MEDI-CAL

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Medi-Cal (also called Medicaid) is a program that provides health coverage to some low-income California residents. Medi-Cal covers families with children and pregnant women, medically needy individuals, the elderly, and people with disabilities, if state and federal guidelines are met. Legal residents who are not U.S. citizens may be eligible for Medi-Cal. Questions concerning immigration status and eligibility should be directed to the California Department of Health Care Services.

· For certain categories of people, eligibility for Medi-Cal is based on the amount of your household income.

In California you may be eligible for Medi-Cal if you are an infant, a child, a pregnant woman, or a parent of a dependent child and your family income meets the Medicaid income standards.

Income eligibility levels for these categories are described below. Your assets and some expenses also may be taken into account, so you should contact the California Department of Health Services for more information.

Low income persons eligible for Medi-Cal in California*

Category            Income eligibility (as percent of federal poverty level)

Infant                          200% (monthly income of $3,052 for family of 3)
Child 1-5                      133%
Child 6-19                    100%
Non-working Parents      100%
Working Parents            106%
Pregnant woman            200%
Medically Needy:     
(Single)                          83%
(Couple)                         97%
   

* Eligibility information was compiled from State Health Facts Online, the Henry J. Kaiser Family Foundation and may have changed since this guide was published. Contact your state Medicaid program for the most up to date information and for other eligibility requirements that may apply.

To get an idea of how your income compares to the federal poverty level,* use the federal poverty guideline issued by the U.S. Department of Health and Human Services for the year 2009:

Size of Family Unit       Poverty Guideline (annual income)
1                                 $10,830
2                                 $14,570
3                                 $18,310

For larger families add $3,740 for each additional person.

So, for example, using this guideline, 200% of the federal poverty level for a family of 3 would be an annual income of $36,620, or a monthly income of $3,052.

*Contact your state Medicaid program for the most up to date information and for other eligibility requirements that may apply.

· People enrolled in SSI/SSP, CalWORKS, Refugee Assistance, Foster Care or Adoption Assistance Program or In-Home Support Services (IHSS) can get Medi-Cal.

· Parents should know that when you get a job and your CALWORKS (also called TANF) benefits end, you generally can stay on Medi-Cal for a 24-month up to one year for kids) transitional period.

In addition, your children may qualify for Medi-Cal if your family’s income meets certain income standards.

· Very poor elderly or disabled people who get Supplemental Security Income (SSI) benefits can also qualify for Medi-Cal.

Disabled individuals should know that if your income earned from a job increases so that you no longer qualify for SSI, you may be able to continue your Medi-Cal coverage at least for a limited time.

· People who have high medical expenses may also qualify for Medi-Cal. You may qualify as medically needy if you have high medical expenses that, when subtracted from your income, would make you eligible for Medi-Cal coverage. For example, people who have to pay a lot for prescription drugs, nursing home care, or other long term care services sometimes qualify as medically needy if they do not have health insurance that covers these services.

· Retired or disabled people who have low incomes and are enrolled in Medicare may also qualify for help from Medi-Cal. Even though your income may be too high to qualify for Medi-Cal insurance coverage, there may be other ways Medi-Cal can help.


If your household income is at or below 100% of the Federal Poverty Level, Medi-Cal will pay your Medicare monthly premium and your Medicare deductibles and coinsurance. This is called the Qualified Medicare Beneficiary (QMB) program.


If your household income is below 120% of the poverty level, Medi-Cal will pay for your monthly Medicare premiums only. This is called the Specified Low-Income Medicare Beneficiary (SLMB) program.


· There may be other ways that Medi-Cal can help. To find out if you or other members of your family qualify for Medi-Cal, contact the California Department of Health Care Services at 1-800-541-555 (in-state) or 916-445-4171 (out-of-state) or visit them online at http://www.dhcs.ca.gov/Pages/default.aspx.


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