Step by Step process for Medi-Cal

Description

Medi-Cal is California’s Medicaid program. This is a public health insurance program that provides free or low cost medical services for children and adults with limited income and resources.

Click to expand each topic below and learn more about the Medi-Cal process.

Are You Eligible?

Medi-Cal eligibility is based primarily on your income and, sometimes, your “countable property“. Effective January 1, 2014, Medi-Cal has been expanded to offer coverage to a larger group of Californians. To learn more about this, visit the Medi-Cal Expansion Information page.

To find out if you and your family may be eligible based on income, use the Covered California Income Guidelines chart.

Pregnant women, children, and disabled persons are allowed to have a higher income on the Federal Poverty Level scale and are urged to apply.

How to Apply for Medi-Cal?

There is no wrong door when applying for health coverage in California. Please choose one of the following ways to apply:

In Person: 
Apply at your local county social services office, where you can get personal assistance completing your application.

By Mail:
Apply for Medi-Cal with a Single Streamlined Application , provided in English and other languages. Send completed and signed applications to your local county social services office.

By Phone:
To apply over the phone, call your local county social services office.

Online:
Apply online at www.CoveredCA.com . Applications are securely transferred directly to your local county social services office, since Medi-Cal is provided at the county level.

If you need additional help applying or have additional questions, you can contact a trained Certified Enrollment Counselor (CEC) for free. Search a list of local CECs or call 1-800-300-1506.

If you have already submitted an application online and haven’t been contacted yet, please don’t submit a duplicate application.

 

The process for verifying your Medi-Cal eligibility

Due to the high volume of new applications, the process is taking longer than normal and the steps mentioned below may be done out of order if it will help in expediting coverage.

The process for verifying your Medi-Cal eligibility, from the time your completed application is received to when you receive your Benefits Identification Card (BIC), normally takes 45 days. The general process for verification is as follows:

1. Apply – Complete application and submit it either in person, by mail, by phone, or online.

2. Receive a Notification of Likely Eligibility by mail.

3. Your county’s social services office may contact you by mail or phone to request paper verification if income, citizenship and other criteria cannot be verified electronically.

4. Receive Final Notice of Action notifying you of whether or not you can receive Medi-Cal.

5. Receive BIC – When you receive your BIC in the mail, you are able to use of the many Medi-Cal benefits available to you.

 

Enroll in a Plan

When you first qualify for Medi-Cal and receive your BIC, you are covered under Fee-For-Service (also called, Regular Medi-Cal). Within 45 days of receiving your BIC, you will be mailed information explaining your health plan options.

However, you must choose a health plan within 30 days of receiving your health plan information mailer. If you do not choose a plan within 30 days, Medi-Cal will choose a plan for you. The health plans available to you depend on what county you live in.

Go to the Medi-Cal Managed Care Health Plan Directory and find your county.

For those Medi-Cal members who are already enrolled and need to pick a health plan, you can do so at the Health Care Options website.

If you see only one health plan, the county has chosen this plan for you. Please wait for your health plan information in the mail.

If you see multiple health plans listed, please explore each plan and choose the one that suits you and your family’s needs. Remember, if you do not pick a plan within 30 days of receiving your health plan information mailer, Medi-Cal will pick a plan for you.

If you live in San Benito County, there is only one health plan available and you may enroll in this health plan. However, you may choose to stay with Fee-For-Service Medi-Cal.

Start Using Your Benefits

Medi-Cal currently provides a core set of health benefits, including doctor visits, hospital care, immunization, pregnancy-related services and nursing home care. The Affordable Care Act ensures all Medi-Cal health plans offer what is known as Essential Health Benefits (EHB). These ten comprehensive services include the following categories:

1. Outpatient (Ambulatory) services
2. Emergency services
3. Hospitalization
4. Maternity and Newborn care
5. Mental Health and Substance Use Disorder Services, including Behavioral Health Treatment
6. Prescription Drugs
7. Programs such as physical and occupational therapy (known as Rehabilitative & Habilitative Services) and devices
8. Laboratory services
9. Preventive and wellness services & chronic disease management
10. Children’s (Pediatric) services, including oral and vision care.

Take a look at the Medi-Cal Health Benefits Chart (PDF) to learn more about the services in each category. For a definition of any of the terms used, please browse the Federal Healthcare.gov Glossary.

Dental Benefits are available May 1, 2014

Dental benefits for adults 21 and older have been restored by the Center for Medicare and Medicaid Services**. You can find a Medi-Cal dentist on the Denti-Cal Search Engine. For information on childern’s dental service, visit the Denti-Cal website.

The following benefits have now been restored:

• Exams and x-rays
• Cleanings
• Fluoride treatments
• Fillings
• Anterior root canals (front teeth)
• Prefabricated crowns
• Full dentures
• Other medically necessary dental services

Denti-Cal adult benefits that will remain in place and do not change as a result of the restoration:

• Pregnancy-related services
• Emergency services
• Services provided to residents of an Intermediate Care Facility/Skilled Nursing Facility
• Services provided to consumers of the Department of Developmental Services

 

**Dental and vision services are available with some limitation. Learn more about dental benefits and further clarification by calling
1-800-322-6384 or visit Denti-Cal .

Mental Health and Substance Use Disorder Services Benefits

The following mental health benefits are now available through Medi-Cal managed care plans and Medi-Cal fee-for-service:

• Individual and group mental health evaluation and treatment (psychotherapy)
• Psychological testing when clinically indicated to evaluate a mental health condition
• Outpatient services for the purposes of monitoring drug therapy
• Outpatient laboratory, drugs, supplies and supplements
• Psychiatric consultation
• All Specialty mental health services currently provided by County Mental Health Plans will continue to be available.

 

The following substance use disorder services are now available through Medi-Cal:

• Voluntary Inpatient Detoxification
• Intensive Outpatient Treatment Services
• Residential Treatment Services
• Outpatient Drug Free Services
• Narcotic Treatment Services

These are all services that Medi-Cal covers today and will continue to cover for current and new enrollees.

Disclaimer: The community resource directory information is deemed accurate and up-to-date, however, you should always contact the agency or provider to confirm this information and make an appointment. Be sure to confirm payment information with the provider, if payment is required. We are not affiliated to any of the organizations listed in this app/website. The information provided in this app/site is for the benefit of the community and and we are not liable for any information changed from the date we published this information. Please contact us if you like to make any changes in the information by emailing beracahsites@gmail.com