Medi-Cal Guidelines in California

The federal government helps low-income individuals who are blind, disabled or at least 65 years old obtain healthcare through the Medicaid program. Senior citizens and their spouses who have earned enough work credits can receive limited health care coverage through the Medicare program. However, these federal insurance programs often leave large gaps, and low-income groups depend upon additional state health assistance. States such as California provide residents with medical assistance to cover medical costs.

Eligible Groups

• The program provides automatic eligibility to Social Security Income recipients, residents receiving the state's CalWorks benefits, refugees in the Refugee Assistance Program and children in California's Adoption Assistance Program or Foster Care Program. Those not receiving governmental cash assistance may qualify if they are age 65 or older, disabled or blind, individuals and children under 21 years old, and parents and caretakers of children whose parents are not able to take care of them because of death, incapacity or unemployment. Individuals who are pregnant, suffer from cervical or breast cancer or live in a skilled or intermediate nursing care facility and refugees who have lived in the U.S. for a minimum time are eligible.

State Residency

• Only residents of California are eligible for Medi-Cal coverage. Californian residents are individuals who permanently live in California with the intent to stay in the state or someone who is working in California or searching for employment in California with the intent to move to the state.

Application Process

• Medi-Cal is available to California's low-income children and adults. If applicants are not automatically eligible for Medi-Cal benefits, they must apply with their local social services or local county welfare office. Applicants must complete and sign a four-page form providing their family's personal and income information. The office contacts the applicant within 45 days in most cases through written notice to notify her of the eligibility determination but may take up to 90 days.

Pregnant Women and Children

• Children and pregnant women can exceed the program's income requirements if their incomes are below certain levels depending upon the child's age. Monthly incomes cannot exceed $1,133 for an individual. The state will not count the family's cars, savings and investment cars, heirlooms and other personal property to determine the child's eligibility.

Benefits

• Medi-Cal insurance offers comprehensive medical and dental care coverage, pays for qualified medical supplies and helps pay for nursing care and hospice care. Medicare coverage extends to mental health, acupuncture, physical therapy and podiatry services. Although not all Medi-Cal providers charge recipients a medical copayment, some providers require it. Medi-Cal coverage can serve as supplemental coverage for Medicare recipients. Since Medicare only covers recipients for limited nursing care and medical care, Medi-Cal can help cover those costs. California provides specific dual eligibility rules for recipients who qualify for Medicare and Medi-Cal. Additionally, California provides dual eligibility guidelines for recipients who qualify for both Medi-Cal and Medicaid. Both Medicare and Medicaid are federal government health insurance programs, but Medi-Cal is a state program.

Estate Recovery

• California requires some Medi-Cal's recipients to pay off their Medi-Cal coverage benefits after receiving services through its Estate Recovery Program. After a Medi-Cal recipient dies, the state's Department of Health Care Services decides whether to pursue repayment from the decedent's estate. The state government bases its decision upon the amount of services provided and the total value of the decedent's assets within the estate. The state can only recover the amount of services actually provided and nothing more. Estate recovery rules prohibit reimbursement when the recipient's spouse is still alive, when the estate's beneficiary is disabled or blind, if the recipient has a surviving child under 21 and for services provided to the recipient before age 55.