $97,303 |
| Each Additional Person | Add $14,311 |
Eligibility Requirements
Do I need Citizenship?
Medi-Cal does not require citizenship to apply for Medi-Cal so long as you meet eligibility requirements.
Disability
Income is not the sole criterion for Medi-Cal eligibility; disability also plays a key role:
- You must have a disability that prevents you from working or attending school.
- Your disability must be expected to last for at least 12 months or result in death.
- You must be unable to provide for your own basic needs due to your disability.
Other eligibility criteria
If you are currently enrolled in one of these programs, you might be qualified for Medi-Cal:
- CalFresh
- SSI/SSP
- CalWorks (AFDC)
- Refugee Assistance
- Foster Care or Adoption Assistance Program
Picking The Right Program
1. Low-Income Worker: Maria works full-time at a minimum wage job and struggles to make ends meet. With her income falling below 138% of the Federal Poverty Level (FPL), Maria qualifies for Medi-Cal. This program would provide comprehensive coverage at low or no cost, making it the best option for her.
2. Retired Senior: Robert, a 70-year-old retired resident of California, has a fixed income that doesn't stretch far enough to cover his healthcare needs. As a senior citizen, Robert is eligible for Medi-Cal, which can supplement his Medicare coverage and help cover costs that Medicare doesn't.
3. Small Business Owner: Linda owns a small business. Her income is too high for Medi-Cal, but she doesn't have access to employer-sponsored health insurance. Linda would be best served by purchasing a health plan through Covered California, where she may qualify for premium tax credits and cost-sharing reductions based on her income.
4. College Student: Sam is a full-time college student working part-time. His income falls below the Medi-Cal threshold, making him eligible for coverage. Medi-Cal would be the best option for Sam, providing him with free or low-cost health services.
5. Immigrant: Ali, a recent immigrant, works in a restaurant and earns a low wage. If he's a legal resident, he may be eligible for Medi-Cal based on his income, meeting his health care needs at minimal cost.
6. Pregnant Woman: Jessica is pregnant and doesn't have health insurance. Regardless of her income, Jessica is eligible for Medi-Cal, which covers pregnancy and childbirth services, making it the optimal choice for her.
7. Disabled Individual: Brian is unable to work due to a disability. Regardless of his income, Brian could qualify for Medi-Cal based on his disability status. Medi-Cal would be the best option for Brian, as it would cover his regular medical needs and any special care related to his disability.
Applying For Medi-Cal
To apply for Medi-Cal, you can do so online, by mail, in person, or over the phone. The most direct method is through the Covered California website, the state's official health insurance marketplace. Alternatively, you can download an application form from the California Department of Health Care Services (DHCS) website or request a paper form by phone and mail it to your local county social services office. In-person applications can be made at the same local offices, and phone applications are handled through the Covered California Service Center.
Documents Needed
When applying for Medi-Cal, you'll need to provide certain documents to verify your eligibility. These documents typically include:
1. Identification: A driver's license, state ID, or passport can serve as proof of identity.
2. Income Verification: Recent pay stubs, tax returns, or unemployment benefits letters help establish your income level.
3. California Residency: Utility bills, rent or mortgage statements, or employment records can demonstrate that you live in California.
4. Citizenship or Immigration Status: A birth certificate, naturalization certificate, or U.S. passport confirms U.S. citizenship, while permanent resident cards or visas provide proof of legal residency.
5. Disability Documentation: If you're applying based on disability, medical records and a Social Security Disability Insurance (SSDI) award letter may be required.
6. Other Information: Depending on your circumstances, additional documents like pregnancy verification or proof of age might be necessary.
What To Get If I am Not Eligible For Medi-Cal?
If you find that you're ineligible for Medi-Cal, don't despair. There are several alternative healthcare coverage options available in California that can provide you with the medical services you need.
Covered California Health Plans
If your income is above the Medi-Cal threshold but still falls within certain limits, you may qualify for insurance through Covered California. This state-run health insurance marketplace offers various plans, with premium tax credits and cost-sharing reductions available for qualifying individuals and families. These subsidies can significantly lower your monthly premiums and out-of-pocket expenses, making healthcare more affordable (Covered California).
Mira
Mira is a great option starting at $45/month if you are not qualified for Medicaid and cannot afford Covered California Plans.
Short-Term Health Insurance
If you're between jobs, waiting for other coverage to start, or otherwise need temporary health insurance, short-term plans might be a viable option. These plans usually provide coverage for a limited period, typically 1 to 12 months. However, they may not cover pre-existing conditions or essential health benefits like preventive care.
Medi-Share or Health Care Sharing Ministries
Medi-Share, or health care sharing ministries, are cooperative groups where members share each other's healthcare costs. This alternative is not insurance but can serve as a cost-effective way to cover healthcare expenses. Note, however, that these ministries often have membership requirements, such as religious affiliations or lifestyle stipulations.
Frequently Asked Questions (FAQs) about Medi-Cal
1. What is Medi-Cal?
Medi-Cal is a public health insurance program in California that provides free or low-cost medical services to eligible residents, including some low-income adults, families with children, seniors, persons with disabilities, pregnant women, children in foster care, and former foster youth up to age 26.
2. Does Medi-Cal only cover basic health services?
No, Medi-Cal covers a wide range of health services, not just basic ones. These include doctor visits, hospital care, immunization, prenatal care, emergency services, and prescription drugs. Dental care and vision services are also included in some cases.
3. If I am employed, am I still eligible for Medi-Cal?
Employment status does not automatically disqualify you from Medi-Cal. Eligibility is primarily based on income, and many low-income workers may still qualify for Medi-Cal.
4. Does Medi-Cal cover long-term care?
Yes, Medi-Cal does cover long-term care in nursing homes and sometimes at home or in community-based settings, given that you meet the eligibility requirements.
5. Is Medi-Cal only for citizens?
While U.S. citizenship is one pathway to Medi-Cal eligibility, certain non-citizens, including lawful permanent residents, refugees, and asylees, can also be eligible.
6. Can I choose my own doctor under Medi-Cal?
Yes, you can choose your own doctor from the network of providers who accept Medi-Cal.
7. Do I have to pay for Medi-Cal?
Most Medi-Cal services are free, but some recipients may need to pay small co-payments for certain medical services, depending on income and family size.
8. Can I have Medi-Cal and private insurance at the same time?
Yes, you can have both Medi-Cal and private insurance. In some cases, Medi-Cal can cover co-payments, deductibles, and other costs not covered by your private insurance.