Medi-Cal Regulations

Medi-Cal is a state and federally funded health care program implemented to help low-income families and individuals with little or no health insurance receive adequate medical care. The program offers free or low-cost medical services to qualifying California residents. The plan offers a range of benefits with many services geared towards children's health and preventative care. Medi-Cal pays for services during qualifying months and may offer retroactive coverage for medical bills received up to three months prior to the application date.

Eligibility

• Medi-Cal is available to individuals under 21 and over 65, as well as qualifying families with children. Additionally, Medi-Cal offers coverage to disabled, pregnant and those receiving qualifying state or federal supplemental income. Families without traditional health insurance through their employer may be eligible for benefits as well. Income and family size help determine eligibility, and the program offers benefits to a wide range of individuals. Low-income individuals needing medical care who don't fit into the traditional requirement categories are encouraged to apply with their Department of Social Services to determine eligibility.

Residence Requirements

• Medi-Cal recipients must show proof of California residency. Proof may include state-issued identification or proof of school or employment. Rent, mortgage or utility bills and receipts are also acceptable proof. (Applicants without an address can also establish proof of residency through other means.) U.S. citizens require a social security card. Eligibility for legal immigrants hinges on factors such as immigration status and work history. Illegal immigrants may be eligible for restricted services under the Medi-Cal program.

Income and Assets

• Eligibility depends on income and household size. According to the Los Angeles Department of Public Social Services, the allowable income for a family of four on Medi-Cal is $1,100 after allowable deductions such as child care and work expenses. Income for all members residing applicants' households must factor into their eligibility. Failure to report any income may result in denial of benefits. Cash value of available property also determines Medi-Cal eligibility. A family of four may have up to $3,300 in assets. Home and vehicle owners receive additional allowances, depending on individual circumstances.

Coverage

• Health coverage available to Medi-Cal recipients may include pregnancy and family planning services, emergency and hospitalization care, child checkups, doctor visits, mental health services, vision care, dental visits and prescriptions. Individuals must use the services of a Medi-Cal provider to ensure that Medi-Cal pays for the services. Some specialty health care may require preauthorization from Medi-Cal before treatment; unauthorized treatment may result in the denial of payment via Medi-Cal.

Applying

• Applicants should submit Medi-Cal applications to a local Department of Human Services or Social Services office and should receive a response within 10 days, verifying receipt of the application. Approval for Medi-Cal may take up to 45 days and applications that require more information may take longer. If MEdi-Cal denies your application you believe the denial was incorrect or discriminatory, you may file a complaint and request a hearing with the California Department of Social Services by calling [phone].