The Basics
Medi-Cal is a program that pays medical expenses for people with low income. This includes people who are aged, disabled, or have high medical costs. If you meet the requirements of the program, Medi-Cal will help pay for doctor visits, hospital stays, prescription drugs, rehabilitation, and other medical services.
Medi-Cal is California’s part of a national health coverage program called Medicaid. Each state runs its own Medicaid program. The states have to follow certain national Medicaid rules, but they have flexibility in how they run their programs. The state Medicaid programs are paid for with a combination of county, state, and federal money.
You can think of Medi-Cal as a single program that you can qualify for in many different ways. The different ways to get Medi-Cal are called eligibility categories. There are over 90 eligibility categories, each with its own rules and requirements.
This article will explain the Medi-Cal benefit in more detail and describe some of the most common eligibility categories for people with disabilities. It will also explain how you can keep your Medi-Cal coverage if you lose it because of a change in income, and how Medi-Cal (or Medi-Cal's Working Disabled Program) may help pay for the premiums of other insurance programs.
Medi-Cal Services
Medi-Cal pays for a wide variety of medical expenses:
Primary Medical Care
- Doctor visits
- Diagnostic testing
- Emergency services
- Surgery
- Hospitalization
- Prescription drugs
- Dental services
- Health screenings for kids
Ongoing Care & Recovery
- Personal care services (IHSS)
- Occupational & physical therapy
- Outpatient drug abuse services
- Nursing facility stays
- Adult day health care
Other medical related costs
- Medical supplies
- Durable medical equipment
- Transportation to doctor visits
- Transportation costs for children with disabilities
Depending on how you qualify for Medi-Cal, the program may pay for all of these services (full-scope Medi-Cal) or just some of them (partial-scope Medi-Cal).
Like other health coverage plans, Medi-Cal has rules about what it will cover. For example, Medi-Cal only pays for prescriptions that are on its list of accepted drugs. Along the same lines, it may refuse to pay for certain procedures like cosmetic surgery, and it will require that you get prior authorization for some services. If Medi-Cal decides not to pay for something and you think it should, you can appeal the decision.
Depending on your situation, you might get employer-sponsored coverage, Medi-Cal, and Medicare all at the same time. This can sound confusing, but it can help you, because one form of coverage may pay for costs that your other coverage won't pay for.
The rules about how your different types of coverage pay for things are very complicated, so it’s important to check with your health coverage plans when you have questions about which plan will pay for what expenses.
Generally speaking, Medi-Cal will only pay for expenses that it covers and that your other coverage won't pay for. How Medicare works with other insurance shows how it works when you have Medicare and other coverage.
Note: DB101 keeps track of changes to health coverage and related laws. DB101 has been and will continue to be updated to reflect any changes. For news related to health coverage, visit Covered California.
Learn more
Eligibility and Application
You can think of Medi-Cal as a single program that you can qualify for in many different ways. These different ways are called eligibility categories. For example, SSI-Linked Medi-Cal is an eligibility category that allows people who qualify for SSI to automatically get Medi-Cal. There are over 90 eligibility categories, each with its own rules and requirements. Once you meet the requirements of an eligibility category, you are eligible for either full or partial-scope Medi-Cal.
DB101 describes the most common eligibility categories for people with disabilities:
- If your family has income at or below 138% of the Federal Poverty Level (FPL) (266% of FPL if you're a child), you may be eligible for Income-Based Medi-Cal
- If you qualify for SSI (Supplemental Security Income), you are automatically eligible for SSI-Linked Medi-Cal
- If you are aged or disabled, you may be eligible for Aged & Disabled Federal Poverty Level Medi-Cal
- If you are disabled and working, you may be eligible for California’s Working Disabled Program. With it, you can have countable income up to 250% of FPL. Note: Medi-Cal's Working Disabled Program used to have a monthly premium. Starting on July 1, 2022, there is no more premium. Learn more about this change.
- If you are aged, blind, or disabled, but your income is too high for other Medi-Cal programs, you may be eligible for Aged, Blind, and Disabled – Medically Needy Medi-Cal. For this program, you may need to spend a certain amount of your own money before Medi-Cal begins to pay for medical services. This payment is called a share of cost.
How to Apply
There are different ways to apply for Medi-Cal:
- Online using BenefitsCal. BenefitsCal lets you apply for other programs like CalFresh or CalWORKs at the same time.
- Online using Covered California, an online one-stop shop where you can learn about your public and private health coverage options.
- In person at your local county social services agency.
- Using a paper application (available in 11 languages) and mailing it in to your local county social services agency.
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.
- 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.
- All immigrant children and young adults who are 25 years old or younger can get Medi-Cal coverage, if they meet all other program requirements.
- All immigrant adults who are 50 years old or older can get Medi-Cal coverage, if they meet all other program requirements.
- Undocumented adults who are 26 to 49 years old do not qualify for full Medi-Cal coverage, though they may qualify for Medi-Cal coverage for emergencies or during pregnancy.
- Non-citizens who have legal immigration status but do not qualify for full Medi-Cal coverage may qualify for private coverage subsidized by the government.
If you are not sure whether you qualify, contact an organization in your area that works with immigrants.
If You Are Approved
Usually, if you are approved for Medi-Cal, you get your health coverage through a managed care program. There are different managed care programs in each county operated by insurance companies and local non-profits.
Having Medi-Cal through a managed care program means that you have a primary care physician who you see for most of your health needs. When you need to see a specialist or have a test done, you usually have to get a referral from your primary care physician. With managed care programs, you have limited options for which specialists and hospitals you can visit, but if you have an emergency, you can go to any hospital.
