Benefits for Young People

Medi-Cal Eligibility for Young People

Medi-Cal helps people with low incomes pay for their visits to the doctor, hospital stays, prescription drugs, medical equipment, and other medical services. Depending on your income, your age, and whether you are disabled, blind, or pregnant there may be more than one way for you to qualify for Medi-Cal. If you qualify for Supplemental Security Income (SSI), you also automatically for Medi-Cal qualify and do not need to fill out an additional application.

To get Medi-Cal, you have to meet certain rules.These rules can seem confusing initially, but are actually pretty simple. First we will present the rules for young people under the age of 19, then we’ll present the rules for anybody 19 or older. Read the section that is appropriate for you.

How to Apply for Medi-Cal

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 if You Are Younger than 19

If you are under age 19, there are 2 common ways to get Medi-Cal. You can qualify:

  1. If you get Supplemental Security Income (SSI) benefits
  2. If your family has low income, regardless of whether or not you have a disability

If you get SSI, you will automatically qualify for Medi-Cal and do not have to fill out an additional application. You can read more about how to qualify for SSI on the SSI Eligibility page of this article. If you have more questions about how this works, talk to a benefits planner.

If you don’t get SSI, you can still qualify for Medi-Cal if:

  • You live in California
  • You and your family have low to moderate income (at or below 266% of FPG, which is $79,800 per year for a family of four)
  • You are a U.S. citizen or an eligible noncitizen:
    • 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 immigrants 50 or older also can.)
    • 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.
    • If you have questions about how your status may affect your eligibility, contact Disability Rights California at 1-800-776-5746 or 1-800-719-5798 (TTY)

The key here is that you and your family must meet the income limit for your family situation.

Health Coverage Income Limits for Your Family
Medi-Cal Minor Consent Program

If you are 12-20 years old, you can apply for the Medi-Cal Minor Consent Program without telling your parents. Your parents’ income will not be counted when your eligibility is considered, so you are more likely to qualify.

However, this program only covers treatment for:

  • Sexually Transmitted Diseases (STDs)
  • Drug and alcohol abuse
  • Family planning
  • Abortion
  • Sexual assault
  • Pregnancy
  • Mental health outpatient care

Los Angeles County has an excellent page about this program. If you want to learn more about this program, talk to a benefits planner.

If you are or have been enrolled in foster care

If you are 17 or younger and in foster care, you may qualify for Medi-Cal no matter how much money you make. If you are 18-20 years old and were in foster care on your 18th birthday, you also may qualify for Medi-Cal no matter how much money you make.

Medi-Cal if You Are 19 or Older

The rules for Medi-Cal if you're 19 or older are a little more complicated than the rules used for people under 19. If you're 19 or older, you may qualify for Medi-Cal if you are in at least one of these situations:

  1. You have income below 138% of the Federal Poverty Guidelines (FPG) ($20,120 per year if you are single).
    Health Coverage Income Limits for Your Family
  2. You are pregnant and have income below 213% of FPG ($42,004 per year if you are single and pregnant with your first child; the baby is counted as a member of the family).
  3. You get Supplemental Security Income (SSI). In this case, you automatically qualify for Medi-Cal and do not have to fill out an additional application (see the SSI Eligibility page of this article).
    • If you're on SSI and your income goes up so much that you stop getting an SSI benefit each month, you may still be able to keep getting Medi-Cal through an SSI rule called 1619(b), as long as you make $57,251 per year or less ($59,105 if you’re blind).
  4. You have low income, low assets, and you have a disability or are blind.

There are other ways to qualify, but these are the most common for young adults.

How the Eligibility Rules Based on a Disability Work when You're 19 or Older

The fourth situation listed above is the most complicated. When Medi-Cal looks at your eligibility based on your disability, your income will be counted, but your parents’ income will not be counted once you turn 19. The exact income limit will depend on your situation, such as whether you are single or married. Usually, if you have a disability and you’re single, the income limit is $1,677, and it’s $2,268 for couples. What's tricky is that not all of your income will be counted by Medi-Cal, so it’s important to go ahead and apply, because you might qualify even if you think you won’t qualify. You can read more about how income is calculated in DB101's Medi-Cal article.

Here are a few reasons you might be able to keep getting Medi-Cal even if your income is above this limit:

  1. When Medi-Cal looks at your income, it'll only count about half of what you earn at a job. Example: If you make $1,000 per month at a job and have no other income, that's only about $457.50 in countable income.
  2. When Medi-Cal calculates your income, it will also reduce the amount stated on your paycheck by the amount you spend on any Impairment Related Work Expenses (IRWEs) or Blind Work Expenses (BWEs). That means that if you pay for certain things that you need in order to do your job, such as medications or accommodations, you should tell Medi-Cal about them, because it might help you qualify for Medi-Cal health coverage.
  3. If you make more than the Medi-Cal income limit, even after IRWEs have been deducted, you may still qualify for Medi-Cal’s Working Disabled Program (WDP), which has higher income limits. The WDP program is described in detail later in this article.

You can also get an idea of whether you would qualify for Medi-Cal by using DB101's School and Work Estimator.

Medi-Cal/MSP asset limit changes

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.

Get more info from Justice in Aging.

Learn more