Medi-Cal Rules That Change

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 ($68,495 per year or less for a family of four).

When your child turns 19, the limit goes down to 138% of FPG ($35,535 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 between 138% and 400% of FPG ($103,000 for a family of four).

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

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:

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.

The bottom line

A few things to remember:

  • At age 18, your child may be able to manage benefits and medical decisions privately.
  • For income-based Medi-Cal, at age 19 the income limit goes down from 266% of FPG to 138% of FPG.
  • For disability-based Medi-Cal, there aren't big changes at age 19.
  • Look into Medi-Cal's Working Disabled Program if your child gets a job.

No matter what, there should be a health coverage option for your child.