At 18, your child can manage his or her Medi-Cal benefits and make medical decisions privately. You won’t have access to your child’s medical records unless he or she authorizes it. That's why it's important to teach your child how to make health decisions and manage benefits now, so that your child will know how to do them later.

Income-Based Medi-Cal

Income-based Medi-Cal covers children 18 or younger if the total combined income of everybody who lives in the same household is 266% of the Federal Poverty Guidelines (FPG) or less ($85,519 per year or less for a family of four).

When your child turns 19, the limit goes down to 138% of FPG ($44,367 per year for a family of four). If your child doesn’t qualify for income-based Medi-Cal as an adult, there are other options:

• If you or your child’s other parent can get employer-sponsored coverage, your child can be on that plan until turning 26.
• If employer-sponsored coverage is not available, your child can get help paying for individual coverage on Covered California if household income is over 138% of FPG.

Note: If your child moves out of your house and you don’t claim your child as a dependent on your taxes, your child might qualify as a single person living alone.

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family:
	$15,650
	$5,500
	$15,060
	$5,380
	$15,650
	$5,500
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: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). For private plans with subsidies, your monthly premium amount depends on your income.

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Disability-Based Medi-Cal and Medi-Cal's Working Disabled Program (WDP)

Most eligibility rules for Medi-Cal and private health insurance don't change when your child turns 19:

• Disability-Based Medi-Cal covers children and adults who get Supplemental Security Income (SSI) benefits and some people with disabilities who have low income and low resources, but don't get SSI. Note: It may be easier for your child to qualify for SSI and disability-based Medi-Cal as an adult, because parental income is no longer counted and does not affect eligibility.
• WDP covers people who have disabilities, don't get SSI, and get paid as much as $79,270 per year at work. If your child is 16 or older and gets paid work, this is an option. Learn more about Medi-Cal's Working Disabled Program.

If your child can’t get Medi-Cal or WDP, other options may include employer-sponsored coverage or income-based Medi-Cal. Employer-sponsored coverage through your job or your child’s other parent's job has to allow your children to be on the plan until their 26th birthday.

If your child gets Supplemental Security Income (SSI) before turning 18, your child’s benefits might go up or down once he or she becomes an adult.

If your child doesn’t get SSI before age 18, he or she might start to qualify as an adult.

Different Definitions of Disability for Children and Adults

To get SSI, your child’s disability must meet the Social Security Administration’s standards:

• For a child under 18, physical or mental impairments must cause severe limitations in daily life.
• For an adult, physical or mental impairments must limit the ability to work.

While these standards are somewhat different, neither one stops a person from working. Working will make your child’s life better over the long term as an adult, without causing SSI benefits to end automatically.

Exactly how your child’s disability is evaluated as an adult depends on whether your child gets SSI before turning 18.

If Your Child Gets SSI Before Age 18

Children who get SSI benefits before turning 18 have to go through an Age-18 Redetermination before turning 19 to make sure their disabilities meet the adult standards:

• The Age-18 Redetermination is simpler than a standard adult disability determination, because your child cannot be disqualified from having a disability just because he or she earns too much money.
• An SSI rule called Section 301 means that if your child is in a program such as an Individualized Education Program (IEP), Vocational Rehabilitation (VR), or Plan to Achieve Self-Support (PASS), he or she may keep getting SSI for a while even if your child’s impairment no longer qualifies as a disability.

If Your Child Doesn’t Get SSI Before 18

If your child didn’t get SSI before turning 18, Social Security will review your child’s medical condition to make sure it matches their definition of disability. As part of this disability determination, they will check to make sure your child earns $1,620 per month or less to be determined to have a disability. This amount is called the Substantial Gainful Activity (SGA) level. After your child starts getting SSI benefits, he or she can make more than the SGA level and keep getting benefits, as long as his or her countable income isn’t over the program’s income limit.

More SSI Changes at 18

Children under 18 who get SSI have representative payees, which means that the child’s benefits are usually sent to the parent. When turning 18, your child can ask to have all benefits sent directly to him or her.

At age 18, other SSI rules can affect whether your child qualifies for benefits and how much your child gets:

• Parent-to-child deeming ends. This means SSI stops counting parental income and resources when figuring out your child’s benefits, so benefits could begin or the benefits amount could go up.
• If somebody else pays for your child’s shelter, including parents, your child’s SSI benefits could go down by up to a third.

Some programs help children, while others help adults. When your child becomes an adult, he or she will no longer qualify for some benefits and may qualify for others instead.

Your Child Will Not Qualify You for CalWORKs

If your family gets benefits from CalWORKs, when your child turns 18 (or 19 if still in school), he or she will no longer count as a child for CalWORKs. This means your family’s CalWORKs benefits may go down or stop.

Social Security Child’s Benefits Are Only for Children

If your child gets Social Security Child’s Benefits based on your or your spouse’s Social Security work record, these benefits will end when your child turns 18, unless he or she is still in high school or doing another form of secondary education. In that case, they end at 19. If your child stops getting Child’s Benefits, he or she may be able to start getting Childhood Disability Benefits (CDB) benefits instead.

Childhood Disability Benefits (CDB) Benefits Might Start

Social Security Childhood Disability Benefits (CDB) benefits help adults with disabilities who are 18 or older with money each month. If your child gets CDB benefits for two years, he or she will also qualify for Medicare health coverage.

Your child may qualify for CDB if he or she:

• Has a disability that began before turning 22 and meets Social Security’s definition of disability for adults
• Is not married, unless the spouse also gets CDB or Social Security Disability Insurance (SSDI) benefits, and
• Has a parent who gets Social Security retirement benefits or SSDI. If your child’s other parent is deceased, your child could also qualify.

Your child can apply for CDB at the local Social Security office.