Note: If you do not have Medi-Cal through a managed care program, you will probably have to switch to managed care in the future.
Learn more
Medi-Cal Categories
Income-based Medi-Cal
Medi-Cal is a major government-funded health program that helps people with low income.
The simplest way to qualify is if you:
- Don't qualify for Medicare, and
- Are a a U.S. citizen or a qualifying immigrant
And you are in one of these situations:
- You are 19-64 years old and your family’s income is at or below 138% of the Federal Poverty Level (FPL) ($20,120 for an individual; $41,400 for a family of four).
- You are a child 18 or younger and your family’s income is at or below 266% of FPL ($79,800 per year for a family of four).
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You are pregnant, and your family’s income is above 138% of FPL, but at or below 213% of FPL ($42,004 if you are single and pregnant with your first child, $63,900 per year for a family of four; the unborn baby is counted as a member of the pregnant woman's family). This is called Medi-Cal for Pregnant Women and it covers pregnancy-related services, including prenatal care, labor, delivery, postpartum care, and family planning services. It may also cover services for any other medical condition that is medically necessary for the woman.
Income-based Medi-Cal counts most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect income-based Medi-Cal eligibility.
If you are in these situations, there are is no limit to how much money or other resources you have and it does not matter whether or not you have a disability.
| Your family size: | |
Income limits for your family: | |
| Income-based Medi-Cal, adults (138% FPG) | |
| Income-based Medi-Cal, children (266% FPG) | |
| Subsidized private plans, reduced fees (250% FPG) | |
| Subsidized private plans (no income limit) | -- |
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Notes:
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Medi-Cal for People with Disabilities
People with disabilities have more ways they can qualify for Medi-Cal if they don't meet the standard eligibility rules described above. For example, if you have a disability, you may qualify for Medi-Cal even if you have higher income or are on Medicare. The main additional ways to qualify are:
- Aged & Disabled Federal Poverty Level Medi-Cal (A&D FPL)
- SSI-linked Medi-Cal and SSI 1619(b)-linked Medi-Cal
- Medi-Cal's Working Disabled Program, and
- Aged, Blind, & Disabled Medically Needy Medi-Cal (ABD–MN)
These ways to qualify are explained here.
Big changes for disability-based Medi-Cal categories with asset limits:
- On July 1, 2022, Medi-Cal asset limits increased to $130,000 for individuals, $195,000 for couples
- On January 1, 2024, these asset limits will be removed completely.
This applies to Medi-Cal through A&D FPL, the Working Disabled Program, and ABD–MN, as well as Medicare Savings Programs (MSPs). If you've been denied Medi-Cal or an MSP because you had too much in assets, try applying again.
Note: This doesn't change SSI-linked Medi-Cal or Medi-Cal through SSI 1619(b), as they still have SSI's $2,000 asset limit. And it doesn't change income-based Medi-Cal, which doesn't have an asset limit.
Aged & Disabled Federal Poverty Level Medi-Cal (A&D FPL).
If you are aged or disabled, and are not eligible for SSI, you may be able to get Medi-Cal through the Aged & Disabled Federal Poverty Level (A&D FPL) program. You must:
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Be either aged (65+), or disabled (meet Social Security’s definition of disability, even if your disability is blindness)
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Have less than $130,000 in assets ($195,000 for a couple). Like SSI, this program does not count all of your assets. Click here for a list of exemptions.
- Note: If your disability began before you turned 26, you can open an ABLE account and save up money without having it counted by Medi-Cal. Learn more about ABLE accounts.
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Have less than $1,677 in countable monthly income for an individual ($2,268 for a couple).
If you are single and live on your own, follow these steps to figure out if your countable income makes you eligible for A&D FPL Medi-Cal. If you live with others, you should use DB101's Benefits and Work Estimator.
- Find your total countable income using Social Security’s rules.
| Your Monthly Earned Income | $ |
| Your Monthly Unearned Income (not including SSI) | $ |
| Your Impairment Related Work Expenses (IRWEs) | $ |
 | |
| Your Monthly Countable Income |
Note: If you are blind, subtract any money you use for Blind Work Expenses (BWEs) from this amount.
- Take the number of people in your household who are not applying for the A&D FPL program, and use it to figure out your Maintenance Needs Level. Maintenance Needs Levels are listed in the table below. Subtract this amount from your total countable income:
| Family Size | MNL |
|---|---|
| 1 |
$600 |
| 2 |
$750 |
| 2 adults |
$934 |
| 3 |
$934 |
| 4 |
$1,100 |
| 5 |
$1,259 |
| 6 |
$1,417 |
| 7 |
$1,550 |
| 8 |
$1,692 |
| 9 |
$1,825 |
| 10 |
$1,959 |
- Subtract any health insurance premiums that you pay. These include Medicare, health, vision, and dental insurance premiums.
- If you are living in a board and care facility, subtract $315.
The number you get is the amount of monthly income that is counted for the A&D FPL program. If it is less than $1,677 for individuals or $2,268 for a couple, then you qualify for free, full scope Medi-Cal based on A&D FPL rules.
If it is higher than $1,677 for individuals, you may qualify for Medi-Cal's Working Disabled Program or ABD-MN Medi-Cal instead.
Aged, Blind, & Disabled Medically Needy Medi-Cal (ABD–MN)
If you cannot qualify for free Medi-Cal or Medi-Cal's Working Disabled Program (described below), you may be able to get Medi-Cal through the Aged, Blind, & Disabled - Medically Needy (ABD–MN) program. However, you would to pay a share of cost. A share of cost is a certain amount of money you must spend on medical care each month before Medi-Cal begins to pay for services.
