FAQMedi-Cal Eligibility and Covered California - Frequently Asked Questions
Medi-Cal Health Coverage
1. What is Medi-Cal? Medi-Cal offers free or low-cost health coverage for California residents who meet eligibility requirements. Most applicants who apply through Covered California and enroll in Medi-Cal will receive care through managed health plans.
Beginning January 1, 2014, California will expand Medi-Cal eligibility for low-income adults. When you complete a Covered California application, your eligibility for Medi-Cal will automatically be determined. You can apply for Medi-Cal benefits regardless of your sex, race, religion, color, national origin, sexual orientation, marital status, age, disability, or veteran status.
2. How much does Medi-Cal cost?
For many individuals who enroll in Medi-Cal, there is no premium, no co-payment, and no out of pocket cost. Some households will see affordable costs, such as a low monthly premium. For some Medi-Cal kids, the premiums are $13 per child, but this is up to a family maximum of $39. In general, individuals in Medi-Cal will get the same health benefits available through Covered California at a lower cost.
3. What is the difference in coverage between Medi-Cal and private coverage?
Medi-Cal is health coverage, just like the coverage offered through Covered California. Medi-Cal provides benefits similar to the coverage options available through Covered California, but often at lower or no cost to you or your family. All of the health plans offered through Covered California or by Medi-Cal include the same comprehensive set of benefits known as “essential health benefits.” Essential health benefits consists of:
Outpatient (Ambulatory) services
Maternity and Newborn care
Mental Health and Substance Use Disorder Services, including Behavioral Health Treatment
Programs such as physical and occupational therapy (known as Rehabilitative & Habilitative Services) and devices
Preventive and wellness services & chronic disease management
Children’s (Pediatric) services, including oral and vision care.
A recent survey of Medi-Cal members by the California Healthcare Foundation (CHCF) found that 90% of respondents rate Medi-Cal as a good or very good program. Medi-Cal emphasizes prevention-oriented health care that promotes health and well-being and works to ensure members receive the right care at the right time.
4. How is the state and/or counties reaching out to the homeless population to sign them up for health care?
Outreach and Enrollment Grants for Targeted Populations: Individuals who are homeless are one of the target populations for $25 million ($12.5 million in The California Endowment funds plus $12.5 million in federal funds) for grants to counties under AB 82, trailer bill language enacted as a part of the 2013-14 budget (see excerpt attached). The Department of Health Care Services (DHCS) has released guidance to the counties about these funds (attached) and held a webinar (attached) to date, with the goal of distributing grants to counties by February 1, 2014. Outreach and Enrollment. California Policy Academy to Reduce Chronic Homelessness Workgroup: California is one of four states that recently participated in a federal Substance Abuse and Mental Health Services Administration (SAMHSA) Policy Academy to Reduce Chronic Homelessness. With the expansion of Medi-Cal eligibility, many people who are experiencing chronic homelessness will be able to enroll in Medi-Cal. The Policy Academy state team and consultant are currently engaging homelessness subject matter experts in a Medi-Cal Outreach and Enrollment workgroup to explore preparing a toolkit of best practices for outreach and enrollment of the chronically homeless population that DHCS could then share with Outreach and Enrollment grantees. This will build upon best practices from the Low-Income Health Program (LIHP) as well as recent philanthropic funding efforts to enroll the chronically homeless population.
5. What health plans are available through Medi-Cal?
Medi-Cal managed care offers a selection of 21 health plans. Your health plan options will vary depending upon the county in which you live. Most counties offer commercial plans, which also operate in Covered California including Anthem Blue Cross, Kaiser, Health Net, and Molina. Other plans are public plans administered by the community. Every county’s Medi-Cal plans provide the same high quality care at the same low or no cost to Californians, no matter where you live. The directory of health plans available through Medi-Cal managed care is available online at: Medi-Cal Managed Care: Health Plan Directory.
6. Will I be able to stay with my doctor?
More than 400 hospitals and approximately 130,000 doctors, pharmacists, dentists, and other health care providers participate in the Medi-Cal program to provide medically necessary services to members. Most Medi-Cal members who participated in the CHCF study said it is easy to find a primary care physician nearby. You can search for a managed care provider on the Department of Health Care Services website at Health Care Options.
