How do I qualify for Medi-Cal?

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You can qualify for Medi-Cal by meeting the requirements of a Medi-Cal eligibility category, which are also called programs. There are many Medi-Cal programs, and each has unique rules. DB101 gives detailed explanations of the following Medi-Cal programs:
  • Income-Based
  • SSI-Linked
  • Aged & Disabled Federal Poverty Level
  • Working Disabled
  • Aged, Blind, & Disabled - Medically Needy

To learn about other eligibility categories, speak with a Benefits Planner or a Medi-Cal eligibility worker at your local county social services agency.

What benefits does Medi-Cal provide?

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Medi-Cal provides coverage for doctor visits, hospital stays, prescription drugs, rehabilitation, and other medical services. Some Medi-Cal programs provide access to all of these services (full-scope Medi-Cal), while others only provide some of them (partial-scope Medi-Cal). For a more detailed list of Medi-Cal services, see the glossary definition of full-scope Medi-Cal.

If you get Medi-Cal and have certain health conditions, you may also have access to other Medi-Cal benefits, including:

See Other Medi-Cal Programs for more details.

How do I apply for Medi-Cal?

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There are different ways to apply for Medi-Cal:

Note: If you get Supplemental Security Income (SSI) or used to and now are on SSI 1619(b), you automatically get Medi-Cal coverage. You do not need to apply for Medi-Cal.

What if I lose my Medi-Cal eligibility?

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There are a number of ways to protect your Medi-Cal coverage. You may first want to consider switching eligibility categories. For example, if you lose your Medi-Cal because your income from a new job is too high, you may want to consider the Working Disabled Program.

If you're on SSI, there are two programs that can help you keep your Medi-Cal when your countable income goes above the limit. If it's too high because you return to work, the 1619(b) provisions protect your Medi-Cal. If it goes above the limit because of an SSDI or CDB cost of living increase and you lose your SSI, the Pickle Amendment allows you to keep your Medi-Cal.

Can I qualify for Medi-Cal while I am eligible for private health coverage?

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Yes. Your enrollment in private health coverage will not jeopardize your participation in Medi-Cal. Obtaining private health coverage may allow you to access providers or services you may not have had available to you on Medi-Cal alone. If you have private health coverage and are eligible for Medi-Cal, you may qualify for the Medi-Cal/HIPP program, which can pay for your insurance premiums.

When using private health coverage and Medi-Cal simultaneously, the private health coverage is billed first. After the private health carrier pays or denies a claim, Medi-Cal is then billed and will pay for services it covers.

Note: You cannot get government subsidies to buy an individual health plan on Covered California if you are on Medi-Cal.

I’m an immigrant. Can I get Medi-Cal?

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  • Undocumented immigrants do not qualify for full Medi-Cal coverage, though they may qualify for Medi-Cal coverage for emergencies or during pregnancy.
  • Some non-citizens who have legal immigration status in the United States do not qualify for full Medi-Cal coverage. However, if their income is at or below 400% of the Federal Poverty Level (FPL), they can qualify for government help paying for individual coverage.
  • Immigrants who have been legal residents for 5 years or longer or meet specific noncitizen requirements qualify for all of the same programs that citizens can get.

If you are not sure whether you qualify, contact an organization in your area that works with immigrants.

Can I work and get Medi-Cal?

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Yes. Medi-Cal is designed to help you work. If you start earning money and your income goes up, there are programs and rules that will help you stay covered:
  • If you have a disability and work, you can switch to Medi-Cal's Working Disabled Program. You’ll have to begin paying for your Medi-Cal coverage, but the amount is small compared to the income you’re earning.
  • If you’re on SSI-Linked Medi-Cal, and then your SSI benefit goes to zero because you go back to work, a section of the SSI regulations called the 1619(b) provisions allow you to keep your Medi-Cal coverage.
  • If you're on SSI-Linked Medi-Cal and your SSDI or CDB benefits increase and make you ineligible for SSI, you can keep your Medi-Cal thanks to a rule called the Pickle Amendment.
  • If your income goes up so much that none of these rules help you keep your Medi-Cal and you cannot get coverage from an employer, you may qualify to get government help paying for a private health coverage plan on Covered California if your income is at or below 400% of the Federal Poverty Guidelines (FPG). See DB101's Buying Health Coverage on Covered California article for more information.