If you are single, you can figure out your share of cost by following the first step for calculating A&D FPL eligibility. After Step 1, take your countable income and subtract the MNL for your family size including yourself and also subtract any health, dental, or vision insurance premiums you pay each month. The resulting figure is your share of cost each month. If you get a number that is 0 or less, then you have no share of cost. You only have to pay a share of cost in months when you have medical expenses.
There are good factsheets translated into a several languages about how your share of cost works.
You live alone and have $1,777 per month in countable income and have no other insurance. Your countable income is too high for free Medi-Cal and you don't work, so you can't get Medi-Cal's Working Disabled Program. You qualify for ABD-MN Medi-Cal.
Your share of cost is $1,777 (your countable income) - $600 (the Maintenance Needs Level for an individual living alone) = $1,777. You will have to pay the first $1,777 in medical expenses during the month before Medi-Cal will start covering you.
SSI-Linked Medi-Cal
If you get Supplemental Security Income (SSI), a benefit for people with low income who are aged, blind, or disabled, you get Medi-Cal automatically. You don’t have to fill out any additional paperwork. Read DB101’s SSI article for more information about whether you qualify for SSI.
Staying on Medi-Cal through SSI 1619(b) if Your SSI Benefits End
If your SSI benefits go to zero because you go back to work, an SSI rule called 1619(b) lets you to keep your Medi-Cal coverage if you:
- Were eligible for SSI benefits for at least 1 month
- Need Medi-Cal coverage to keep working
- Still meet all the other SSI requirements, such as being disabled and having resources below $2,000, and
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Make less than $57,251 in gross income per year.
- Note: If your earnings are over this limit and you have high medical expenses, you might still qualify for 1619(b). Ask your local Social Security office about the 1619(b) Individualized Earnings Threshold.
For additional information, read the DB101 SSI article, check out Social Security’s webpage on 1619(b), or talk to a benefits planner.
Note: If you don’t qualify for Medi-Cal through 1619(b) because your income is too high, you may qualify for Medi-Cal's Working Disabled Program.
Joe had been getting SSI for several years when his health improved and he decided to go back to work. After he started working, his income increased to $2,800 per month ($33,600 annually) causing his monthly SSI benefit to drop to zero.
Even though his income is now higher than the usual income limits for Medi-Cal, he is still eligible for Medi-Cal through 1619(b) because his annual income is less than $57,251.
After working for a year, Joe got a raise and went over the 1619(b) limit, so he switched to Medi-Cal's Working Disabled Program so he could keeping getting his Medi-Cal coverage.
Medi-Cal's Working Disabled Program
If you are working, disabled, and your income is too high to qualify for free Medi-Cal, Medi-Cal's Working Disabled Program may allow you to get Medi-Cal. Note: Medi-Cal's Working Disabled Program used to have a monthly premium. Starting on July 1, 2022, there is no more premium. Learn more about this change.
To qualify, you must
- Meet the medical requirements of Social Security’s definition of disability. You don't have to meet the income and work requirements.
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Be working and earning income. The Medi-Cal regulations do not define what “working” means for this program, and you can qualify if you are working part time. You can use pay-stubs or other written verification from an employer to prove that you’re working.
- Note: You can remain enrolled in the program if you become unemployed for up to 26 weeks.
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Have assets worth less than $130,000 for an individual ($195,000 for a couple). The same asset exclusions apply for this program as for A&D FPL Medi-Cal except for a couple of major differences:
- Retirement funds like a 401(k) or Individual Retirement Account (IRA) are not counted as assets for this program.
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If you are enrolled in the program, you can save earnings in a separate bank account and this money will not count against the program’s resource limit. There is no limit to how much of your earnings you can save this way and still remain eligible for Medi-Cal.
- Note: If you ever need to qualify for a different Medi-Cal program that has a resource limit, the earnings you saved in this account while on WDP will not be counted as resources.
- Tip: If your disability began before you turned 26, you can open an ABLE account and save up money without having it counted by Medi-Cal. Learn more about ABLE accounts.
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Have countable income less than 250% of the Federal Poverty Level ($3,038 per month for individuals and $4,108 for couples).
- Keep in mind that these are countable income limits, which is your gross income minus certain deductions. Your gross income can be much higher than your countable income. For example, an individual with no unearned income can make $73,920 a year in gross income and still be eligible for this program.
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Disability income does not count for the WDP program. This means that SSDI, Worker’s Compensation, California State Disability Insurance, and any federal, state, or private disability benefits are not considered as income for this program.
- Note: If you got SSDI before you reached retirement age and now your SSDI benefits have been converted to Social Security retirement benefits, they will not be counted as income either.
- Have countable unearned income less than the appropriate SSI/SSP benefit rate. Again, disability income doesn't count.
If you are single and live on your own, you can use the tool below to help figure out your countable income. Remember not to list any money you get from disability benefits as unearned income. Compare the results to the WDP income limit ($3,038 per month for individuals) to see if you're eligible. If you live with others, you should use DB101's Benefits and Work Estimator instead, since the calculation requires more information about their income.
| Your Monthly Earned Income | $ |
| Your Monthly Unearned Income (not including SSI) | $ |
| Your Impairment Related Work Expenses (IRWEs) | $ |
| |
| Your Monthly Countable Income |
For more information Medi-Cal's Working Disabled Program, contact your local county social services agency.
