For low income individuals and families, Medi-Cal, California’s Medicaid program, offers much needed healthcare coverage. Participation in Medi-Cal, however, is limited those who meet strict eligibility guidelines. Whether you are planning to apply for Medi-Cal coverage now, or you are planning to ensure coverage is available in the future, it helps to have a basic understanding of the eligibility criteria.
Medi-Cal is the name of California’s Medicaid program. Medicaid is a healthcare program that is primarily funded by the federal government; however, the individual states may supplement federal funds if they so choose. In addition, the states administer the Medicaid program, accounting for some differences in both eligibility guidelines and benefits offered from one state to the next. In all states though, an applicant’s income and assets will be considered when determining eligibility.
California Medi-Cal Eligibility Requirements Categories
The California Medi-Cal program has over 90 different categories, each with its own separate eligibility rules and requirements. There are, however, several broad umbrella categories that help explain who might be eligible for coverage, including:
- Income Based Medi-Cal — requires family income at or below 138% of the Federal Poverty Level (FPL) or 266% of FPL if the applicant is a child.
- SSI-Linked Medi-Cal – if you qualify for Supplemental Security Income (SSI) you are automatically eligible for Medi-Cal.
- Aged and Disabled Federal Poverty Level Medi-Cal – for applicants who are 65 and over, or disabled, and whose income meets the FPL requirement.
- California’s Working Disabled Program – if you are disabled, but still working with income up to 250% of the FPL, you may qualify for Medi-Cal. You may have to pay a small premium under this category.
- Aged, Blind, and Disabled – Medically Needy Medi-Cal – if you are 65 or older, blind, or disabled, but your income is too high for other categories, you may qualify under the “share of cost” category that requires you to spend a pre-determined amount of your own money on healthcare expenses before Medi-Cal will start covering costs.
Additional Medi-Cal Eligibility Requirements
In addition to meeting the program specific requirements, you must be a resident of the State of California and be a United States national, citizen, permanent resident, or legal alien. The other important eligibility consideration is the “countable resources” limit. This requirement can be extremely confusing because there are a number of factors that impact how much property you may own and still qualify for Medi-Cal. In general, the countable resources limit is just $2,000 for an individual and $3,000 for a married couple. If you are married and applying for Medi-Cal to help cover long-term care costs, the “Community Spouse Resource Allowance (CSRA)” applies instead of the general resources limit. The CSRA permits your spouse to keep the marital residence along with other exempt personal property. A community spouse is also allowed to keep his or her income and may, in some cases, be entitled to keep some of the institutionalized spouse’s income as well.