Medi-Cal offers free to low-cost health coverage for children and adults who have limited income and access to resources. Essentially, it is the State of California’s Medicaid program. Medi-Cal covers payment for a range of medical services and is supported by both state and federal taxes. The Medi-Cal program provides a critical service to those in need, but it is a complicated system to understand. It can also be difficult unraveling the eligibility requirements for Medi-Cal. Here is some of the basic information you need to know about being eligible for Medi-Cal.
Eligibility for Medi-Cal
The Medi-Cal program is expansive and is comprised of separate programs that are intended to provide assistance to California residents that find themselves in a variety of medical situations. It provides coverage to:
- Low income adults
- Families with children
- Senior citizens
- People with disabilities
- Pregnant women
- Children in foster care
- Former foster youth up to the age of 26
There are specific requirements set forth for a person to be eligible for Medi-Cal benefits. For instance, to qualify for the Medi-Cal program, you must be a resident of California. You must also be a U.S. national, a citizen, or have a qualifying immigration status. Additionally, you must fall into one of the following categories:
- Be over 64 years of age;
- Be pregnant or have a child age 18 or under;
- Be disabled;
- Be blind;
- Have a child, parent, or spouse in your household who is either blind or disabled.
There is also the need-based requirement to consider in determining your eligibility for Medi-Cal. Medi-Cal provides medical coverage to those who need it and whose financial status would be classified as low income. In order to qualify for Medi-Cal benefits, your annual household income, prior to taxes, must fall below a certain amount. That amount will vary depending on the size of your household. For instance, if there is only one member of your household, you must make $16,612, or less, annually to qualify for Medi-Cal. If there are two members of your household, you must make $22,491, or less, annually to qualify for Medi-Cal.
How income is calculated for Medi-Cal eligibility can also be complicated. Most people’s income eligibility for the program will be calculated based on the Modified Adjusted Gross Income (MAGI) method. The MAGI methodology was established by the Affordable Care Act. It exempts certain resources, including certain personal property and money held in savings accounts, from becoming part of the income calculation for Medi-Cal eligibility purposes. If a Medi-Cal applicant’s eligibility is based on being blind, disabled, or being over 64 years of age, then the MAGI method of calculation will not be applicable.
Income that will be included in Medi-Cal eligibility calculations includes that which is earned from wages received from work. It will also include income generated from interest on financial accounts such as retirement accounts, savings accounts, and annuities. Certain types of income will not be counted towards Medi-Cal eligibility, such as unavailable income. If an applicant does not have access to the income, then it will not be counted towards Medi-Cal eligibility. Things like workers’ compensation and settlements from an insurance company will also not be included in Medi-Cal eligibility. Other sources of income that are exempt for Medi-Cal eligibility calculation purposes include public assistance and child support.
If you qualify for Medi-Cal, it will cover a variety of medical expenses including costs associated with primary medical care and related medical costs. This means Medi-Cal will provide coverage for medical expenses such as those associated with:
- Doctor visits
- Diagnostic testing and lab work
- Emergency services
- Prescription medication
- Health screenings for minors
- Occupational and physical therapy
- Nursing facility stays
- Outpatient drug abuse services
- Medical supplies
- Durable medical equipment
- Transportation for doctor visits
You should always verify whether a certain medical service is covered under your Medi-Cal plan as it may vary depending on things such as what type of Medi-Cal program you qualify for. Additionally, Medi-Cal may require prior authorization for certain procedures.
Medi-Cal Planning Attorneys
The critical service provided by Medi-Cal help Californians in need of assistance with medical coverage. You can take steps now to help ensure that you qualify for these benefits. Consult with a knowledgeable Medi-Cal planning attorney today.