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Income-Based |
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Must have: |
Low to moderate income |
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Income Limits: |
138% of FPL for adults 19-64 years old. 266% of FPL for children 18 and under. |
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How Income is Counted: |
Earned and unearned income is counted based on IRS rules for modified adjusted gross income (MAGI). Learn more about what types of income affect income-based Medi-Cal eligibility. |
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Countable Assets Limits: |
No asset limit |
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Cost of Benefit: |
Free |
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Benefit: |
Full-scope Medi-Cal |
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Aged & Disabled Federal Poverty Level |
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Must Meet SSI's definition of: |
Age or disability |
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Income Limits: |
Countable Income less than $1,677 for individual, $2,268 for couples |
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How Income is Counted: |
SSI's countable income calculation - MNA for number of household members not applying – health, vision, and dental insurance premiums |
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Countable Assets Limits: |
Up to $130,000 for Individual, $195,000 for couples |
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Cost of Benefit: |
Free |
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Benefit: |
Full-scope Medi-Cal |
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SSI-Linked |
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Must Meet SSI's definition of: |
Age, blindness, or disability |
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Income Limits: |
Countable income less than the SSI/SSP benefit amount for your living situation |
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How Income is Counted: |
SSI's countable income calculation |
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Countable Assets Limits: |
Up to $2,000 for an individual, $3,000 for couples. Note: These are SSI's limits. If your assets are too high for SSI, you may still qualify for other Medi-Cal categories. |
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Cost of Benefit: |
Free |
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Benefit: |
Full-scope Medi-Cal |
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Medi-Cal's Working Disabled Program |
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Must Meet SSI's definition of: |
Disability |
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Income Limits: |
Countable Income less than 250% of the Federal Poverty Level ($3,038 per month for individuals, $4,108 for couples) |
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How Income is Counted: |
SSI's countable income calculation, but any disability income is not considered income |
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Countable Assets Limits: |
Up to $130,000 for Individual, $195,000 for couples; money in retirement accounts is not considered as an asset |
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Cost of Benefit: |
Free |
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Benefit: |
Full-scope Medi-Cal |
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Aged, Blind & Disabled - Medically Needy |
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Must Meet SSI's definition of: |
Age, blindness, or disability |
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Income Limits: |
No income limit, but your countable income determines your share of cost |
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How Income is Counted: |
SSI's countable income calculation - MNL for number of people in household, including the applicant – health, vision, and dental insurance premiums |
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Countable Assets Limits: |
Up to $130,000 for individuals, $195,000 for couples, with an additional $65,000 per additional family member |
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Cost of Benefit: |
Share of cost |
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Benefit: |
Full-scope Medi-Cal |
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It is important to remember that these are just some of the many ways to get Medi-Cal. To learn about other eligibility categories, you can visit a benefits planner or talk to a Medi-Cal eligibility worker at your local county social services agency.
Learn more
Keeping Your Medi-Cal
Medi-Cal eligibility categories have complicated rules for how much money you can earn. So, when your income changes, it may affect your eligibility for Medi-Cal coverage. There are, however, a number of programs designed to help you keep your coverage when your income goes up.
Working Disabled Program
If you’re receiving free Medi-Cal and your income goes up because you are working, you may be eligible to switch to the WDP program. Medi-Cal workers are required to automatically check to see if you are eligible for this program when your income disqualifies you from your eligibility category. If they don’t, you should ask them to. You’ll have to begin paying for your Medi-Cal coverage, but the amount is small compared to the income you’re earning. See above for a description of this program.
SSI’s 1619(b) Provisions
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. In order to continue your Medi-Cal coverage under this program, you must:
- Have been eligible for an SSI cash payment for at least 1 month
- Still meet SSI requirements, like disability, blindness, or age, that don’t have to do with income
- Need Medi-Cal coverage to continue working, and
- Have less than $57,251 in gross earnings ($59,105, if blind) or have high medical expenses that will be evaluated on a case by case basis. Note that this program does not use the countable income calculation.
The $57,251 income limit is called a threshold amount. This is what Social Security calculates as the value of your SSI and Medi-Cal benefits. They determine this based on the SSI benefit in California, along with averages of medical costs in the state. So, if you’re earning enough money to replace the benefits and cover your medical costs without help from the government, then you’re usually not eligible for the program.
If your expenses are higher than the state average, Social Security may increase the threshold on a case-by-case basis. If you have IRWEs, BWEs, are contributing to a PASS, have a publicly funded personal assistant, or have medical expenses higher than the state average, you may be eligible for an individual threshold amount.
Pickle Amendment
When calculating your countable income, SSI considers any Social Security Disability Insurance (SSDI) or Childhood Disability Benefits benefits as unearned income. SSDI and CDB benefits increase every year to cover cost of living increases. This increase may be enough to make you ineligible for SSI, and the Medi-Cal linked to it. The Pickle Amendment protects Medi-Cal coverage for people in this situation. In other words, if you lose your SSI benefit because of a cost of living increase in your SSDI or CDB benefit, you can keep your Medi-Cal.
For more information, see Health Consumer Alliance’s excellent pamphlet on 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 family’s income is at or below of the Federal Poverty Guidelines (FPG), $36,450 for an individual ($75,000 for a family of four), the federal government will also help you get a plan that has lower copayments and other expenses.
Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG for federal subsidies and 600% of FPG for state subsidies.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.
| Your family size: | |
Income limits for your family: | |
| Income-based Medi-Cal, adults (138% FPG) | |
| Income-based Medi-Cal, children (266% FPG) | |
| Subsidized private plans, reduced fees (250% FPG) | |
| Subsidized private plans (no income limit) | -- |
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Notes:
| |
See DB101's Buying Health Coverage on Covered California article for more information.
