Many people assume that Medi-Cal is basically a type of public assistance program meant to benefit only the poor. In reality, Medi-Cal provides health coverage for various groups of individuals, not simply the poor. In fact, there are several categories of individuals that may be eligible for Medi-Cal benefits.
The basic purpose of the Medi-Cal program
Medi-Cal is a federal public health insurance program, created to provide health care coverage to low-income individuals, as well as pregnant women, seniors and individuals with disabilities. As of last year, approximately 80 million people received health care coverage through Medi-Cal. Of that number, 5 million were seniors and 9 million were individuals with disabilities. Children also account for nearly 31 million of all Medi-Cal recipients. Considering these numbers, it is clear that Medi-Cal is not only for the poor.
What are the income limits for Medi-Cal benefits?
The federal government has established certain “mandatory” populations in each state that must be eligible to receive Medi-Cal benefits, in order for that state to receive federal funding for its Medi-Cal program. Children (up to age 18), who are part of a family whose income is below 133% of the federal poverty line, are entitled to Medi-Cal benefits. The income limit in 2015 for a family of three, for example, is $26,719.00 a year. Pregnant women whose income is below 133% of the poverty line are also eligible for Medi-Cal benefits. Most seniors and individuals with disabilities who receive benefits through the Supplemental Security Income (SSI) program, are typically eligible for Medi-Cal, as well.
Medi-Cal benefits for the “medically needed”
Some individuals whose income exceeds these set limits, may still be eligible for Medi-Cal if they fall into the new category of the “medically needy.” If your medical expenses are so extensive that your income is, in reality, reduced to below the eligibility limit, then you may also be eligible for Medi-Cal under this new category. In states that have a medically needy program, individuals are allowed to use their medical expenses to reduce their countable income, in order to qualify.
States have discretion with regard to Medi-Cal eligibility
States are given very wide latitude when it comes to determining which categories of people, and the level of income, to which a state will provide Medi-Cal benefits. This is why Medi-Cal eligibility varies from state to state. In addition to the income requirements, individuals must also meet federal and state requirements with regard to residency, immigration status, and documentation of U.S. citizenship, for instance.
Not all low-income individuals are eligible
Although Medi-Cal is for more than just the poor, it does not cover every category of low-income individuals. Individuals age 21 and older, who do not have children, are not disabled, pregnant or elderly, are generally not eligible for Medi-Cal, regardless of their income level. Legal immigrants are not allowed to apply for Medi-Cal during the first five years of their residency in this country.
If you have questions regarding Medi-Cal eligibility, or any other Medi-Cal planning needs, please contact the Schomer Law Group either online or by calling us at (310) 337-7696.