Medi-Cal: California’s Medicaid Program

December 21, 2011
By

In California, Medicaid is termed “Medi-Cal.” It is governed by federal and state governance as well as the governance of 58 counties, and is a patchwork of various programs and services subject to complex federal, state and county criteria eligibility. The applicant must supply proof of California residency. A social security number or pending application is required. Those eligible for the program include low-income families enrolled in CalWORKS or Aid to Families with Dependent Children, seniors and those disabled who participate in the Supplemental Security Income program, persons meeting refugee assistance criteria, children and pregnant women whose family income falls below a stipulated level, children in foster care or receiving adoption assistance, some low-income Medicare beneficiaries, and those living in a skilled nursing or intermediate care home. One need not be a U.S. citizen in order to receive certain Medi-Cal benefits. For example, some aliens may be eligible for full or restricted benefits depending upon their citizenship status and provided that they are not “illegal aliens.”
Financial need alone does not make one eligible for Medi-Cal. The individual’s medical need and other economic resources are considered. But only those who are functionally impoverished will be considered. The general rule is that Medi-Cal applicants must not have financial resources over the limits for family size.

The 2011 poverty guidelines are located at http://aspe.hhs.gov/poverty/11poverty.shtml.

A buy-in program is available through Medi-Cal that allows those eligible to have higher incomes and still maintain their coverage. Some persons will automatically qualify for their Medicare Part B premiums to be paid this way. Those enrolled in programs such as Supplemental Security Income, Temporary Assistance to Needy Families, Refugee Assistance and Cash Assistance Program for Immigrants also may qualify for Medi-Cal buy-in benefits.

In California each county has a significant role administering Medi-Cal. Procedures are not uniform between the 58 counties, and each county is authorized to determine eligibility according to its own interpretation of state guidance. Thus, some counties have criteria and procedure manuals of their own, as well as forms and administrative systems.

Benefits include medical services, drug and alcohol detoxification, long-term care, mental health benefits, medications, podiatry services, pharmacy and vision care services, durable medical equipment, acupuncture, chiropractic services, audiology, medical transportation, prosthetics, physical therapy, speech therapy, in-home operations, nursing facility/acute hospital services, and some dental services.

There are multiple avenues to enrollment: automatic, via mail-in application, face-to-face, presumptive eligibility and a few others.

 

Save

Tags: , , , ,

3 Responses to Medi-Cal: California’s Medicaid Program

  1. Kevin Knauss on December 21, 2011 at 7:37 pm

    One of the issues I am dealing with is when someone’s resources or income make them ineligible for Medi-Cal, are they eligible for a guarantee issue HIPAA plan? No one seems to know. I guess I will find out as the client goes through the process.

  2. Claudia on December 21, 2011 at 7:58 pm

    Kevin, I have the same problem. Cal-Cobra expires at the end of this month. My Kaiser individual policy will cost nearly $1,000 per month. Unaffordable.

  3. Kevin Knauss on February 20, 2012 at 10:19 pm

    Follow up, Transitioning off of MediCal because of increased resources does not make you eligible for a guarantee issue HIPAA plan. If you are uninsurable you must go with the higher MRMIP plan from California.

Leave a Reply

Your email address will not be published. Required fields are marked *