There may be a situation where, as a California resident, you need emergency health care coverage under Medi-Cal. Since Medi-Cal is a state-funded health insurance benefits program that has income and asset limitations, in terms of eligibility, obtaining approval for emergency Med-Cal benefits can be tricky. There are a couple of options you have for streamlining the application process in order to obtain either prioritized or temporary approval of emergency Medi-Cal benefits.
What is Emergency Medi-Cal?
The purpose of Emergency Medi-Cal is to provide medical care for people who are in need of sudden treatment in emergency situations. Emergency Medi-Cal is only available for serious and sudden medical emergencies. No pre-payment will be required, however, the treatment will not be covered by Medi-Cal if a medical review team determines that there was no actual emergency. So, how do you expedite the application for emergency Medi-Cal benefits?
Option No. 1 – Go to the emergency room
If you are experiencing a true medical emergency, where your only choice is to go straight to the nearest hospital, then go. The hospital will provide you with the health care you need. Then, the hospital’s billing department will assist you in applying for emergency Medi-Cal benefits.
Option No. 2 – Submit the application in person
If the situation is not life-threatening and you need to be rushed to the hospital, then you have the option of submitting your application to your local office of the State of California Department of Health Care Services. For Los Angeles residents, that would be the Los Angeles County office. First, go the website and access the application online. Fill out the application online with as much information as you can. At the least, be sure to include the following information:
- your name and mailing address,
- information about adults and children in your household,
- income and asset information,
- monthly expense information,
- other coverage information,
- citizenship information,
- military service,
- school attendance,
- information release option and signatures.
If you have any difficulty completing any other portions of the application, leave those areas blank and a case manager can assist you, when you visit the local office in person.
By taking your application to the local Health Care Services office in person, you allow your case manager to make an assessment of your situation immediately and hopefully make a decision more quickly. It is important to explain your medical situation and why you need emergency approval.
Medi-Cal eligibility for Los Angeles residents
The most important part of the Medi-Cal application process is the determination of eligibility. There are several different ways to qualify for Medi-Cal benefits, which are often referred to as eligibility categories. For example, SSI-Linked Medi-Cal is an eligibility category which allows individuals who qualify for SSI to automatically qualify for Medi-Cal.
Common eligibility categories for individuals with disabilities
If your family has income at or below 138% of the Federal Poverty Level, you may be eligible for Income-Based Medi-Cal. If you are aged or disabled, you may be eligible for Aged & Disabled Federal Poverty Level Medi-Cal. If you are disabled but still working, you may be eligible for California’s Working Disabled Program.
If you are elderly, blind, or disabled, but your income is too high for other Medi-Cal programs, you may be eligible for Aged, Blind, and Disabled – Medically Needy Medi-Cal. For this program, you may need to employ strategies to qualify for Medi-Cal, such as Medi-Cal Trusts, speaking to your Trusts and Estates Attorney, and using the “spend down” technique to spend down your assets in specific amounts before Medi-Cal begins to pay for medical services. This payment is called a share of cost.
How is Medi-Cal different from Medicare?
One primary difference between Medicare and Medi-Cal is that Medi-Cal is an income-based or needs-based health care assistance program. Federal, state and local tax funds are used to assist eligible individuals in paying their medical expenses. Typically, Medi-Cal recipients are only required to pay a small co-payment for covered medical expenses, if anything at all.
Why Medi-Cal planning is so important?
The purpose of the benefits Medi-Cal provides is to help qualified residents in California pay for their medical services. Because Medi-Cal is a needs-based program, there are qualifications guidelines that need to be followed. The goal of Medi-Cal planning is to prevent the need to spend all of your resources in order to become or remain eligible for benefits.