How to Apply For Medicaid in California
Key takeaways:
California’s Medicaid program, called Medi-Cal, provides health insurance coverage to low-income individuals and families.
Most participants qualify because of income. But there are other factors that can make a person eligible, such as disability and pregnancy.
If you meet the requirements, you can apply for Medi-Cal in person, by mail, by phone, or online.
California provides health insurance coverage for nearly 14 million people through its state Medicaid program, called Medi-Cal, and Children’s Health Insurance Program (CHIP).
Trying to figure out whether you qualify for Medicaid and how to apply can be confusing. Fortunately, you can get eligibility information and apply for Medi-Cal online, by mail, by phone, or in person. If you have any issues, you can call the program’s help line or visit your county's Department of Social Services.
What is Medicaid?
Medicaid is a public assistance program that provides health coverage to low-income families and individuals. More than 82 million Americans receive low-cost or free insurance coverage through this program as of June 2022.
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Medicaid recipients include:
People with disabilities
Low-income adults
Older adults
Children
In 2014, California added more than 4 million low-income adults to the program when the Affordable Care Act (ACA) allowed states to expand Medicaid. In 2022, Medi-Cal extended eligibility to more than 185,000 people ages 50 and older — regardless of immigration status.
How does California’s Medicaid program work?
Each state operates its Medicaid program according to federal requirements. But, because the federal guidelines are broad, eligibility requirements and benefits vary from state to state.
Medi-Cal benefits include coverage for:
Medical and dental appointments
Mental health services
Maternity and newborn care
Emergency services
Prescription medication
Family planning
Treatment for substance use disorder
Transportation services
Vision care
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Even if you have other health insurance coverage, you may qualify for Medi-Cal. In this case, the program would cover allowable costs not paid for by your primary insurance. Just be sure to report having private health insurance when you are applying for Medi-Cal or asked about it on the California Department of Health Care Services (DHCS) website or over the phone. You must also report this coverage to your local Department of Social Services and healthcare provider when prompted.
What is Covered California?
If you don’t qualify for Medi-Cal, you may be eligible for coverage through Covered California, the state’s health insurance marketplace. Like Medi-Cal, Covered California offers plans with essential health benefits. And you use the same application to apply.
If you qualify for both programs, Medi-Cal is the better option because you get the same benefits at a lower cost. In some households, referred to as “mixed-program families,” some family members qualify for Medi-Cal while others are only eligible for Covered California.
What’s the difference between Medi-Cal and Covered California?
Medi-Cal is a public program funded by federal and state taxes. Covered California allows you to buy health insurance at federally subsidized rates. If you have low or moderate income, you may receive monthly subsidies that lower your premium costs on plans purchased through Covered California.
You can apply for Medi-Cal at any time. But Covered California’s open enrollment is only in the fall (unless you’ve had a qualifying life event).
How do I apply for California’s Medicaid program?
The fastest way to submit your Medi-Cal application is online.
If you prefer to mail the document, you can do the following:
Go to the DHCS website.
Choose your language.
Print out the application
Fill out the document.
Send the form to the address on the website or your local Department of Social Services.
If you want to submit an application in person, you have a few options:
Visit your local Department of Social Services.
Ask for help at a nearby community center.
Check with a local school or public library
You can also call your local Department of Social Services and apply over the phone.
After you submit your information, officials must verify your application. Below are the steps in the notification process for Medi-Cal approval:
You receive a Notification of Likely Eligibility by mail.
Your local Department of Social Services may call or send a letter asking for paper verification if they can’t electronically verify your information.
You get a Final Notice of Action by mail letting you know if you qualify for Medi-Cal.
If you’re approved, your Medi-Cal Benefits Identification Card (BIC) arrives in the mail. You’ll need to show your BIC card when you receive healthcare and dental services.
From start to finish, the Medi-Cal application process takes about 45 days. But if you apply based on disability, it could take up to 90 days.
What does the Medi-Cal application process involve?
Along with your application, you must provide evidence confirming your Medi-Cal eligibility to be considered. Before filling out your application, gather documents showing proof of the following that apply:
Social Security number (SSN)
Citizenship or U.S. national status
Immigration status or lawful presence
Lack of minimum essential coverage (MEC)
American Indian and Alaska Native status
You can submit Medi-Cal documentation online, by fax, by mail, or in person.
Who is eligible for California’s Medicaid program?
Most people’s Medi-Cal eligibility is based on their modified adjusted gross income (MAGI). This method compares your household income and size to the federal poverty level (FPL).
Different categories of Medicaid recipients are given different household income caps. These groups include:
Adults
Children
Pregnant women
Medi-Cal Access Program participants
County Children’s Health Initiative Program (CCHIP) recipients, which only applies to San Francisco, San Mateo, and Santa Clara county residents
Covered California provides a link to the latest income eligibility information to help you determine if you meet Medi-Cal or Covered Cal requirements.
There are other ways to qualify for Medi-Cal. You may be eligible if you are:
Blind
Disabled
Under 21
65 or older
Pregnant
On refugee status for a limited time
Diagnosed with breast or cervical cancer
In an intermediate care or skilled nursing home facility
A parent or caretaker relative of an age-eligible child
You may also qualify for Medi-Cal if you participate in one of these programs:
California Work Opportunity and Responsibility to Kids (CalWORKs)
Foster care or the Adoption Assistance Program (AAP)
Supplemental Security Income/State Supplementary Payment (SSI/SSP)
How much does Medi-Cal cost?
Many Medi-Cal recipients have no premiums, copays, or out-of-pocket costs.
But some recipients must pay, or agree to pay, a share of cost (SOC) based on income. This is a monthly dollar amount that you must pay toward your healthcare expenses before Medi-Cal benefits kick in. The SOC is similar to a deductible on a high-deductible health plan.
Are you eligible for CHIP or WIC?
California’s CHIP program, also known as California Healthy Families (SCHIP), provides low-cost comprehensive health coverage for children and, in some cases, pregnant women. Participants in this program belong to households that earn too much income to qualify for Medi-Cal.You can visit beneifts.gov to check your eligibility.
Another resource for women and children in California is the state’s WIC program — short for the Special Supplemental Nutrition Program for Women, Infants, and Children — which provides free supplemental foods, nutrition education, and healthcare referrals. You must have a low income and be at nutritional risk to qualify. You can visit benefits.gov to check your eligibility for California’s WIC program.
Do I need to renew Medi-Cal coverage?
You must renew your Medi-Cal coverage at least once a year to continue using your benefits. This is typically done automatically. But your local Department of Social Services may send you a renewal form if they’re missing information.
You have 90 days to submit a renewal form if you receive one. As long as you still qualify for Medi-Cal, you’ll keep coverage with no gaps.
Who do I contact with questions about California’s Medicaid program?
You may have questions as you move through the Medi-Cal application process. Here are some ways to get answers:
Review the frequently asked questions section of the program’s website.
Call or visit your county Department of Social Services.
Call Medi-Cal’s help line at 800-541-5555 or 916-636-1980.
If you are hearing impaired, send a TTY message to 866-784-2595.
You can also reach out by mail, email, or in person at the addresses listed on the DHCS website.
The bottom line
To receive Medi-Cal benefits, you must meet the program’s requirements and submit an application with proper documentation. If you’re approved, you should get benefits within 45 to 90 days. If you’re not approved, you may still qualify for low-cost health insurance through Covered California.
If you have children, you could also be eligible for assistance through California’s Children’s Health Insurance Program (CHIP) program and/or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
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References
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