Learn more
Other Medi-Cal Programs
Besides health care services, Medi-Cal also pays for health insurance premiums in certain circumstances. There are a number of premium payment programs, organized into the following two categories:
Medicare Savings Programs
Medi-Cal (or Medi-Cal's Working Disabled Program) may help pay your Medicare Part B premiums.
And, depending on if you qualify, four additional Medi-Cal programs can help pay for more Medicare premiums, copayments, or deductibles. These programs are known as Medicare Savings Programs or Medicare Buy-Ins.
Each program has specific income limits and pays for different Medicare costs:
The Qualified Medicare Beneficiary (QMB) program pays for Medicare Part A and Part B premiums, coinsurance and deductibles. To qualify, an individual must:
- Be eligible for Medicare Part A and Part B
- Have countable income at or below 100% of the Federal Poverty Guidelines (FPG) ($1,215 per month, $1,644 for couples)
- Have resources at or below the limit ($130,000 for individuals, $195,000 for couples).
- Meet Medi-Cal requirements besides income and assets limits
This program does not apply benefits retroactively.
The Specified Low-Income Medicare Beneficiary (SLMB) program pays for Medicare Part B premiums. To qualify, an individual must:
- Be eligible for Medicare Part A and Part B,
- Have countable income at or below 120% of FPG ($1,458 per month, $1,972 for couples)
- Have resources at or below the limit ($130,000 for individuals, $195,000 for couples)
- Meet Medi-Cal requirements besides income and assets limits
The Qualified Individual-1 (QI-1) program pays for Medicare Part B premiums. To qualify, an individual must:
- Be eligible for Medicare Part B
- Have countable income that's higher than 120% of FPG, but at or below 135% of FPG (between $1,458 and $1,641 per month for individuals, and between $1,972 and $2,219 for couples)
- Have resources at or below the limit ($130,000 for individuals, $195,000 for couples)
- Meet Medi-Cal requirements besides income and assets limits
The Qualified Disabled Working Individual (QDWI) program pays for Medicare Part A premiums. The QDWI program is for Social Security Disability Insurance (SSDI) beneficiaries who lose their SSDI and Medicare benefits due to earnings above the SGA amount. To qualify, an individual must:
- Be less than 65 years old
- Still be disabled
- Still be eligible for Medicare under a work incentive program
- Have countable income at or below 200% of FPG ($2,430 per month for individuals, $3,287 for couples)
- Have resources at or below the limit ($130,000 for individuals, $195,000 for couples)
- Not be eligible for Medi-Cal
SSDI has rules that encourage you to return to work. After your SSDI benefit ends, you will still receive free Medicare benefits for 93 months. After that period ends, you may want to consider the QDWI program.
Call your county Health Insurance Counseling & Advocacy Program (HICAP) office to learn more about whether you qualify for a Medicare Savings Program. If you do, they'll explain how to apply at your local county social services agency.
Learn more about how Medi-Cal can help you pay your Medicare expenses in DB101's Medicare article.
Big changes for disability-based Medi-Cal categories with asset limits:
- On July 1, 2022, Medi-Cal asset limits increased to $130,000 for individuals, $195,000 for couples
- On January 1, 2024, these asset limits will be removed completely.
This applies to Medi-Cal through A&D FPL, the Working Disabled Program, and ABD–MN, as well as Medicare Savings Programs (MSPs). If you've been denied Medi-Cal or an MSP because you had too much in assets, try applying again.
Note: This doesn't change SSI-linked Medi-Cal or Medi-Cal through SSI 1619(b), as they still have SSI's $2,000 asset limit. And it doesn't change income-based Medi-Cal, which doesn't have an asset limit.
Medi-Cal’s Health Insurance Premium Payment (Medi-Cal/HIPP)
There are certain situations when Medi-Cal will pay for private health insurance premiums. This program is for people who:
- Are on Medi-Cal,
- Also have private health insurance, or have private coverage available,
- Have a high cost medical condition, AND
- Have lost (or are about to lose) private coverage
The idea is that when you lose your private insurance, Medi-Cal can either pay for your medical expenses or pay for you to keep your private coverage. Medi-Cal will do whichever costs less. If you currently have private health insurance, the program is called Health Insurance Premium Payment (HIPP). If you have private coverage available, but aren’t using it, the program is called Employer Group Health Plan (EGHP). Besides the difference in names, the programs are otherwise identical and are usually simply referred to as Medi-Cal/HIPP.
To qualify for the Medi-Cal/HIPP program, you must:
- Be on Medi-Cal
- Have a high cost medical condition
- Have available, or be currently using, group health coverage, COBRA, or a conversion policy. A conversion policy is one where you converted a private group policy into a private individual policy
- Apply for Medi-Cal/HIPP within 30 days of your coverage ending (20 if you’re using a conversion policy)
- Have a policy that covers your high cost medical condition
- Not be part of a pre-paid or county health plan (County Health Initiative, Geographic Managed Care, County Medical Services Program)
- Not be covered by Medicare or TRI-CARE (formerly known as CHAMPUS)
- Not be covered through the MRMIP program
Medi-Cal should evaluate your eligibility for Medi-Cal/HIPP when you indicate that you have insurance available but haven’t applied for it, that you are about to end your health insurance, or that your policy has lapsed. To apply, you’ll need to provide forms from your insurance company describing your benefit and a diagnosis signed by your doctor.
If you are eligible for Medi-Cal/HIPP, you will still be on Medi-Cal. The only change will be for those who did not previously have private coverage. If that’s the case, Medi-Cal will become the payer of last resort. If you are accepted into the Medi-Cal/HIPP program you must participate or else you can lose your Medi-Cal eligibility. Your eligibility for the program is reevaluated every year.
