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Health Coverage (Medi-Cal)

Santa Clara County Social Services Agency wants to keep you safe & healthy.
Agencia de Servicios Sociales del Condado de Santa Clara quiere mantenerlo seguro y saludable.
Sở Xã Hội của Hạt Santa Clara muốn quý vị được an toàn va khỏe mạnh.

Lobbies are temporarily closed.
Recepciones temporalmente cerradas.
Sảnh chính tạm thời đóng cửa.

Medi-Cal is California's version of the federal Medicaid health coverage program. This is a public health care program for California residents with low income and resources.

Medi-Cal is a large program that provides a range of free or low-cost health services aimed to assist Californians with medical needs.

Are You Eligible?

Medi-Cal eligibility is based mainly on your income, and in some cases, your property.

Medi-Cal has no sign-up period, you can apply at any time.

You can use the online tool See if I'm Eligible before completing an actual application to estimate your Medi-Cal eligibility.

Once you apply a County Eligibility Worker will decide if you qualify.

Application Process

Application Process

Using Benefits

Using Your Benefits

Renewing Coverage

Keeping Your Coverage

Application Process

  1. Complete & Submit Application
  2. Paper Documents may be needed if income, citizenship or other information cannot be verified electronically or is questionable. For a list of paper documents that could be needed view Commonly Used Verification Documents.
  3. Within 45 Days of the day you apply, you will get a Notice of Action (NOA) in the mail. This will let you know if your Medi-Cal application was approved or denied.
  4. If approved:
    • You will get a Benefits Identification Card (BIC) in the mail. For the first 45 days you will be covered under Fee-For-Service Medi-Cal (also called, Regular Medi-Cal).
    • Within 45 days of getting your BIC, you will be mailed information about your Health Plan options.
    • Once you receive your Health Plan options, you have 30 days to select a plan. If you do not select a plan, a plan will be assigned to you.

      For a full list of medical plans, go to the Medi-Cal Managed Care Medical Plan Directory.
      For a full list of dental plans, go to the Medi-Cal Managed Care Dental Plan Directory.

Using Your Benefits

Medi-Cal offers a core set of health benefits; these services include the following:

  • Outpatient (Ambulatory) Services
  • Emergency Services
  • Hospitalization
  • Maternity and Newborn Care
  • Mental Health and Substance Use Disorder Services, including Behavioral Health Treatment
  • Prescription Drugs
  • Programs such as Physical and Occupational Therapy (known as Rehabilitative & Habilitative Services) and Devices
  • Laboratory Services
  • Preventative and Wellness Services & Chronic Disease Management
  • Children's (Pediatric) Services, including Oral and Vision Care
  • Transportation Services
  • Other:
    • Dental – Visit Medi-Cal Dental for more information
    • Vision
    • Non-Emergency Medical Transportation Services
    • Long Term Services and Supports

Look at the Medi-Cal Health Benefits to learn more about these services. For the meaning of the terms used visit Healthcare.gov Glossary.

Keeping Your Coverage

To keep your health care benefits you must renew your coverage each year.

  1. Your coverage may be renewed automatically if all your information can be verified electronically. If this occurs, you will receive a Notice of Action (NOA) to confirm the renewal.
  2. If the County cannot electronically verify all your information, you will receive a Renewal form in the mail. Please review, complete and return along with requested documents.
  3. When the completed Renewal Form is received, the County will send you an NOA. This will tell you if you are still eligible for the Medi-Cal program. If you do not return the Renewal Form on time, you will lose your coverage.
  4. You will have 90 days to contact the county if your medical coverage has been lost due to not returning the requested information. You will have to provide further information in order to restore benefits.

Protect yourself against scams, always keep your EBT and PIN safe and secret. If you receive a text, email or phone call asking for your EBT or PIN, DO NOT provide your information, this is a SCAM!

If you lose your card or are a victim of a scam call 1-877-328-9677.

 

Account Maintenance

Please keep your phone number and email addresses updated. You can update your contact information through MyBenefitsCalWIN or call your County Eligibility Worker.


Medi-Cal Program
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Things to Know
  
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Did you know? Many of the people who qualify for Medi-Cal, can also qualify for CalFresh Food benefits. CalFresh Food helps supplement your food budget and buy healthy nutritious food.
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The State of California is providing full coverage Medi-Cal for all persons up to age 26 regardless of immigration status.

