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About Medi-Cal Health Plans
Medi-Cal is California’s Medicaid program. This is a public health insurance program which provides needed health care services for low-income individuals, including families with children, seniors, persons with disabilities, foster care, pregnant women, and low income people with specific diseases such as tuberculosis, breast cancer or HIV/AIDS. Medi-Cal is financed equally by the State and federal government. Medi-Cal offers 21 managed care health plans, some of which are also offered by Covered California. Your choices depend on the county in which you live.
What is Medi-Cal?*
Medi-Cal offers free or low-cost health coverage for California residents who meet eligibility requirements. Most individuals who apply through Covered California and enroll in Medi-Cal will receive services through health plans, similar to most of the health coverage options available through Covered California. On January 1, 2014, California expanded Medi-Cal eligibility for some low-income adults. When you complete a Covered California application, your application will be automatically reviewed for Medi-Cal eligibility.
What Does Medi-Cal Cover?
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
- 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
Who Pays for Health Services Provided by Medi-Cal?
For many individuals who enroll in Medi-Cal, there are no premiums, no co-payments, and no out of pocket cost. Some households will see affordable costs, such as a low monthly premium. For some Medi-Cal kids, the premium is only $13 per child. In general, individuals in Medi-Cal will get the same health benefits available through Covered California at a lower cost.
Who’s Eligible for Medi-Cal?
To be eligible, your annual income must be 138 percent of the federal poverty level or less (in 2014 that would mean an individual who earned $16,105 or less). For a family of four, your annual income must be $32,913 or less.
You can also get Medi-Cal if you are:
- 65 or older
- Under 21
- In a skilled nursing or intermediate care home
- On refugee status for a limited time, depending how long you have been in the United States
- A parent or caretaker relative or a child under 21 if:
- 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 is under employed or unemployed
- Have been screened for breast and/or cervical cancer (Breast and Cervical Cancer Treatment Program)
What Are the Benefits of Medi-Cal?
Medi-Cal gives you benefits similar to those of Covered California, but often at lower or no cost to you and your family.