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Medi-Cal Eligibility and Covered California – Frequently Asked Questions

Below you will find the most frequently asked questions for current and potential Medi-Cal coverage recepients. If you do not find an answer to your question, please contact your local county office from  County Listings page or email  at  Medi-Cal Contact Us.

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.

Medi-Cal has always covered low-income children, pregnant women and families.  On January 1, 2014, California expanded
Medi-Cal eligibility to include 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 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.

3. What is the difference in coverage between Medi-Cal and Covered California?

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 consist of:

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

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.  For more information on Outreach and Enrollment efforts click on the link 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?

6. Will I be able to stay with my doctor?

7. Is it possible for the members of the same family to qualify for different coverage at the same time?

8. What do I do if I have questions about medications, accessing doctors, or specialists?

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?

11. If someone’s Medi-Cal coverage is cancelled due to increased income or decreased household size, does that person qualify for special enrollment into Covered California?

Yes, losing health coverage such as Medi-Cal is considered a qualifying event that would trigger a special enrollment period.  Other qualifying events include:

• Permanently moved to/within California
• Lost or will soon lose their health insurance, including Medi-Cal eligibility (also known as loss of Minimal Essential Coverage (MEC)
• Had a baby or adopted a child
• Got married or entered into a domestic partnership
• Domestic violence survivors  (If married, abuser’s income not counted if survivor lives apart and is unable to file joint tax return.)
• Returned from active duty military service
• Released from jail or prison
• Gained citizenship/lawful presence
• Federally Recognized American Indian/ Alaska Native
• Other qualifying events as identified on the Covered California portal

In the event that one of these life events does occur, 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 if you are otherwise eligible, and you could be eligible for the premium assistance that is only available through Covered California.

12. My Medi-Cal has been discontinued and I am now able to enroll in Covered California during a Special Enrollment Period (SEP), how can I avoid a gap in my health coverage?

If your Medi-Cal will be or has been discontinued, in order to avoid a gap in your health coverage, you should pick a Covered California plan before the date your Medi-Cal ends.  If you do not select a Covered California plan in the same month your Medi-Cal ends, you will not have health care coverage for at least a month.  You must also pay your Covered California premium by the due date when you are billed in order to be covered.  If your request for enrollment is completed within 60 days of the qualifying life event date, the soonest your Covered California health plan can start will be the 1st of the month following your Covered California plan.selection.  If you wait more than 60 days after your Medi-Cal ends to pick a Covered California plan, you may not be able to enroll until Covered California’s next Open Enrollment Period. You may contact Covered California online at CoveredCA.com or call 800-300-1506 or contact your County Eligibility Worker for assistance in selecting your Covered California plan.  You may reach your County Eligibility Worker at the county social services agency via  http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx.

13. I previously was denied Medi-Cal due to owning a car. Do I qualify now?

14. If I sign up for Medi-Cal, will anything happen to my assets?

Family

1. Will my family and I qualify for the same program?

2. I just found out I am pregnant. Can I apply for health insurance that will cover me during my pregnancy?

3. I just had a new baby. What should I do about health insurance?