Medi-Cal Basics

Covered California™ and the California Department of Health Care Services (DHCS) have partnered to offer a one-stop-shop online enrollment channel for millions of consumers to receive low-cost or no-cost health insurance.

Covered California's new private health insurance marketplace offers affordable coverage for residents previously uninsured. Millions are eligible for financial assistance to help pay for coverage. This assistance includes subsidies and low-cost or no-cost Medi-Cal. DHCS oversees Medi-Cal, the state's Medicaid health care program, which covers a number of medical services for children and adults with limited income and resources.

Covered California's online marketplace is the single online channel where Californians can apply for both Medi-Cal and Covered California health insurance plans. It's a “no wrong door” approach that enables Californians to determine their eligibility for subsidized health benefits, compare insurance plan options and enroll for coverage. Covered California's new online marketplace launched Oct. 1, 2013, to allow individuals to begin enrollment in Covered California health insurance plans and Medi-Cal. Actual coverage in Covered California's health plans is effective beginning January 2014.

Expanded Coverage

Medi-Cal, as a health insurance program, has been covering Californians who couldn't afford health care since 1966. As of 2013, there were 8.5 million people enrolled. Under the Patient Protection and Affordable Care Act, Medi-Cal coverage will expand in 2014, making 1 million to 2 million new people eligible. In recent surveys, most current individuals enrolled in Medi-Cal reported having a positive experience with the program and agreed that Medi-Cal provides access to high-quality care.

Beginning Jan. 1, 2014, single adults without children, ages 19-64, will be eligible for Medi-Cal. Enrollment for Medi-Cal coverage for these individuals began on Oct. 1, 2013. Coverage for these new enrollees begins Jan. 1, 2014.

For all Medi-Cal applicants, there are new, simplified procedures for Medi-Cal eligibility that also begin Jan. 1, 2014. Eligibility is based upon income, as required by the Affordable Care Act. To verify income and other eligibility data, faster, more convenient electronic methods will be used whenever possible. Medi-Cal still accepts applications and enrolls individuals who qualify using the eligibility procedures that were in place before the Affordable Care Act expansion. Periodic redetermination of eligibility for those who are enrolled will also be much simpler and will be done electronically whenever possible.

What services will Medi-Cal provide for me?

Medi-Cal covers a core set of services, including doctor visits, hospital care and pregnancy-related services, as well as nursing home care for individuals age 21 or older. The Affordable Care Act ensures all Medi-Cal health plans offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include:

  • Ambulatory patient services.
  • Emergency services.
  • Hospitalization.
  • Maternity and newborn care.
  • Mental health and substance use disorder services, including behavioral health treatment.
  • Prescription drugs.
  • Rehabilitative and habilitative services and devices.
  • Laboratory services.
  • Preventive and wellness services and chronic disease management.
  • Pediatric services (including oral and vision care).

Starting in 2014, the array of mental health and substance use disorder services will expand to better meet the needs of individuals eligible for Medi-Cal. All Medi-Cal beneficiaries who qualify will be able to receive the following mental health benefits through Medi-Cal managed care plans and Medi-Cal fee-for-service:

  • Individual and group mental health evaluation and treatment (psychotherapy).
  • Psychological testing when clinically indicated to evaluate a mental health condition.
  • Outpatient services for the purposes of monitoring drug therapy.
  • Outpatient laboratory, drugs, supplies and supplements.
  • Psychiatric consultation.
  • Specialty mental health services currently provided by county mental health plans will continue to be available.
  • Substance use disorder services benefits.
  • Voluntary inpatient detoxification.
  • Intensive outpatient treatment services.
  • Residential treatment services.
  • Outpatient drug-free services.
  • Narcotic treatment services.

Dental care, vision services and speech therapy are generally available only to children and youths under age 21, but certain adults and pregnant women are also eligible for these services. Dental services will be available to all adults starting in May 2014.

These are all services that Medi-Cal covers today and will continue to cover for current and new enrollees.

Do I qualify for Medi-Cal?

The Medi-Cal expansion starting on Jan. 1, 2014, will open the door for a few million more low-income Californians under age 65 who are currently ineligible for coverage. To be eligible, your annual income must be 138 percent of the federal poverty level or less (in 2013 that would mean an individual who earned $15,856 or less).

The Medi-Cal expansion also allows coverage for parents who would lose coverage under current rules if their income slightly exceeds the federal poverty level.

Enrollment

Covered California is the new marketplace for affordable, low-cost and no-cost health insurance, including Medi-Cal. It's a “no wrong door” approach that helps Californians learn their eligibility for subsidized health benefits, compare insurance plan options and enroll to receive coverage. The online portal launched on Oct. 1, 2013, allowing individuals to pre-enroll in the Covered California health plans and Medi-Cal prior to Jan. 1, 2014. It's important to note that California has also maintained existing pathways in which individuals can enroll. All counties still process applications at local county social services departments as well as accept applications by mail. In addition, locally based enrollment assisters are available to help.

For more information on Medi-Cal, you may visit the DHCS website at www.dhcs.ca.gov.