Other Information
Some examples of high cost medical conditions are AIDS, asthma, cancer, diabetes, heart disease, paralysis, and pregnancy. There are many others, and Medi-Cal evaluates applications on a case-by-case basis.
Medi-Cal/HIPP will pay for family members who aren’t on Medi-Cal when it will save money for the state. For example, let’s say that you have private health coverage that also covers your family members. You are not on Medi-Cal, but your family members are. If it saves the state money, Medi-Cal/HIPP will pay for your premiums so that your family members can be on the private policy.
Learn more
Example
Michael's Story
Michael is 35 years old and lives with his parents. Last year, during a routine physical exam, he found out that he has cancer of the lymph nodes in his neck. The cancer has not responded to therapy, and he hasn’t been able to work for the last 9 months. Although he’s getting $980 a month in State Disability Insurance, he is starting to worry about staying afloat financially. He already knows that he does not qualify for Social Security Disability Insurance (SSDI) because he has not worked enough in the past. He asks around for advice, and a friend recommends that he find out if he is eligible for Medi-Cal. Michael finds his local county social services agency and makes an appointment with a case worker named Melissa.
Michael gets there early and reads through a few brochures about Medi-Cal. He sees a brochure about being able to enroll in a program called Supplemental Security Income-Linked Medi-Cal. When he and Melissa sit down to discuss his case, it’s the first thing he asks.
“Well,” Melissa says, “that depends on your situation. Why don’t you tell me a little bit about yourself?”
Michael explains his medical condition and that he is getting $980 in SDI. Melissa shakes her head.
“For the SSI-Linked Medi-Cal program, you have to meet all of the requirements of the SSI Program. It seems like you would meet everything except for the income limits. Basically, you can’t have an income that’s higher than the maximum SSI benefit amount. In your case, that amount is $833.89."
Melissa pulls out a table showing SSI benefit amounts and points to a line that says, ‘Single person living in the household of someone else.’ You have $960 in countable income, which is over the limit.”
“Wait a second. I have $980 in SDI benefits. Why did you say that I only have $960 in countable income?”
Melissa explained that Social Security doesn’t count all of your income when figuring out if you are eligible for the SSI program. “Instead,” she says, “they use a countable income calculation. For example, they subtract $20 from any unearned income like your SDI check. They also take deductions from your earned income, but since you don’t have any, we won’t go into that right now. In any case, your countable income is too high for SSI, so you can’t get SSI-Linked Medi-Cal.”
Michael looks upset and asks, “So I’m not eligible for Medi-Cal because my countable income is too high?”
“No, you just can’t qualify for SSI-Linked Medi-Cal. There are many other ways to qualify. For example, the Aged and Disabled Federal Poverty Level program allows you to have up to $1,677 in monthly countable income and get free, full-scope Medi-Cal. It looks like you may qualify for Medi-Cal through that program.”
“Why do you say ‘may qualify’? I have less than $1,677 in countable income,” Michael says.
Melissa explains that there is also a limit of $130,000 on resources for an individual and asks Michael if he owns anything or has any assets. “Your home and one car, by the way, don’t count.”
“Nope, just one junky car.”
“Then it looks like you can qualify for free, full-scope Medi-Cal under the Aged and Disabled Federal Poverty Level program.”
Michael looks happy at first, but quickly grows serious again. He has been thinking about going to work and asks Melissa if he can get employer-sponsored health coverage and still get Medi-Cal.
“Absolutely,” Melissa says. “When you go for medical services, your private insurance will be billed first. Anything that they don’t cover will then be billed to Medi-Cal, who will pay for any services that are part of full-scope Medi-Cal.”
Michael relaxes again and Melissa then helps him fill out his application.
Two months later, Michael gets a letter in the mail saying that he has been accepted to Medi-Cal through the Aged and Disabled Federal Poverty Level program. The letter includes his Medi-Cal card, and explains what services are covered and how to use the benefit.
Fourteen months later, Michael, still disabled, begins working part-time earning $3,285 a month in gross income. He is no longer receiving SDI, since that benefit usually only lasts for a year. Even without running through the countable income calculation, he can tell that he’ll be over the income limit for the Aged and Disabled FPL program. He’s worried that he’ll lose his Medi-Cal because of his earned income. He calls and makes another appointment with Melissa. At her office again, she explains that, as he suspected, his income will make him ineligible for A&D FPL Medi-Cal.
Michael asks, “So, I’m out of luck?”
“Not necessarily,” Melissa responds. She explains that there’s something called the Working Disabled Program that allows people to have countable income at 250% of the Federal Poverty Level and keep their Medi-Cal.
Melissa walks him through the countable income calculation, this time explaining the deductions for earned income. “Since you no longer have any unearned income, we take that $20 deduction and apply it to your earned income. There’s another $65 we take off for earned income, and then we divide that by 2. So, if you’re making $3,285 a month,” Melissa says, “then you’ll have $1,600 in countable income ($3,285 - $20 deduction - $65 = $3,200 and $3,200/2= $1,600).
“We’ll start the paperwork to have you switched over to the WDP program.”
“Thanks so much for all of your help, Melissa.”
“You’re welcome!”
Learn more
Frequently Asked Questions
How do I qualify for Medi-Cal?
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:
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Income-Based
-
SSI-Linked
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Aged & Disabled Federal Poverty Level
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Working Disabled
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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?
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:
- Medi-Cal's Health Insurance Premium Payment (Medi-Cal/HIPP) program
- In-Home Supportive Services (IHSS), and
- Medicare Savings Programs.
See Other Medi-Cal Programs for more details.
How do I apply for Medi-Cal?
