Medi-Cal

What is Medi-Cal? (California Medicaid Program)

California Medicaid or Medi-Cal is a benefits assistance program that helps limited-income individuals and families get access to healthcare. If you want to apply for Medi-Cal, you have to make sure you qualify and are eligible. There are strict eligibility requirements that you must follow to apply for California Medicaid. In this article, we will explain how Medi-Cal works and provide details on eligibility guidelines, including income limits, and how to apply.

Table of Contents:

  • What is Medi-Cal?
  • Who is Eligible for Medi-Cal?
  • Medi-Cal Income Limits
  • How to Apply for Medi-Cal
  • California Medicaid Phone Number
  • Medi-Cal FAQs

What is Medi-Cal?

Medi-Cal is the name for the California Medicaid health care program. It provides medical services to low-income people at little or no cost.

It is administered by the Centers for Medicare and Medicaid Services (CMS) and the California Department of Health Care Services (DHCS).

If you qualify for Medi-Cal and are approved for benefits, you can get help to pay for doctor’s visits, medication, dental screenings, rehabilitation, surgery, visits to the hospital, and more.

Who is Eligible for Medi-Cal?

There are three ways you can qualify for Medi-Cal:

First, you can qualify if you meet the income limits.

To see if you qualify based on income, look at the chart below. Income numbers are based on your annual or yearly earnings.

Second, you can also get Medi-Cal if you are:

  • 65 or older
  • Blind
  • Disabled
  • Under 21
  • Pregnant
  • In a skilled nursing or intermediate care home
  • On refugee status for a limited time, depending on how long you have been in the United States
  • A parent or caretaker relative of an age-eligible child
  • Have been screened for breast and/or cervical cancer (Breast and Cervical Cancer Treatment Program)

Third, if you are enrolled in one of the following programs, you can also get Medi-Cal:

  • CalFresh
  • SSI/SSP
  • CalWorks (AFDC)
  • Refugee Assistance
  • Foster Care or Adoption Assistance Program

California Medi-Cal Income Limits

The California Medicaid Income Limit is calculated as a percentage of the Federal Poverty Line (FPL).

To be eligible for Medicaid, you cannot make more than the income guidelines outlined below:

  • Children up to age 1 with family income up to 266 percent of FPL
  • Any child age 1-5 with a family income up to 266 percent of FPL
  • Children ages 6- 18 with family income up to 266 percent of FPL
  • CHIP for children with family income up to 266%-322% percent of FPL
  • Pregnant women with family income up to 213 percent of FPL
  • Parents of minor children with family income up to 114 percent of FPL
  • Individuals who are elderly, blind, and disabled with family income up to 100% of the FPL
  • Adults without dependents under Medicaid expansion with income up to 138% of the FPL

Below are the California Medi-Cal income limit charts, one showing eligibility for children and the other showing eligibility for adults.

First is the income limit for children by age category.

Find the age category your child falls into and you will see the income limit by household size.

California Medicaid Income Limit – Children
Children Medicaid Ages 0-1 Children Medicaid Ages 1-5 Children Medicaid Ages 6-18 Children Separate CHIP
% FPL 100% 266% 266% 266% 322%
Household Size
1 $13,590 $36,149 $36,149 $36,149 $43,760
2 $18,310 $48,705 $48,705 $48,705 $58,958
3 $23,030 $61,260 $61,260 $61,260 $74,157
4 $27,750 $73,815 $73,815 $73,815 $89,355
5 $32,470 $86,370 $86,370 $86,370 $104,553
6 $37,190 $98,925 $98,925 $98,925 $119,752
7 $41,910 $111,481 $111,481 $111,481 $134,950
8 $46,630 $124,036 $124,036 $124,036 $150,149

Next, you will find below the income limit for adults by category.

Find the category you fall into and you will see the income limit by household size.

