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 ($82,992 per year or less for a family of four).

When your child turns 19, the limit goes down to 138% of FPG ($43,056 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:
	$15,060
	$5,380
	$15,060
	$5,380
	$15,060
	$5,380
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 $76,320 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.