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Health Coverage: Medi-Cal

Last modified: 5/23/2012 10:13 AM
General Overview
  
24-Hr Automated InfoLine: 
1-877-96-BENEFITS  or
1-877-962-3633
 
Program Categories
 
Medi-Cal is made up of almost 40 different programs, each with different eligibility requirements. To provide a general understanding of these different programs, they have been divided into health insurance categories for:

 
 
The eligibility information listed below will give you an idea of whether you may be eligible to receive Medi-Cal coverage. 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 Eligibility Worker will explain in further detail what requirements specifically apply to your situation.
 
General Eligibility Requirements
 
Income
 
The income limits vary according to family size and program category. Income is used to determine if a person/family is eligible for free Medi-Cal or Medi-Cal with a share of cost. Income over the limit becomes the monthly share of cost. A share of cost is similar to a monthly deductible. It is the amount of medical expenses that a Medi-Cal beneficiary must pay or be obligated to pay before Medi-Cal will cover any medical expenses. However, if Medi-Cal is not used in a given month, no share of cost will need to be paid in that month.
 
Note: Individuals who have income over the monthly amounts in the Income Limit Chart below may still apply for and be eligible to receive Medi-Cal benefits.
 
Medi-Cal Program Income Limit Chart
(Effective 12/1/89)
 
Number of Persons Limit
 1 person
$ 600  
 1 adult & 1 child
750  
 2 adults
934  
 3 persons
934  
 4 persons
1,100  
 5 persons
1,259  
 6 persons
1,417  
 7 persons
1,550  
 8 persons
1,692  
 9 persons
1,825  
10 persons
 1,959  
For each additional person add:
14  
One person in Long-Term Care (LTC):
35  

 

Depending upon the Medi-Cal program category, there are certain deductions allowed to reduce the net countable income. There is also specific unearned income that is not countable, such as CalWORKs payments.
 

Property

Property is defined as follows: Real property includes land, houses, and other buildings. Personal property includes bank accounts (checking or savings), stocks, bonds, cash on hand, and so on.
Property limits vary according to family size and program category. Property limits for most Medi-Cal programs are as follows:
 
  
Medi-Cal Program Property Limit Chart

Number of Persons Limit
 1 person
$ 2,000  
 2 persons
3,000  
 3 persons
3,150  
For more than 3 persons, add $150 for each additional person up to a maximum of $4,200 for 10 or more persons.

 

  • Exempt Property. A home and one vehicle, regardless of value, are not counted toward the property limit. EXCEPTION: Under the Medi-Cal Section 1931(b) Program, vehicles are treated differently. Your Eligibility Worker will explain more about that.
  • Other Real Property. The current property limit for land or houses not used as the applicant’s home is $6,000 net equity, provided the land or houses are utilized. It is considered utilized if it is producing a net yearly income of at least 6% of its net market value.
  • Property Waiver. The property limit is waived for pregnant women and children under 19 years of age whose income is below the Federal Poverty Level (FPL) or a percentage of the Federal Poverty Level.


Residency

Persons applying for Medi-Cal health coverage must be considered California residents.

 
Citizenship/Immigration Status and Scope of Benefits

 

  • The full scope of Medi-Cal benefits may be provided to U.S. citizens, nationals born in certain U. S. territories, and legal permanent residents who meet all eligibility requirements. 
  • If all other eligibility requirements are met, noncitizens without satisfactory immigration status (undocumented) are eligible for Medi-Cal benefits restricted to emergency care and pregnancy-related services.