Skip Ribbon Commands
Skip to main content

Affordable Care Act & Medi-Cal Q&A

If you applied for Covered California and your application shows that you are eligible for Medi-Cal, here’s some important information about the Medi-Cal program and the quality health care that is available.

1. What is Medi-Cal?

Medi-Cal offers free or low-cost health coverage for California residents who meet eligibility requirements. Most individuals who apply through Covered California and enroll in Medi-Cal will receive services through health plans, similar to the majority of the health coverage options available through Covered California. On January 1, 2014, California expanded Medi-Cal eligibility for some low-income adults. When you complete a Covered California application, your application will be automatically reviewed for Medi-Cal eligibility.

Learn more about Medi-Cal Eligibility.

2. Is there a deadline to enroll in Medi-Cal?

You can enroll in Medi-Cal during any month of the year. If you are eligible for Medi-Cal, you are eligible for the entire month in which you were found eligible. In some cases, you may be able to get Medi-Cal coverage right away. Contact your county human services agency for more information. However, you can only enroll in Covered California health plans during the open enrollment period. If your application also includes people who are found eligible for a Covered California health plan, see Question 4. 

3. Already applied, but still waiting for Medi-Cal to process your application?

If you have already applied, you do not need to apply again.  We are processing your application as quickly as possible.  Due to the large number of Medi-Cal applications received, processing is taking longer than expected.  Please read the letter we sent to those who are waiting for Medi-Cal to process their application.

If you need immediate assistance, go to your
county human services agency for in-person assistance with your application.


In
the event of an emergency in which medical care is needed, call 9-1-1 or go to your nearest hospital.  If approved for coverage, Medi-Cal will cover costs associated with services rendered while your application was pending.

Another way to get medical care is to go to a clinic called a Federally Qualified Health Center.  You can see a list of these health centers in your area on the Find A Health Center website.

 

Why is my application pending?

Your application may be pending for a number of reasons.  In many cases, applications are pending because we haven’t received all of the documents needed to verify your information.  If you have applied and your application is pending, please send the documents to your county human services agency.  If you applied on the CoveredCA.com website, you can also submit your information online through that website. 

You can get more information about this, and about the status of your application, from your county human services agency

If you are worried about a tax penalty, please know that you will not be penalized if your application was pending after March 31, 2014.

4. It looks like Covered California found me eligible for tax credits, but my children are listed for Medi-Cal instead. Why is this?

The Covered California application can tell you if you qualify for more than just one health coverage program. It is possible for different members of the same family or tax household to be eligible for different programs, including Medi-Cal. For example, in some cases, both parents could be able to get tax credits for coverage with a Covered California health plan, while their children would be able to get Medi-Cal coverage. This is because the rules for children to qualify for Medi-Cal are different than for adults. This helps makes sure that no child goes without affordable coverage.

In other types of cases, a family’s application could show that one parent who has affordable coverage through their job can get a Covered California plan with no tax credits, while the other parent can get the tax credits with a Covered California plan, and the children can get Medi-Cal.
If you are trying to enroll some household members in Medi-Cal and others in Covered California, remember that Covered California only accepts enrollments during its open enrollment period unless you have a “qualifying event,” such as losing your health coverage because of a change in marital status.

5. Will I be able to get good quality health care through Medi-Cal?

Yes. Medi-Cal is health coverage, just like the coverage from Covered California. Medi-Cal gives you benefits similar to those of Covered California, but often at lower or no cost to you and your family. All of the health plans offered by Covered California and Medi-Cal include the same full set of benefits, which are called "essential health benefits.”
A recent survey of Medi-Cal members by the California Healthcare Foundation found that 90% of the members who answered rated Medi-Cal as a good or very good program. Medi-Cal emphasizes prevention-oriented health care that promotes health and well-being and works to ensure that members receive the right care at the right time.

6. What health plans are available through Medi-Cal? Are they government plans?

Medi-Cal offers 22 health plans, some of which are also offered by Covered California. Your choices depend on the county in which you live. Most counties offer commercial plans, including Anthem Blue Cross, Kaiser, Health Net, and Molina, as well as local not for profit health plans like L.A. Care. In some counties, one public plan is available and all Medi-Cal members are enrolled in that plan. An example is Cal Optima health plan in Orange County. Every county’s Medi-Cal plans provide the same high quality care to Californians at low or no cost, no matter where you live. The directory of Medi-Cal health plans will give you more information about your specific county.

