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. You will have to pay a small premium for Medi-Cal coverage, but you can have countable income up to 250% of FPL
  • 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
  • Undocumented immigrants over the age of 18 do not qualify for full Medi-Cal coverage, though they may qualify for Medi-Cal coverage for emergencies or during pregnancy. Undocumented children who are 18 or younger can qualify for Medi-Cal.
    • In 2020: Medi-Cal rules will change in 2020 so that undocumented young adults ages 19-25 may qualify for Medi-Cal.
  • 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.

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.