What is Aged and Disabled Federal Poverty Level Medi-Cal?

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Aged and Disabled Federal Poverty Level Medi-Cal provides free, full scope Medi-Cal services for disabled or aged individuals who meet the income and asset requirements of the program. Blind people are also eligible, but must be determined disabled.

To qualify for the Aged and Disabled Federal Poverty Level Medi-Cal, an individual's monthly total countable income (minus a Maintenance Needs Allowance and any health, vision, and dental insurance premiums) must be less than $1,242 ($1,682 for a couple).

Does what I have in the bank and/or what I own, such as my home or car, affect my eligibility for Aged and Disabled Federal Poverty Level Medi-Cal?

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Yes. You are allowed to have assets up to $2,000 in value ($3,000 for a couple). Some of your assets, like your home and car, are not counted for this program. Click here for a list of additional exemptions.

Assets may include:

  • checking and savings accounts;
  • the value of stocks, bonds, and trust deeds;
  • additional cars or recreational vehicles; and
  • promissory notes and loans that are payable to you.
Note: If your disability began before you turned 26, you can open an ABLE account where over time you can save up money and not have it counted by Medi-Cal. Learn more about ABLE accounts.

What is SSI-Linked Medi-Cal?

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SSI-linked Medi-Cal provides free, full scope Medi-Cal services for California residents who qualify for Supplemental Security Income (SSI). If you get SSI, you do not need to apply for Medi-Cal separately; you'll get it automatically.

What is Medically Needy Medi-Cal?

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Medically Needy Medi-Cal provides full scope Medi-Cal services to aged, blind, or disabled people with income above the eligibility levels of no-cost Medi-Cal programs. The program usually requires that you incur a monthly share of cost, similar in principle to a monthly copayment.

This Medi-Cal eligibility category is often called “share of cost Medi-Cal. A share of cost is often more expensive than paying a premium to get Medi-Cal's Working Disabled Program, if you work.

What does "incurring medical expenses" mean?

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"Incurring medical expenses" means that you have to pay for part of your medical expenses out of your own pocket if you get Medically Needy Medi-Cal. You are responsible for the first medical expenses of each month, up to your share of cost amount.

How do I figure out my share of cost?

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First, use the countable income calculation to find your countable income.

Next, subtract any health, vision, and dental insurance premium payments.

Finally, subtract a maintenance needs level (MNL) for your family size: If you are the only person in your family, deduct $600; if there are two in the family, deduct $750; if there are 2 adults or 1 adult and 2 children= $934, 4 people= $1,100; 5= $1,259; 6= $1,417; 7= $1,550; 8 = $1,692.

The figure you get after this calculation is the amount you must pay at the beginning of each month before Medi-Cal begins paying for services. The $600 figure is Medi-Cal’s maintenance need level.

What is the Medi-Cal Working Disabled Program (WDP)?

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The WDP program provides full scope Medi-Cal to disabled individuals who work and have income that is too high to qualify for other Medi-Cal categories. For this program, you can have up to 250% of the Federal Poverty Level in countable income and still receive Medi-Cal benefits. Enrollees pay a monthly, sliding-scale premium for this health coverage.

You may be eligible for Medi-Cal's Working Disabled Program (WDP) if you meet all the following criteria:

  1. You meet Medi-Cal’s definition of disability. Your earnings due to work are not considered when determining whether a disability exists or persists.
  2. Your total countable income can not exceed 250% of the Federal Poverty Level (see FAQ 3);
  3. You meet assets requirements for Medi-Cal. This Medi-Cal program exempts all Internal Revenue Service (IRS) approved retirement accounts, such as employer sponsored 401k, 403b accounts, or individual retirement accounts (IRAs) authorized in the IRS codes; and
  4. Your countable unearned income is less than the appropriate SSI/SSP benefit rate. Again, disability income doesn't count.
  5. You are working.

Is all of my income taken into account when determining 250% of the federal poverty level for this Medi-Cal program?

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No. This program uses Social Security's countable income calculation to determine your income. Additionally, the WDP Program does not count unearned income from private or public disability benefits (such as SDI, SSI, SSDI, STD, LTD ) when determining your countable income.

Important: Medi-Cal’s deeming rules apply when a worker has combined household income, for example income from a spouse.

How much does Medi-Cal's Working Disabled Program (WDP) cost?