7. Is it possible for the members of the same family to qualify for different coverage at the same time?
The Covered California application is a single application for multiple health coverage programs. It is common for different members of the same family or tax household to be eligible for different programs. In some cases, both parents could be eligible for tax credits through Covered California, while the children are eligible for Medi-Cal. This is because the eligibility rules for Medi-Cal kids are different than for adults, which ensures that no child lacks affordable coverage. In other cases, one parent may be eligible for Covered California without subsidies because they have access to affordable coverage through their job, while their spouse is eligible for premium assistance tax credits through Covered California and the children are eligible for Medi-Cal.
8. What do I do if I have questions about medications, accessing doctors, or specialists?
If you have questions about your coverage under Medi-Cal managed care, you can call your health plan’s customer service representatives directly, just as you would under any other health coverage plan. To access the Medi-Cal managed care health plan directory, please log on to: Medi-Cal Managed Care: Health Plan Directory.
9. Can I decline Medi-Cal and enroll in a Covered California health plan and receive the federal premium assistance?
Under federal law, if you are currently enrolled in or are eligible for Medi-Cal, you are ineligible to purchase subsidized coverage through Covered California. If you are eligible for Medi-Cal, you can still purchase a health coverage plan through Covered California, but you cannot receive premium assistance to reduce its cost and will have to pay the full cost of the Covered California health care plan’s premium.
10. Is there a deadline to enroll in Medi-Cal?
No. There is no deadline to enroll in Medi-Cal. When you are determined eligible for Medi-Cal, you are eligible for the entire month for which you are determined eligible. In some cases, you may be able to receive Medi-Cal coverage right away. Contact your county human services agency at http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx for more information. However, enrollment in Covered California only occurs during open enrollment, so if you are trying to enroll some household members in Medi-Cal and others in Covered California, be sure to enroll in time for the households seeking coverage through Covered California.
11. If someone’s Medi-Cal coverage is cancelled due to increased income, does that person qualify for special enrollment into Covered California?
Yes, losing coverage such as Medi-Cal is considered a qualifying event that would trigger a special enrollment period. Other qualifying events include the loss of a job, a marriage or divorce, or the birth of a child. In the case of such an event, you would be eligible to enroll within 60 days of that event. During that period you could not be denied coverage by a health plan in Covered California or in the individual market, and you could be eligible for the premium assistance that is only available through Covered California.
12. I previously was denied Medi-Cal due to owning a car. Do I qualify in 2014?
The Affordable Care Act simplified financial eligibility requirements for Medi-Cal program eligibility. Under these simplifications, “property,” such as a car, is no longer counted. You should apply through Covered California for health coverage even if you previously were determined to be ineligible for Medi-Cal coverage and even though you may think your financial situation has not changed.
13. If I sign up for Medi-Cal, will anything happen to my assets?
Medi-Cal only tries to recover its costs for medical assistance when a recipient is over 55, or when a member of any age is cared for at an institution, such as a nursing home. If you are under 55, you can sign up for Medi-Cal knowing that nothing will happen to your assets unless you are institutionalized. For those over 55 or in an institution, the Department of Health Care Services may present a claim for the cost of your care. It would be paid from your estate at the time of your death, and would not seek payment during your lifetime or the lifetimes of your surviving spouse, disabled son, or daughter, or while your child is under 21 years of age. For more information, please visit Third Party Liability.
1. Will my family and I qualify for the same program?
Depending on your household size or family income, you or your family may qualify for different programs. For example, you may qualify for affordable private health insurance available through Covered California. However, your child may qualify for free Medi-Cal. We will tell you which health insurance you and other members qualify for.
2. I just found out I am pregnant. Can I apply for health insurance that will cover me during my pregnancy?
Yes. Make sure to answer yes to the application question “Are you pregnant?” or tell the person helping you to fill out your application. You can apply for health insurance that can cover pre-natal care, labor and delivery, and postpartum care. Health insurance plans can no longer deny you health insurance if you are pregnant.
3. I just had a new baby. What should I do about health insurance?
If you did not have Medi-Cal or Access for Infants and Mothers (AIM) at the time of delivery, fill out this application for your newborn. If you did have Medi-Cal or AIM during your pregnancy, you do not need to fill out this application. Call your county worker to make sure your baby is covered from birth, or fill out a newborn referral form. Print the form at www.dhcs.ca.gov/formsandpubs/forms/Forms/mc330.pdf. If you had AIM, call 1-800-433-2611, or go to www.aim.ca.gov to register your baby.