Click here for more information​.​

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How much does Medi-Cal cost?
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For many individuals who enroll in Medi-Cal, there is no premium, no co-payment, and no out of pocket cost.  Some households will see affordable costs, such as a low monthly premium.  For some Medi-Cal children, the monthly premiums are $13 per child up to a family maximum of $39 per month.  In general, individuals in Medi-Cal will get the same health benefits available through Covered California at a lower cost.​

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How can I find a health care provider?
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Santa Clara County has two managed care plans, Santa Clara Family Health Plan and Anthem Blue Cross.

All plan enrollment and disenrollment are handled by Medi-Cal Managed Care Health Care Options.

Online - https://www.healthcareoptions.dhcs.ca.gov/

Phone - 1-800-430-4263

In Person Monday – Friday 8am-12pm & 1pm-5pm

  • Benefit Assistance Center
    1867 Senter Rd. San Jose, 95112

    South County Social Services
    1879 Tomkins Ct. Gilroy, 95020

    North County Social Services
    1330 W. Middlefield Rd. Mt. View, 94043

Is it possible for the members of the same family to qualify for different coverage at the same time?
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The application is a single application for multiple health coverage programs. It is common that members of the same family or tax household are eligible for different programs.

For example, both parents could be eligible for tax credits through Covered California, while the children are eligible for Medi-Cal. This is because the eligibility rules for Medi-Cal kids are different than for adults, which ensures that no child lacks affordable coverage.​

What do I do if I have questions about medications, accessing doctors, or specialists?
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If you have questions about your coverage under Medi-Cal managed care, you can call your health plan’s customer service representatives directly, just as you would under any other health coverage plan.

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Is there a deadline to enroll in Medi-Cal?
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No, there is there is no deadline or open enrollment period for Medi-Cal. You can apply at any time during the year.​

If my Medi-Cal coverage is cancelled due to increased income or decreased household size, would I qualify for special enrollment info a Covered California plan?
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Yes, losing health coverage such as Medi-Cal is considered a qualifying event that would trigger a special enrollment period.

You will receive a notice informing you how to enroll in a Covered California plan. You may also contact your local county office to request assistance in enrolling in a Covered California plan. ​​

If I sign up for Medi-Cal, will anything happen to my assets?
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Medi-Cal only tries to recover its costs for medical assistance after your death when a recipient is over age 55, or when a member of any age is cared for at an institution, such as a nursing home. Medi-Cal does not seek payment during your lifetime or the lifetimes of your surviving spouse, disabled son or daughter, or while your child is under 21 years of age.

If you are under 55, you can sign up for Medi-Cal knowing that nothing will happen to your assets unless you are institutionalized.

For those over age 55 or in an institution, the Department of Health Care Services may present a claim for the cost of your care. It would be paid from your estate at the time of your death.

For more information, please visit California Department of Health Care Services Third Party Liability & Recover Division.

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I just found out I am pregnant. Can I apply for health insurance that will cover me during my pregnancy?
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Yes. Make sure to answer yes to the application question “Are you pregnant?” or tell the person helping you to fill out your application. You can apply for health insurance that can cover pre-natal care, labor and delivery, and postpartum care. Health insurance plans can no longer deny health insurance if you are pregnant.

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What do I do if I have a question or a complaint about my application or case?
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  • Contact the County Worker that is handling your case. You will find their contact information of the top right corner of the last County Notice of Action (NOA).
  • If you are not satisfied with the response from your County Worker, ask to speak to a Supervisor.
  • If you are not satisfied with the response from a Supervisor;
  • You may request a free confidential case review from our County Ombudsman Office by emailing Ombudsman@ssa.sccgov.org.

    OR

    You have a right to ask for Hearing. To request a Hearing, follow the instructions on the back side of the County NOA you received.

    Fill out the back of the NOA and send or take page to;
    Appeals Unit
    County of Santa Clara Social Services
    333 W Julian St.
    San Jose, CA 95110-2335

    OR

    Call 1-800-952-5253
    TDD for hearing or speech impaired 1-800-952-8349

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Last updated: 7/1/2020 3:41 PM