There are different ways to apply for Medi-Cal:
- Online using BenefitsCal. BenefitsCal lets you apply for other programs like CalFresh or CalWORKs at the same time.
- Online using Covered California, an online one-stop shop where you can learn about your public and private coverage options.
- In person at your local county social services agency.
- Using a paper application (available in 11 languages) and mailing it in to your local county social services agency.
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?
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?
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?
- 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.
- All immigrant children and young adults who are 25 years old or younger can get Medi-Cal coverage, if they meet all other program requirements.
- All immigrant adults who are 50 years old or older can get Medi-Cal coverage, if they meet all other program requirements.
- Undocumented adults who are 26 to 49 years old do not qualify for full Medi-Cal coverage, though they may qualify for Medi-Cal coverage for emergencies or during pregnancy.
- Non-citizens who have legal immigration status but do not qualify for full Medi-Cal coverage may qualify for private coverage subsidized by the government.
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?
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. See DB101's Buying Health Coverage on Covered California article for more information.
What is Aged and Disabled Federal Poverty Level Medi-Cal?
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 $1,677 ($2,268 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?
Yes. You are allowed to have assets up to $130,000 in value ($195,000 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:
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checking and savings accounts;
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the value of stocks, bonds, and trust deeds;
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additional cars or recreational vehicles; and
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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.
Big changes for disability-based Medi-Cal categories with asset limits:
- On July 1, 2022, Medi-Cal asset limits increased to $130,000 for individuals, $195,000 for couples
- On January 1, 2024, these asset limits will be removed completely.
This applies to Medi-Cal through A&D FPL, the Working Disabled Program, and ABD–MN, as well as Medicare Savings Programs (MSPs). If you've been denied Medi-Cal or an MSP because you had too much in assets, try applying again.
Note: This doesn't change SSI-linked Medi-Cal or Medi-Cal through SSI 1619(b), as they still have SSI's $2,000 asset limit. And it doesn't change income-based Medi-Cal, which doesn't have an asset limit.
What is SSI-Linked Medi-Cal?
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?
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 usually more expensive than Medi-Cal's Working Disabled Program, if you work.
What does "incurring medical expenses" mean?
"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?
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)?
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. Note: Medi-Cal's Working Disabled Program used to have a monthly premium. Starting on July 1, 2022, there is no more premium. Learn more about this change.
You may be eligible for Medi-Cal's Working Disabled Program (WDP) if you meet all the following criteria:
- You meet Medi-Cal’s definition of disability. Your earnings due to work are not considered when determining whether a disability exists or persists.
- Your total countable income can not exceed 250% of the Federal Poverty Level (see FAQ 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.
- Your countable unearned income is less than the appropriate SSI/SSP benefit rate. Again, disability income doesn't count.
- You are working.
Is all of my income taken into account when determining 250% of the federal poverty level for this Medi-Cal program?
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?
Medi-Cal's Working Disabled Program costs the same as regular full-scope Medi-Cal without a share of cost: there is no monthly premium, but there may be small copayments for some services or medications. Note: Medi-Cal's Working Disabled Program used to have a monthly premium. Starting on July 1, 2022, there is no more premium. Learn more about this change.
Use the Medi-Cal for the Working Disabled Estimator to get an idea of whether you'd qualify for this program.
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)?
Yes. You are allowed to have assets up to $130,000 in value ($195,000 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:
- Retirement funds like 401(k)’s and IRA's.
- 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.
- 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?
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)?
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)?
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, 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.
|
Medi-Cal Program |
1619 (b) provisions |
WDP |
|---|---|---|
|
Cost |
None. |
None. Note: Medi-Cal's Working Disabled Program used to have a monthly premium. Starting on July 1, 2022, there is no more premium. Learn more about this change. |
|
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?
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?
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:
- have a high-cost medical condition such as HIV/AIDS, cancer, pregnancy and organ transplantation; and
- be insured under a private health insurance policy that does not exclude the individual’s high-cost medical condition. The policy can be individual, group, continuation coverage such as COBRA, Cal-COBRA or OBRA (for self-insured trusts) or COBRA conversion policy.
Those ineligible for the HIPP program include individuals enrolled in:
- Medi-Cal Managed Care program
- Medi-Cal prepaid health plan
- County Organized Health System (COHS)
- Medicare
- TRI-CARE (formerly known as CHAMPUS)
- County Health Initiative
- Geographic Managed Care Program of the County Medical Services Program (CMSP), and
- California’s Major Risk Medical Insurance Pool (MRMIP).
What can I use Medi-Cal/HIPP for?
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?
To apply for the HIPP program you must submit the following:
- Medi-Cal/HIPP Department of Health Care Service Form 6172 (HIPP application);
- An insurance policy or description of benefits from the insurer or employer;
- A physician letter of diagnosis of high-cost medical condition; and
- A premium payment notice or election form from COBRA or Cal-COBRA.
Learn more
Common Pitfalls
Not getting health coverage because you think it will be too expensive
In the past, some people found it impossible to find health coverage that was affordable and met their needs. Now, there should be an option for almost everybody, even if you have a disability. The exact health coverage that will be right for you will depend on things like your family’s income, whether you have access to employer-sponsored coverage, your age, where you live, and whether you have a disability.
If you have the option of employer-sponsored coverage or public health programs like Medicare or Medi-Cal, they are probably your best bet.
If you don’t, you will probably end up getting an individual plan through Covered California and the government may help you pay for that plan. Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG for federal subsidies and 600% of FPG for state subsidies.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.
Note: If you do not have coverage, you may have to pay a tax penalty on your California taxes.
