Residents of California are generally familiar with the state’s Medi-Cal program – “Medi-Cal.” This health care program provides payment for a variety of medical services for those with limited income and resources. Like in many other states, Medi-Cal provides waivers for additional services, which may not specifically be available under the standard Medi-Cal programs within the state. There are a variety of Medi-Cal waivers available in California.
What is Medi-Cal coverage?
Medi-Cal is a health care assistance program that provides health care services to U.S. citizens with low income. Medi-Cal programs, while funded in part by the federal government, are run independently by each state. Therefore, Medi-Cal benefits and eligibility requirements are different from one state to the next. Patients receiving Medi-Cal benefits typically pay a small co-pay, if anything at all, for health care.
Eligibility for Medi-Cal coverage in general
California’s state Medi-Cal program is referred to as Medi-Cal. Only California residents can be eligible for Medi-Cal. You must also be either a U.S. citizen, U.S. national, permanent resident or legal alien. Applicants must also have very limited income and be either pregnant, blind, have a disability or a family member in your household with a disability, be responsible for children under 19 years of age, or be 65 years of age or older.
The purpose of Medi-Cal waivers is to provide additional services to specific groups, specific geographic locations, or those individuals who may not otherwise be eligible for Medi-Cal. For example, there are waiver programs that provide home and community-based medical services, family planning services, managed care and specialty mental health services. There are services targeted at the elderly or developmentally disabled.
List of Current Medi-Cal Waivers
California’s Department of Health Care Services has several Medi-Cal waiver programs available. There are often programs that expire and programs that are still under development. Here is a list of current waiver programs:
- Acquired Immune Deficiency Syndrome (AIDS) Waiver
- Assisted Living Waiver (ALW)
- Home and Community-Based Services Waiver for the Developmentally Disabled (HCBS-DD)
- Family Planning, Access, Care and Treatment Program (Family PACT)
- In-Home Operations (IHO)
- Developmentally Disabled – Continuous Nursing Care (DD-CNC)
- Multipurpose Senior Services Program (MSSP)
- Nursing Facility/Acute Hospital (NF/AH)
- Specialty Mental Health Consolidation Program (SMHC)
- Pediatric Palliative Care Waiver (PPC)
How do I obtain Medi-Cal waiver services?
For certain Medi-Cal waiver programs, the first step in receiving benefits is simply to contact your local social services office. For other programs, an initial assessment must be completed, which is coordinated through that particular program’s administrator, in order to determine whether or not you are eligible for the services. In order to participate in any waiver program, you will be required to demonstrate you are eligible for Medi-Cal benefits. Both determinations can be made simultaneously.
If you have questions regarding Medi-Cal, Medi-Cal waivers, or any other Medi-Cal planning issues, please contact the Schomer Law Group either online or by calling us at (310) 337-7696.