Medicaid Eligibility in California

Calendar Icon Updated February 11, 2019
Medicaid

Medi-Cal  is the Medicaid program of California. It is a health insurance program  that is public and designed to provide the health care services that  are needed for people who have a low income, families that include  children, persons with disabilities, seniors, foster care, women who are  pregnant and even people with a low income who suffer from things like  HIV/AIDS, tuberculosis, and breast cancer. This program is funded by  both the federal and the state government.

California’s Requirements for Medicaid Qualification

If you want to get the inexpensive or even free medical assistance  that is Medicaid in California, you must qualify. If you don’t meet the  eligibility requirements, you will not be accepted. Different types of  criteria must be met in order to qualify. You must meet aspects that are  income related as well as some that are not related to income.

You  have to be a citizen of the US and a state resident of California. If  you are not a citizen, you need to be a permanent US resident, a legal  alien, or a US national. You also need to meet requirements that pertain  to a specific need for health care and/or medical insurance.

Those who meet income requirements and are age 65 or older can  qualify for Medicaid, as well as people who are disabled or blind. If  you happen to be in a nursing home or are pregnant, you might be  eligible for Medicaid. You can also qualify if you are 21 or younger.  People who are in treatment programs for cervical or breast cancer might  also be eligible. If you are the caretaker of children who are not yet  21, you might be eligible IF the parent of the child is:

  • Not living in the household with the child
  • Underemployed
  • Unemployed
  • Deceased

Please note: Even if you qualify under one of the above conditions, you still have to meet the income requirements.

How to Apply for Medicaid in in California

You can apply for California Medicaid do so online, in person, by  mail, or by phone. Either way, you will have to fill out an application  regarding your identity, your family members and financial situation,  whether or not you currently have insurance, and more. To  get the application, you can either download and print it before  filling it out, or you can get an application from the Social Services  office in your county.

No matter which way you apply, you will be informed of the decision by either telephone or mail within a few weeks.

The California Medicaid Application can be found on the California Department of Health Care Services Ways to Apply for Medi-Cal page.

What Does Medicaid Cover in California?

There are some Medicaid benefits that the federal government requires states to cover. Then, there are  other optional benefits that will vary from one state to the next. The  federally mandated benefits include:

  • Inpatient hospital stays
  • Outpatient hospital services
  • EPSDT (Early and Periodic Screening Diagnostic, and Treatment)
  • Nursing home services
  • Home health
  • Physician services
  • Services provided by rural health clinics
  • Services provided by federally qualified health centers
  • X-Ray and lab services
  • Services related to family planning
  • Services provided by nurse midwives
  • Services provided by certified pediatric and family nurse practitioners
  • Services provided by freestanding birth centers that are licensed and state recognized
  • Transportation to medical services
  • Smoking cessation counseling services for pregnant women

Income Requirements for California Medicaid

When it comes to meeting the income requirements, you have to be a  member of a low-income household. The exact amount is determined by the  income of the household as well as by the number of family members in  said household. The income of the household cannot go over 138% of what  your family’s size is based on the Federal Poverty Level. If you are the  only person in your household, you can’t earn more than $16, 395  annually if you are to be eligible for Medicaid. If there are two  members of the household, the cutoff is anything over $22,108 for the  year. More info can be found here.

How Much Does Medicaid Cost in California?

Most of the people who receive Medicaid in California do not pay  anything for it because they have such low income. If there are costs  associated with various parts of Medicaid they are not very much at all  due to the income requirements. For eligible children, the premiums  might be as little as $13 monthly, while for a family that premium might  go as high as $39.

Cost and Coverage of Medicaid in California

Prescription Drugs with Medicaid in California?

Most prescriptions will be covered under Medi-Cal. They might be the  generic versions of a more expensive brand-name drug though. If there is  ever a co-pay for prescriptions, it will be one that is small.

Which Medicaid plan is best in California?

This will vary depending on what your needs are in relation to what  you qualify for. You can get more information on the different programs here.

Eligibility Team

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