Medi-Cal is a health coverage program that provides free or low-cost benefits to more than 14 million Californians. It covers many health services, including inpatient and outpatient medical care, long-term nursing home care, and prescription drug coverage. It also provides dental and vision care.
Table of Contents
What is Medi-Cal?
Medi-Cal is California’s Medicaid program that offers eligible people free or low-cost medical and dental care. It includes adults, children, seniors, and people with disabilities.
You can apply for Medi-Cal online, by phone, or in person at your county social services office. You’ll need to provide information about your income, citizenship, and other details to verify your eligibility.
Paper documents may also be required. These can include Social Security numbers, immigration documents, and income and employment information.
The application process can take some time. Therefore, it’s essential to complete your application as quickly as possible.
Your county health department will inform you if your application is approved or denied and if you need to return any paper documents. If you return the documents within 90 days, your Medi-Cal coverage will be recovered.
Who is Medi-Cal for?
Medi-Cal is a state program that provides health care coverage to low-income residents. It is one of the features of what Medi-Cal covers. Millions of Californians qualify for Medi-Cal. It includes people with disabilities, children, pregnant women, older adults, and families.
Medi-Cal covers many services, including doctor visits, prescriptions, hospital stays, rehabilitation, and long-term care. It also helps pay for dental and vision care.
In addition to Medi-Cal, many other programs provide free or low-cost health care to Californians with limited income and resources.
Most Medi-Cal members receive care through a Managed Care Plan. Depending on the county they live in, they may have options to choose from the commercial plan or public plans administered by their county.
What are Medi-Cal’s Eligibility Criteria?
Several factors, including income and health status, determine Medi-Cal eligibility. There are over 90 different eligibility categories, and each category has its own rules.
For example, seniors and adults with disabilities can qualify for SSI-linked Medi-Cal, which automatically allows them to get full-scope Medi-Cal benefits if they meet SSI requirements. Some of these eligibility categories require a high income or a combination of income and health status; others are designed to cover a specific group of people with certain diseases.
In addition to the general income and health eligibility criteria, California’s Medicaid program includes several small programs that operate within the more extensive.
What is Medi-Cal’s Income Limit?
To be eligible for free Medi-Cal, your family income must be less than the federal poverty line (FPL). This amount may vary based on the program and the household size.
Individuals earning above the income limit might still get Medi-Cal with a Share of the Cost (SOC). A SOC, like a deductible, is the amount you pay out of pocket each month before Medi-Cal begins to reimburse your medical bills.
If you have countable assets, these count towards Medicaid’s asset limit. These include cash, stocks, bonds, investments, vacation homes, bank accounts (checking, savings, money market), and Covid-19 stimulus checks.
You can also use your spouse’s resources to help you get coverage. For example, Medi-Cal has a spousal impoverishment protection program that allows you to transfer some or all of your income and resources to your spouse until their combined resources and income reach the limits.
You should contact your county Medi-Cal office to find out if you can transfer resources to your spouse. If you need help determining whether or not you can transfer resources to your spouse, talk with a Medi-Cal counselor.
What is Medi-Cal’s Managed Care Plan?
If you qualify for Medi-Cal, your health care will be covered under a managed care plan. These plans are regulated by the California Department of Health Care Services (DHCS) and administered by your county.
Managed care contracts are risk-based, which means that they require a high level of performance and accountability. They also allow states to target beneficiaries who are most likely to use services and develop strategies for improving the quality of their care.
Mental health treatments for mild and moderate mental illness, drug use disorder treatment, and long-term services and supports such as nursing homes and particular home and community-based programs are examples of benefit carve-outs in managed care contracts. However, access to these services remains challenging, as do language and cultural gaps in the provider network.
What is Medi-Cal’s Co-Pay?
When you see a doctor or visit the emergency room, you may be asked to pay a co-pay. But, depending on your plan, you might not have to pay anything or just a few dollars.
A co-pay is like a deductible – you pay before your insurance kicks in. It might be as little as $30 for a visit to your primary care physician or as much as $150 for an orthopedic surgeon appointment.
The essential thing to understand is that your co-pay may be more than what you would pay with your employer-sponsored health insurance.
An excellent medical plan will save you time and money in the long run while also giving you peace of mind knowing you have reliable coverage for all your healthcare needs.
What is Medi-Cal’s Deductible?
The Medi-Cal deduction allows patients to pay for some or all of their medical expenditures while still getting program assistance. This amount can cover medical and dental services and prescription drugs like an insurance deductible.
This deduction may be applied to all household members, not just the household member who is disabled or elderly. In addition, it can be claimed for any unreimbursed medical costs, including any paid or outstanding bills.
Some households with incomes higher than the state’s limit on Medi-Cal can still qualify for the program if they agree to pay a share of the cost. The person or couple must agree to pay a certain percentage of their monthly income toward their medical expenses, similar to an insurance deductible.