Medi-Cal provides public health insurance for California residents who have limited resources and income. In California, the program is called Medi-Cal. Nationally, the program is known as the Medicaid healthcare program. This program pays for a variety of medical services for children and adults with limited income and resources. You may apply for Medi-Cal benefits regardless of sex, race, religion, color, national origin, sexual orientation, marital status, age, disability, or veteran status.
Medi-Cal is a complex public health insurance program made up of many separate smaller programs designed to assist families and individuals obtain affordable medical services. The information you provide on your Medi-Cal application and any required verifications you submit are used to determine the Medi-Cal program(s) for which you might qualify and which program may be most appropriate for you and your family.
Who can get Medi-Cal?
People in many different situations qualify for Medi-Cal. Some are listed below:
65 years of age or older
Under 21 years of age
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 not be eligible depending upon how long they have been in the U.S.)
Parent or caretaker relative of a child under 21, and
The child’s parent is deceased or doesn’t live with the child, or
The child’s parent is incapacitated, or
The child’s parent, who is the primary wage earner, is unemployed or underemployed.
How is my Medi-Cal application processed?
When the County receives your application, it will be assigned to an Eligibility Technician (ET). The worker will review your application and determine if additional information is needed. Once the Eligibility Technician (ET) has all of the necessary information, he or she will determine if you are eligible for Medi-Cal. You will get a letter in the mail telling you if your Medi-Cal application is approved or denied. If you do not understand this letter or do not agree with the information in this letter you should contact your Eligibility Technician (ET). If you want to meet with your worker to discuss your application, call your worker to set up an appointment. However, anyone can help you with the application process --- a family member, friend, or anyone else of your choice.
How long does it take?
Forty-five (45) days are allowed to process a Medi-Cal application not involving a disability. If you are applying for Medi-Cal based on a disability, your application process may take up to 60 days or longer. To avoid delays in the processing of your case, submit all information requested of you as soon as possible. Ask your Eligibility Technician (ET) for help if you are having trouble obtaining information.
Do I have to pay for Medi-Cal?
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.
What is the Healthy Families Program?
The Healthy Families Program is a low-cost health coverage program for children ages 0 through 19. The Healthy Families Program is administered by the State of California Department of Health Services. The Healthy Families Program offers:
Low-cost comprehensive health, dental, and vision insurance
Choice of health, dental, and vision insurance plans
Low monthly premiums from $4 per child to a maximum of $27 per family
No co-payment for preventive services; $5 co-payment for non-preventive services
Medical assistance for children without health insurance and children receiving Medi-Cal benefits with a share of cost
Medical assistance for children in single or two-parent working families
Medical assistance for children whose families have property (such as savings or cars) which makes them ineligible to Medi-Cal
To apply for The Healthy Families Program, you may obtain a mail-in application by calling this toll free number: 888-747-1222
What is Cal-Optima?
Cal-Optima is the managed care program that administers Medi-Cal benefits in Orange County. Once your Medi-Cal application is approved, you will receive enrollment information from Cal-Optima and at that time you will be able to choose a health care provider.
What do I do with unpaid medical bills?
Any bill received 3 months prior to your application for Medi-Cal may be covered by requesting Retroactive Medi-Cal Coverage. In addition, certain unpaid, old medical bills can be used to reduce your Medi-Cal share of cost (SOC).
What is the difference between SSI Medi-Cal and “County” Medi-Cal?
If you receive SSI/SSP payments, your Social Security Administration (SSA) Office automatically sets up Medi-Cal for you. No separate application for Medi-Cal is needed. People not receiving SSI/SSP must apply for Medi-Cal with the county Social Services Agency (SSA). The Social Security Administration is in no way affiliated with the county Social Services Agency.
What is the difference between Medicare & Medi-Cal?
Medicare is a federal health insurance program available to most people 65 years of age or older, certain disabled or blind persons, regardless of income. Medicare is administered though the Social Security Administration. The county Social Services Agency does not process applications for Medicare benefits.
How do I find my worker's name and telephone number?
The name, worker number, and telephone number of your Eligibility Technician (ET) may be found at the top right-hand corner of all Notices of Action sent to you.
Where do I go if I’m not eligible for the Medi-Cal Program?
If you are an adult between the ages of 21 and 64, do not have dependant children in the home and you are not blind or disabled, you may still qualify for help through the Medical Services Initiative (MSI) Program. For information about that program, please call 714-834-6248.