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Medi-Cal

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    Medi-Cal

    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:

    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.

    Medi-Cal and immigrants
    • 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

    In-Home Supportive Services (IHSS)

    IHSS helps pay for personal assistance services so that people with disabilities can live in the community.

    Medi-Cal for the Working Disabled Estimator

    Worried about losing Medi-Cal? See how the Working Disabled Program can help.

    Medicare

    Medicare is public health coverage for people with disabilities and seniors.