California Medicaid Income Limit – Adults
Pregnant Women Medicaid Adults (Medicaid) Parent/ Caretaker Seniors & People w/ Disabilities (Medicaid) Adults (Medicaid) Expansion to Adults
% FPL 100% 213% 114% 100% 138%
Household Size
1 $13,590 $28,947 $15,493 $13,590 $18,754
2 $18,310 $39,000 $20,873 $18,310 $25,268
3 $23,030 $49,054 $26,254 $23,030 $31,781
4 $27,750 $59,108 $31,635 $27,750 $38,295
5 $32,470 $69,161 $37,016 $32,470 $44,809
6 $37,190 $79,215 $42,397 $37,190 $51,322
7 $41,910 $89,268 $47,777 $41,910 $57,836
8 $46,630 $99,322 $53,158 $46,630 $64,349

How to Apply for California Medicaid

Californians have three ways to apply for Medi-Cal:

  • Online: It takes about 30 minutes to sign up for Medi-Cal online through Covered California.
  • In-person: You can enroll in person at a County Social Services Office. Additionally, California has hundreds of Medi-Cal enrollment centers and thousands of certified enrollers ready to help you apply for Medicaid.
  • Over the phone: You can request a phone call from an enroller to get free advice and apply for Medi-Cal over the phone.

California Medicaid Phone Number

If you are trying to reach California Medi-Cal by phone, here is the number to call.

DHCS Medi-Cal Telephone Service Center – 1-(800) 541-5555

If you are calling outside of California, please call (916) ​636-1980)

Hours:

The DHCS Medi-Cal Telephone Service Center is open Monday through Friday from 8 a.m. to 5 p.m., except for holidays.

California Medi-Cal FAQs

Here are some of the most frequently asked questions about California Medi-Cal:

I’m an immigrant. Can I get Medi-Cal?

Immigrants who have been legal residents for 5 years or longer or meet specific noncitizen requirements qualify for all of the same programs that citizens can get.

Some non-citizens who have legal immigration status in the United States do not qualify for full Medi-Cal coverage.

However, they may qualify for private coverage subsidized by the government.

Additionally, undocumented children and young adults who are 25 years old or younger can get Medi-Cal coverage, if they meet all other program requirements.

Furthermore, undocumented adults who are 26 years old and older do not qualify for full Medi-Cal coverage, though they may qualify for Medi-Cal coverage for emergencies or during pregnancy.

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.

However, some households will pay a low monthly premium.

Additionally, for some Medi-Cal children, the monthly premiums are $13 per child up to a family maximum of $39 per month.

In general, individuals in Medi-Cal will get the same health benefits available through Covered California at a lower cost.

How can I choose a health insurance plan?

If you qualify for private health insurance plans through Covered California, you can visit CoveredCA to easily shop and compare health insurance plans.

Covered California will offer choices of private health insurance plans and Medi-Cal plans.

If you qualify for Medi-Cal, the coverage and costs are different, and they may even be free.

What if I am not happy with my Medi-Cal health plan?

If you are not happy with your Medi-Cal health plan, you have the right to:

  • Change your health plan
  • File a complaint or grievance with your health plan
  • Report the problem to the California Department of Health Care Services State Ombudsman
  • Report the problem to the California Department of Managed Health Care Office of Patient Advocacy
  • Ask for a State Fair Hearing with an Administrative Law Judge

Does California Medicaid have a website?

The Medi-Cal website address is www.medi-cal.ca.gov.

California Medicaid Summary

We hope this post on California Medicaid was helpful.

Questions?

If you have further questions about California Medicaid or Medi-Cal, please let us know in the comments section below.

Be sure to check out our other articles about Medi-Cal and CalFresh including:
$3,000 Child Tax Credit from 2021 Stimulus
California P-EBT Extension for 2020/2021
How much will I get in CalFresh in 2021?
How to Complete CalFresh SAR 7 Form
Get Printable CalFresh SAR 7 Form

Kwame Kuadey

Kwame Kuadey writes about personal finance and the social safety net. His career started in banking but he caught the entrepreneurial bug and has spent the last decade building successful businesses, including an Inc. 500 Company. Kwame believes everyone has the power to improve their quality of life by seeking knowledge and taking action. In 2012, Kwame founded Empower Media to help low-income households improve their financial situation. His expertise is in topics relevant to low-income households, including government benefits and assistance, banking products, access to credit, plus tools & resources to help reduce income volatility and build wealth. Kwame has been featured in The Wall Street Journal, Forbes, Entrepreneur, Inc. Magazine, Washington Post, ABC, and NPR.

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