Medi-Cal Programs: Mixed-Program Families

Families may find that some household members qualify for Medi-Cal while other family members qualify for Covered California, possibly with premium assistance and cost-sharing reductions. These two-program families are called “mixed-program families.” Your family can apply for both through Covered California application. 

Individuals in a mixed-program family will face different, but typically lower, costs due to their eligibility for both Covered California and Medi-Cal. Covered California health plans require payment of premiums and other costs such as copays and coinsurance, while Medi-Cal can provide health coverage at low- to no-cost. 

A family with some members enrolled in a Covered California health plan and other members enrolled in a Medi-Cal plan may be able to see the same doctors, depending on the health plans available in your family’s ZIP code. If you can select the same health insurance company and the same health plan for those who have Medi-Cal and Covered California, it will be more likely that all family members can see the same doctor(s). However, the best way to ensure your family can see some of the same doctors would be to call the health plans you are considering to check on the network prior to selecting it. 

After you apply for coverage, the family members who are conditionally eligible for Covered California may select their health plan online. The family members who are conditionally eligible for Medi-Cal will be contacted by their local county human services agency within 45 days of submitting the application. 

If a family does not want to be enrolled in multiple programs, a family can decline MediCal coverage and purchase coverage through Covered California. However, those family members who are eligible for Medi-Cal and decline it, cannot qualify for premium assistance or cost-sharing subsidies through Covered California, no matter what their yearly household income is. Financial help is not available for individuals who are Medi-Cal eligible but decline Medi-Cal coverage.

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