This article Advocates Guide to Medi-Cal Services has some important updates.
It can be challenging to figure out how different forms of health coverage work together.
The Medi-Cal program (part of the national Medicaid program) helps pay for various medical services for eligible people. Both county and state taxes fund it.
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What is Medi-Cal?
Medi-Cal is California’s version of the national Medicaid health care program. It pays for various medical services for low-income residents, including doctor visits, hospital stays, and prescriptions. Medi-Cal is funded by both county and state taxes, as well as federal money. The program is designed to provide quality, affordable health coverage for all who meet the eligibility requirements.
Eligibility is determined based on income and other factors, such as pregnancy or immigration status. Most adults aged 19-64 qualify for comprehensive Medi-Cal if their annual family income is below about (138% of the FPL) and they satisfy other requirements. Pregnant women may qualify for special “Medi-Cal for pregnant women” coverage if their family income is below about (323% of the FPL).
In some cases, a person may have both employer-sponsored insurance and Medi-Cal. Knowing which plan covers what costs and how the programs work together is essential if this is the case. This can help you avoid duplication of benefits and save on copayments.
Some have published several short papers about different aspects of the Medi-Cal program. The first, Medi-Cal Explained, offers an overview of the program’s people and services and how it is organized, managed, and financed. It also describes the challenges the program faces in the future.
Who is eligible for Medi-Cal?
Many low-income families, seniors, and individuals in California are eligible to receive Medi-Cal benefits. This includes children, adults, and parents with incomes below certain limits (depending on family size). It also includes foster adults who are under the age of 26 or former foster youth. Both state and federal funds finance a public health insurance program called Medi-Cal.
County human services departments administer Medi-Cal. While counties have flexibility in how the program is run, they must follow federal Medicaid guidelines.
The program has transitioned from a fee-for-service payment and delivery system to a managed care model. Under the old system, beneficiaries could see any provider that accepted the program. The state enters into agreements with health plans for managed care that provide health services for enrollees in exchange for a capitation payment for each person enrolled in their schedule. The projects are accountable for and at risk for delivering the services they contract to provide.
To be eligible for Medi-Cal, you must be a resident of the state of California. To prove this, you may need to submit documents like a driver’s license or ID card, proof of address (like a utility bill), a pay stub, school enrollment information for your children, or an affidavit from your doctor stating that you live in California and intend to remain here. If you don’t have these documents, you can still apply by submitting immigration documentation and an affidavit from your employer or the county social services office.
What are the benefits of Medi-Cal?
The program pays for a wide range of healthcare services for individuals with low incomes. This includes the primary benefits of health care and prescriptions and more specialized health services, like behavioral counseling and community support services for people with chronic illnesses or disabilities.
Most people in Medi-Cal are enrolled in a managed care plan, a health care delivery system financed equally by the state and county. Doctors, pharmacies, clinics, and laboratories are all included in the networks of providers for these plans. Medi-Cal beneficiaries are required to use providers within their network.
Many Medi-Cal beneficiaries can access transportation services to their doctor’s office, mental health or substance abuse treatment, and grocery stores. They also can receive help cleaning and grooming their homes or getting medical supplies and equipment.
The program’s eligibility rules are based on how much you earn and how much you have in assets. However, if your disability began before you turned 26, you can open an ABLE account and save money without counting against your Medi-Cal asset limit. The county office that oversees your Medi-Cal benefits will determine how much you need to contribute towards the cost of your coverage.
How do I apply for Medi-Cal?
If you live in California, you can apply for Medi-Cal at Covered California or your county social services office. You can also apply for other benefits simultaneously, such as the food stamp program and the federal Supplemental Security Income (SSI) program. You will need to provide several pieces of information when applying for Medi-Cal. This includes your Social Security number, income information, and immigration documents for anyone in your household who doesn’t have American citizenship.
If you get approved for Medi-Cal, you may have to pay a small amount of your own money towards your healthcare costs before the program begins covering your expenses. This is called your “share of cost.”
Medi-Cal is part of a nationwide Medicaid program each state runs according to federal rules. Each state’s program is funded with local, county, and state money. In addition to paying for the program, Medicaid also pays for other government programs like Medicare and Social Security. Depending on where you live, your Medi-Cal may be delivered through a managed care program operated by an insurance company or non-profit organization. Many of these plans have customer/member service offices you can call if you have any problems with your coverage. Your goal should also have a list of physicians in the network.
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