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The premium you pay depends on your countable income and family situation. It can range from $20 to $250 for an individual, or $30 to $375 for couples. Use the Medi-Cal for the Working Disabled Calculator to get an idea of whether you'd qualify for this program and what your premium would be.

Does what I have in the bank or what I own, such as a home or car, affect my eligibility for Medi-Cal's Working Disabled Program (WDP)?

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Yes. You are allowed to have assets up to $2,000 in value ($3,000 for a couple). Some of your assets, like your home and car, are not counted for this program. Click here for a list of additional exemptions.

Assets may include:

  • checking and savings accounts;
  • the value of stocks, bonds, and trust deeds;
  • additional cars or recreational vehicles; and
  • promissory notes and loans that are payable to you.

Note: This category of Medi-Cal exempts (does not consider) some types of resources:

  1. Retirement funds like 401(k)’s and IRA's.
  2. Any money that you earn from your work while you are on the program, as long as you put that money into a separate bank account.
  3. Any money you have in an ABLE account, if your disability began before you turned 26. Learn more about ABLE accounts.

What does Medi-Cal's Working Disabled Program (WDP) consider work?

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Work is not specifically defined by Medi-Cal's Working Disabled Program (WDP). A disabled worker on the WDP Program must provide proof of current employment. Proof of employment includes pay stubs or written verification of employment from your employer.

If you are self-employed, you will have to provide records such as recent IRS tax returns to demonstrate employment. Also, for the independent contractor, verification may be provided with a 1099 IRS form as proof of employment.

Also, you are still considered to be working under the WDP Medi-Cal if you are receiving vacation or sick leave pay from your employer.

How do I apply for Medi-Cal's Working Disabled Program (WDP)?

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To apply for Working Disabled Program (WDP), request an appointment with your local county WDP coordinator. The Department of Health Care Services has a webpage listing where to find a county social services agency.

Medi-Cal provides applications in eleven languages. You can download an application online, but you must submit your application in person or by U.S. mail.

If you are currently enrolled in another eligibility category of Medi-Cal, talk to your Medi-Cal eligibility worker and ask to be transferred to this program.

What is the difference between Supplemental Security Income (SSI) 1619(b) provisions and Medi-Cal's Working Disabled Program (WDP)?

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Although both programs provide full scope Medi-Cal, there are several differences between SSI 1619 (b) provisions and WDP Medi-Cal. SSI 1619(b) provisions allow you to keep Medi-Cal at no cost, but limits your income to the state's threshold amount and has special rules for retirement funds, which sometimes are exceptions and require approval from Social Security. WDP Medi-Cal, on the other hand, requires that you pay a monthly premium based on your total countable income and does not have any limitations on retirement funds. In order to qualify for SSI, Social Security has determined that you are unable to work for at least twelve months. WDP does not have this rule and thus allows you to work with a disability.
1619(b) Provisions and WDP Benefits Compared

Medi-Cal Program

1619 (b) provisions

WDP

Cost

None.

Premium based on total countable income that cannot exceed 250% of the Federal Poverty Level.

Retirement Funds

Allowable based upon exception and approval.

Allowable.

Initial Eligibility Rules

Unable to work for initial 12 months of receiving SSI due to a disability. Generally, earnings cannot exceed state's threshold amount.

Able to work initial 12 months with a disability.

As your circumstances change, it is important to review which Medi-Cal eligibility category may be most cost effective for you.

What happens if I stop working?

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If you stop working, you can stay on Medi-Cal’s Working Disabled Program (WDP) for up to 6 months. You may also become eligible for free Medi-Cal instead, for which you would not need to pay a premium. If you are in this situation, talk to a Benefits Planner.

What is the Medi-Cal/HIPP program?

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HIPP stands for Health Insurance Premium Payment. The Medi-Cal/HIPP program pays private health insurance premiums so that individuals with high cost medical conditions may continue their private health coverage rather than relying solely on Medi-Cal.

To be eligible for the Medi-Cal/HIPP program you must:

Those ineligible for the HIPP program include individuals enrolled in:

What can I use Medi-Cal/HIPP for?

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You can use Medi-Cal/HIPP to cover the cost of private health insurance premiums. Medi-Cal will cover services that are not available under the private policy in addition to deductibles and copayments. If you have a share of cost it must be met before you can use Medi-Cal services.

How do I apply for Medi-Cal/HIPP?

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To apply for the HIPP program you must submit the following: