Medi-Cal is a health care assistance program developed by the federal government along with Medicare. Both programs were established by a 1965 amendment to the Social Security Act. The purpose of the Medi-Cal program is to extend healthcare services to U.S. citizens based on their income or financial need. Many clients ask: “Is Medi-Cal available in California? The answer is yes. Medi-Cal is run by state governments, and California’s program is known as Medi-Cal.
What is Medi-Cal?
In simple terms, Medi-Cal is a need-based medical assistance program. As such, eligibility is based entirely on income and financial need, regardless of age. The cost of health coverage is paid with federal, state and local tax funds. Patients with Medi-Cal normally pay a small co-pay, if anything at all. Because Medi-Cal is run by each state, the benefits and eligibility requirements are different from state to state.
What are the minimum benefits provided under Medi-Cal?
Medi-Cal is available to adults with children who are earning less than a certain level of income set by the state. It is also available to pregnant women and disabled persons. Nationally, the minimum eligibility level for Medi-Cal is 133% of the federal poverty level, as of January 1, 2014. Although Medi-Cal is state-run, there are certain federally mandated benefits that each state must provide. Following are examples of required benefits:
- Inpatient hospital services
- Outpatient hospital services
- Early and periodic screening, diagnostic and treatment services
- Nursing facility services
- Home health services
- Physician services
- Rural health clinic services
- Lab and x-ray services
- Family planning
- Nurse midwife services
- Certified pediatric and family nurse practitioner services
- Freestanding birth centers
- Transportation for medical care
- Tobacco cessation counseling
Is Medi-Cal Available in California to everyone?
Not all individuals living in California will be eligible to receive assistance through Medi-Cal. According to California’s Medi-Cal program, the following individuals may be eligible:
- Children under 21 years of age
- Persons 65 years of age and older
- Disabled and blind persons
- Pregnant women
- Women who have been screened for breast and/or cervical cancer
- Families where at least one child is under 21 and at least one parent is absent, disabled, unemployed or working (depending on hours worked and income earned)
- Anyone who is eligible for CalWORKS; Supplemental Security Income and State Supplemental Program (SSI/SSP); Entrant or Refugee Cash Assistance (ECA or RCA); or In-Home Supportive Services (IHSS); Foster Care or Adoption Assistance Program.
Other individuals may also be eligible; however, they may be required to pay a share of their medical expenses each month, before coverage will begin.
With the extended coverage, which became available in January of this year, Medi-Cal is now available to adults under 138% of the federal poverty level, who have been citizens or legal California residents for 5 or more years. If your income is close to the required levels, you should still apply, as some types of income may not actually be counted.
How do I apply for Medi-Cal in California?
California’s Medi-Cal program provides free or low-cost health care coverage for California residents who are deemed eligible. California’s State-based Marketplace is called “Covered California.” Beginning January 1, 2014, California expanded Medi-Cal eligibility for low-income adults. The Medi-Cal program offers 21 different health plans for managed care, and the options that are available depend on the county in which you live.
If you have questions regarding Medi-Cal, or any other estate planning needs in Los Angeles, please contact the Schomer Law Group either online or by calling us at (310) 337-7696.