The Medi-Cal Program
The Medi-Cal program provides health care coverage for children under age 21 as long as other eligibility requirements are met. If a child is living with his/her parents, the parents income and other resources are considered in determining Medi-Cal eligibility. Children under 19 years of age who have been determined eligible for no-cost Medi-Cal benefits are guaranteed this coverage for up to 12 months. General Medi-Cal
eligibility requirements apply.
Children under 19 years of age who do not qualify for no-cost Medi-Cal coverage due to family income or property, may qualify under one of the Federal Poverty Level (FPL) programs. Under FPL programs, family income limits are higher than those for other Medi-Cal programs. There is NO property limit for the FPL programs.
*Note: A share of cost is similar to a monthly deductible. It is the amount a Medi-Cal client must pay for medical expenses or be obligated to pay before Medi-Cal will cover medical expenses.
The eligibility information listed below will give you an idea of which children may be eligible to receive Medi-Cal coverage under the FPL programs. However, eligibility for Medi-Cal can only be fully evaluated by an Eligibility Worker (EW) at one of the Social Services Agency Intake Offices
. If and when you decide to apply, your EW will explain in further detail what requirements specifically apply to your situation.
Basic Eligibility Requirements
Children being evaluated for the Federal Poverty Level (FPL) programs must meet the following requirements:
- A family’s income must be within the applicable FPL income limit according to the age of the children and family size. (See FPL Chart below).
- There is no property limit and no property verification is required.
- Children must be under 19 years of age.
- Custodial parents must cooperate with the Local Child Support Agency when there is an absent parent. If parents do not cooperate with Child Support Agency requirements, only the parents will be ineligible for Medi-Cal; however, the children remain eligible.
Federal Poverty Level (FPL) Programs
Income Limits Chart
|Number of Persons
||Children Ages 6-18
||Children Ages 1-5
||Infants to Age One
||Targeted Low Income Children’s Program Ages 1-19|
||100% of FPL
||133% of FPL
||200% of FPL
||Under 150% FPL
||150% to 250% FPL *(Subject to Premium)|
|For each additional person add:
*Infants under Age 1 are not subject to a premium. Premiums are $13 per child –Maximum $39 per family
Applying for Medi-Cal
If you would like to apply for Medi-Cal coverage for children under 19 years of age, you may:
- Apply in person by visiting one of the Social Services Agency Intake Offices and filling out a Medi-Cal application, or
- Call an Intake Office and ask for a mail-in Medi-Cal application.
- Apply online via the Benefits CalWIN website at http://www.mybenefitscalwin.org . Your worker will review your online application and contact you by phone or mail if additional information is needed.
Note: Once your completed application is received, an Eligibility Worker will decide which Medi-Cal program would best fit your situation.
Documents You Will Need to Bring When You Apply
Your Eligibility Worker (EW) will tell you exactly what documents you will need to provide as proof of identity, income, residence, and so on. The following list contains examples of some of the most common items you may need to provide so that your EW can see if you are eligible for Medi-Cal benefits.
Proof of Identity
- California Driver’s License or ID from the Department of Motor Vehicles (DMV)
Proof of Social Security Number
- Social Security Card
- Proof of application for Social Security Card
Proof of Immigration Status
- Permanent Resident Card/Green Card/Alien Registration Card
Proof of Income
- Pay stub
- Employer’s documents
- Other papers that provide proof of monthly income (e.g., Social Security Award Letter, Unemployment check stub, and/or Disability check stub)
- Housing bill/receipt
- Utility bill
Other Health Insurance Programs for Children
The following are other programs in Santa Clara County that provide health services to children: