Medi-Cal
is California’s Medicaid health care program. You must be a resident of California to get Medi-Cal. A California resident is someone
who lives here and plans to stay in California. This
program pays for a variety of medical services for children and adults with limited income and resources. Medi-Cal is supported
by federal and state taxes.
You can apply
for Medi-Cal benefits regardless of sex, race, religion, color, national origin, sexual orientation, marital status, age,
disability, or veteran status. If you are found (or determined) eligible, you can continue to get Medi-Cal as long as you
continue to meet the eligibility requirements. Your local County Welfare/Social Services Department manages Medi-Cal eligibility
determinations.
Medi-Cal is
a large program made up of many separate programs designed to assist Californians in various family and medical situations.
When you apply for Medi-Cal, the information you provide on your Medi-Cal Application and any required verification will be
used to determine which program(s) you qualify for, and which program is best for you and your family
People in many different situations qualify
for Medi-Cal. They are listed below. If you are not in one of these groups, call your county social service agency to determine
if you qualify for a county-operated medical assistance program. You may automatically
be eligible for Medi-Cal if you receive cash assistance under one of the following programs:
- SSI/SSP (Supplemental Security Income/State Supplemental Program)
- CalWORKs (California Work Opportunity and
Responsibility to Kids). Previously called Aid to Families with Dependent Children (AFDC).
- Refugee Assistance
- Foster Care or Adoption Assistance Program.
Even if you don’t receive cash assistance, you may
be eligible for Medi-Cal if you are one of the following:
- 65 or older
- Blind
- Disabled
- Under 21
- Pregnant
- Diagnosed with breast or cervical cancer
- In a skilled nursing or intermediate care facility.
- Refugee status during a limited period of eligibility.
Adult refugees may or may not be eligible depending upon how long they have been in the U.S.
- Parent or caretaker relative of a child under 21 and
- Parent is deceased, absent, or incapacitated
or
- The child’s parent who is the primary wage earner
is unemployed or underemployed.
If your income
is less than Medi-Cal limits for your family size, you will receive Medi-Cal services at no cost to you. If your income is
more than Medi-Cal limits for your family size, you will have to pay a certain amount only in the month you have medical expenses.
The amount that you pay is called your share of cost (SOC). When you pay or promise to pay that amount, we say that you have
met your SOC. Once you have met your SOC, Medi-Cal will pay the rest of your covered medical bills for that month. For example,
if your SOC is $50, you must first pay or obligate (obtain your providers agreement to make payments on the SOC) $50. Your
provider will enter the amount you paid or obligated into the Department’s database. Your case will certify when the
amounts you paid or obligated equal the amount of your share of cost. Once your share of cost is certified; providers checking
your eligibility will be advised that you are eligible and covered services may now be billed to the Medi-Cal program.