Not looking into Medi-Cal because you think there’s no way you can qualify
Medi-Cal used to be mainly for people with disabilities, seniors, children, and pregnant women. Starting in 2014, it is for anybody with low income (at or below 138% of the Federal Poverty Level (FPL), $20,120 for an individual in 2023 ($41,400 for a family of four). No matter how much money you have in the bank or what your health situation is, you could qualify.
It is easy to check if you can get Medi-Cal: just go to Covered California and fill out an application. They’ll let you know whether you qualify and help you sign up.
If you can’t get Medi-Cal, you can get health coverage through your employer or through Covered California, depending on your situation.
Believing you have to get the same health coverage for every member of your family
There may be situations where it makes more sense for different members of your family to get health coverage in different ways. Do not feel that just because one member of your family gets a certain plan, the entire family needs to get that plan.
For example, let’s say you work for a company that only offers health coverage for you and your children, but not your spouse. You could take the coverage for yourself and your spouse could get coverage on Covered California. Since your employer doesn’t offer coverage for your spouse, your spouse might even qualify to get government help paying for an individual plan through tax subsidies. If your income is low enough, your children could sign up for Medi-Cal, even if you and your spouse don’t qualify for it.
As you can see, in some situations it can make sense for a single family to get totally different types of coverage for different family members.
Dropping or not enrolling in Medicare
If you are eligible for both Medi-Cal as a person with a disability and Medicare, you should enroll in both. If you have both, you’ll have better health coverage, because Medi-Cal covers many services that Medicare does not cover. Medi-Cal (or Medi-Cal's Working Disabled Program) may even pay your Medicare Parts A, B, and D premiums, deductibles, and copayments for you.
Not going back to work because you fear losing your Medi-Cal coverage
In the past, people feared that if they got a job while they were on Medi-Cal, they’d lose their Medi-Cal, because they would no longer have low enough income to qualify.
Starting in 2014, if you lose one health coverage option, there will be another one you can get. If you lose your Medi-Cal coverage, you will either become eligible for employer-sponsored coverage or private individual coverage. And, if you can’t afford the individual coverage, the government may help you pay for it.
The bottom line: There is a coverage option for everybody. Do not worry that getting a job will leave you without health coverage.
Basing decisions on misinformation
Most of us usually rely on other people’s experiences to understand how to deal with our own situations. The problem with this is that disability and government benefits are person-centered. Benefits programs fit each person differently, based on a variety of facts and conditions, such as:
- Your work history
- How much you earn
- What you own
- What your disability is and the extent of your impairment
- How clearly you report the details of your condition to your medical provider
- How well your medical provider understands or documents these details
- What benefits an employer provides, and
- What benefits you have purchased individually.
Not Keeping Complete Earnings Records
It is your responsibility to maintain accurate and detailed records. The earnings you report to Medi-Cal will be verified. Clearly document all communication with Medi-Cal. Make copies of letters and keep records of phone conversations, including the date and time phone calls take place and the name of the individual who was assisting you. These steps can help you avoid pitfalls during the application process and while maintaining eligibility for benefits. Many people keep a journal of Medi-Cal contacts in a spiral notebook.
Learn more
Resources
Apply for Medi-Cal
There are different ways to apply for Medi-Cal:
- Online using BenefitsCal. BenefitsCal lets you apply for other programs like CalFresh or CalWORKs at the same time.
- Online using Covered California, an online one-stop shop where you can learn about your public and private coverage options.
- In person at your local county social services agency.
- Using a paper application (available in 11 languages) and mailing it in to your local county social services agency.
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.
Learn more about Medi-Cal
To learn more about Medi-Cal:
- Visit the Medi-Cal website, which has a helpful set of frequently asked questions.
- Visit or call your local county social services agency.
- Get local help from Covered California.
- If you have a disability, talk to a benefits planner to learn more about health programs for people with disabilities.
The Health Consumer Alliance website provides publications on many aspects of Medi-Cal.
The National Immigration Law Center has a section on immigrants and public benefits, including health care.
Getting Help with Your Benefits
If you get Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), or Childhood Disability Benefits (CDB), and you're looking for a job, a trained Benefits Planner can help you avoid problems with your job plan. If you need help or have questions about your situation, you can call the Ticket to Work Help Line at 1-866-968-7842 or 1-866-833-2967 (TTY), Monday through Friday.
View DB101's full list of experts who can help you understand different benefits.
Community-Based Organizations
Various community-based organizations guide people through state, federal, public, and private health and income programs. Some organizations may work with specific populations while others work with people with any type of disability. Here are a few examples
Goodwill Industries services range from personal evaluation and office skills training to career counseling, childcare, and transportation. Some Goodwill Industries centers also do benefits planning for people who get SSI, SSDI, and Medicare. Find locations at www.Goodwill.org, or by calling (voice) 1-800-466-3945.
The California Foundation for Independent Living Centers lists centers serving people with all disabilities. Many of these centers do benefits planning for people who get SSI, SSDI, and Medicare. If they don't offer benefits planning themselves, Independent Living Centers can refer you to local benefits planners. Find the list of independent living centers at www.CFILC.org, or by calling (voice) 1-916-325-1690 or (TTY) 1-916-325-1695.
The California Department of Public Health's Office of AIDS lists 1,300 organizations offering HIV/AIDS services throughout California. Some of these organizations provide case management, benefits planning, and benefits counseling services that can include help with public and private benefits programs. You can search the list online, or call (voice) 1-800-367-AIDS (2437) or (TTY) 1-888-225-AIDS (2437).
Disability Rights California provides representation for consumers of public programs who are disabled. Website publications include topics on health care, benefit programs, and In-Home Supportive Services.