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Medi-Cal

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    Medi-Cal

    Eligibility and Application

    You can think of Medi-Cal as a single program that you can qualify for in many different ways. These different ways are called eligibility categories. For example, SSI-Linked Medi-Cal is an eligibility category that allows people who qualify for SSI to automatically get Medi-Cal. There are over 90 eligibility categories, each with its own rules and requirements. Once you meet the requirements of an eligibility category, you are eligible for either full or partial-scope Medi-Cal.

    DB101 describes the most common eligibility categories for people with disabilities:

    • If your family has income at or below 138% of the Federal Poverty Level (FPL) (266% of FPL if you're a child), you may be eligible for Income-Based Medi-Cal
    • If you qualify for SSI (Supplemental Security Income), you are automatically eligible for SSI-Linked Medi-Cal
    • If you are aged or disabled, you may be eligible for Aged & Disabled Federal Poverty Level Medi-Cal
    • If you are disabled and working, you may be eligible for California’s Working Disabled Program. With it, you can have countable income up to 250% of FPL. Note: Medi-Cal's Working Disabled Program used to have a monthly premium. Starting on July 1, 2022, there is no more premium. Learn more about this change.
    • If you are aged, blind, or disabled, but your income is too high for other Medi-Cal programs, you may be eligible for Aged, Blind, and Disabled – Medically Needy Medi-Cal. For this program, you may need to spend a certain amount of your own money before Medi-Cal begins to pay for medical services. This payment is called a share of cost.

    How to Apply

    There are different ways to apply for Medi-Cal:

    Note: If you get Supplemental Security Income (SSI) or used to and now are on SSI 1619(b), you automatically get Medi-Cal coverage. You do not need to apply for Medi-Cal.

    Medi-Cal and immigrants

    Since January 1, 2024, all immigrants in California can get Medi-Cal coverage, if they meet all other program requirements.

    If you are an immigrant and aren't sure about what benefits you can get, contact an organization in your area that works with immigrants.

    If You Are Approved

    Usually, if you are approved for Medi-Cal, you get your health coverage through a managed care program. There are different managed care programs in each county operated by insurance companies and local non-profits.

    Having Medi-Cal through a managed care program means that you have a primary care physician who you see for most of your health needs. When you need to see a specialist or have a test done, you usually have to get a referral from your primary care physician. With managed care programs, you have limited options for which specialists and hospitals you can visit, but if you have an emergency, you can go to any hospital.

    Note: If you do not have Medi-Cal through a managed care program, you will probably have to switch to managed care in the future.

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