Medi-Cal Insurance Program Information

The state of California chose to name its Medicaid program "Medi-Cal." Medicaid is not to be confused with Medicare. Medicare is the federal health program for seniors, disabled individuals and certain dependents and is funded primarily through employer and employee payroll taxes. Medicaid is different in each state and is funded by both the federal and state governments. Medicaid is an insurance program to provide health care for low-income families, seniors, pregnant women, foster children, disabled individuals and certain individuals suffering from specific illnesses.

Eligibility

• Individuals who currently receive benefits from supplemental security income (SSI) or state supplementary payment (SSP), California's aid for dependent children (AFDC), in-home supportive services, adoption assistance or foster care assistance programs or refugee assistance are eligible for Medi-Cal. You are also eligible if you are 65 years of age or older, younger than 21 years of age, pregnant, blind, disabled, or are on limited refugee status. Parents or guardians of children under the age of 21 may be eligible if the parent is deceased, absent, incapacitated, unemployed or underemployed. All applicants must be California residents who are not incarcerated and who do not receive public assistance from another state.

Benefits

• Qualified individuals receive coverage for doctor's visits, hospital stays, long-term care, vision care and prescription drugs. Medical equipment, such as wheelchairs and hearing aids, are also covered. Treatment for alcohol or drug abuse programs and mental health services are included. Medi-Cal recipients are eligible to apply for waivers to defray the costs of programs such as nursing home or assisted-living centers. Children are eligible to receive dental care, alternative treatments such as acupuncture and chiropractic care and speech therapy. Transportation for doctor's visits, physical therapy and psychological counseling are available for qualified individuals.

Application

• Individuals can complete an application at their nearest county welfare office. An application is available on the Department of Health Care Service's website that applicants can print, complete and mail to the office. The online application is posted in 11 different languages. Those who need services immediately, are homeless or minors seeking confidential counseling services should take the application to the nearest social services or welfare office rather than mail it. Individuals who need assistance with the application can go to their local social services agency for help.

Financial Information

• Applicants must disclose the income of every individual in the household as well as their assets and resources. The individual's residence is not considered a resource, but bank accounts, cash on hand, life insurance policies, stocks and similar assets are counted. The DHCS then subtracts applicable expenses, such as child care or alimony or child support paid under a court order to determine whether the family qualifies for any or all of the services provided by Medi-Cal.

  To qualify for free care, the family's income, after allowable deductions, must be no more than the limit for the family size. For example, a family of three cannot have an income greater than $934 per month after deductions, a family of six cannot have more than $1,417 monthly income and a family of eight cannot earn more than $1,692 per month after deductions. If the income exceeds the limit, the family may qualify for partial payments.