7. How do I choose a Medi-Cal health plan?

In 22 California counties, one public health plan is available and all Medi-Cal members are automatically enrolled in that plan (the County Organized Health System (COHS) model). For the other 36 counties, you will receive a packet of information that will explain your Medi-Cal health plan choices and provide you with a form to make a choice.

Due to high volume of applications being processed, we are experiencing a delay when sending choice packets. You will be sent a health plan choice packet in the mail shortly.  It will help you pick a health plan of your choice and view different providers that accept Medi-Cal near you.  In the meantime, since you received your Benefits Identification Card (BIC), you can still receive services while you wait for your health plan choice packet.

You can contact Health Care Options toll-free at 1-800-430-4263 Monday through Friday, 8 a.m. to 5 p.m. for help. The directory of Medi-Cal health plans will give you more information about your specific county.

8. How much does Medi-Cal cost?

For many individuals who enroll in Medi-Cal, there are no premiums, no co-payments, and no out of pocket cost. Some households will see affordable costs, such as a low monthly premium. For some Medi-Cal kids, the premium is only $13 per child. In general, individuals in Medi-Cal will get the same health benefits available through Covered California at a lower cost.

9. Can I stay with my doctor? I hear that many doctors don’t accept Medi-Cal?

More than 400 hospitals and about 130,000 doctors, pharmacists, dentists, and other health care providers are in the Medi-Cal program. All of those hospitals and most of those providers are also in Covered California. Many Medi-Cal members say that it is easy to find a primary care doctor nearby. You can search for a Medi-Cal provider on the DHCS Health Care Options website.

10. I have questions about medications, accessing doctors, or specialists. Who do I call?

If you have questions about your coverage under a Medi-Cal health plan, you can call your health plan’s customer service line, just as you would under any other health  plan. The directory of Medi-Cal health plans has more information.

11. My children are eligible for Medi-Cal, but I am eligible for Covered California. How do we both get enrolled?

If you are a household in which some members qualify for Medi-Cal and others qualify for Covered California, you only need to complete one application. Enter all of your family members on the application. When your eligibility is determined, your notice will show which family members qualify for which programs. If some in your household are qualify for Covered California, you must pick a health plan for those individuals before your enrollment can be completed. For enrollment in Medi-Cal, you may be asked to contact your county human services agency to finish enrollment and select a health plan. You can apply for Medi-Cal, and find out more information, at your county human services agency.

12. My children are eligible for Medi-Cal, but I am eligible for Covered California. Can we see the same doctors?

While different members of your household may be enrolled in different coverage, you may still be able to see the same primary care physician and other providers. Check to see if your providers are listed in both the Covered California and Medi-Cal health plan  provider directories, or contact your plans directly.

13. Can I decline Medi-Cal and enroll in a Covered California health plan and receive the federal premium assistance?

 If you are enrolled in or are eligible for Medi-Cal, you cannot receive financial assistance for other coverage through Covered California. You can still purchase a health coverage plan through Covered California, but you will have to pay the full cost of the Covered California health care plan’s premium. 

14. If someone's Medi-Cal coverage is cancelled due to increased income or decreased household size, does that person qualify for special enrollment into Covered California?

Yes, losing health coverage such as Medi-Cal is considered a qualifying event that would trigger a special enrollment period.  Other qualifying events include:

  • Permanently moved to/within California
  • Lost or will soon lose their health insurance, including Medi-Cal eligibility (also known as loss of Minimal Essential Coverage (MEC)
  • Had a baby or adopted a child
  • Got married or entered into a domestic partnership
  • Domestic violence survivors  (If married, abuser’s income not counted if survivor lives apart and is unable to file joint tax return.)
  • Returned from active duty military service
  • Released from jail or prison
  • Gained citizenship/lawful presence
  • Federally Recognized American Indian/ Alaska Native
  • Other qualifying events as identified on the Covered California portal 

 

In the event that one of these life events does occur, you would be eligible to enroll within 60 days of that event.  During that period you could not be denied coverage by a health plan in Covered California or in the individual market if you are otherwise eligible, and you could be eligible for the premium assistance that is only available through Covered California.

15. My Medi-Cal has been discontinued and I am now able to enroll in Covered California during a Special Enrollment Period (SEP), how can I avoid a gap in my health coverage?

It is important to know that if your Medi-Cal will be or has been discontinued, and you are now able to enroll in Covered California, in order to avoid a gap in your health coverage, you should pick a Qualified Health Plan (QHP) and pay your first premium prior to the effective date of your Medi-Cal discontinuance.  If you do not select a QHP and pay your first premium in the same month as your Medi-Cal discontinuance, it will result in a gap in coverage.  If your request for enrollment is completed within 60 days of the qualifying life event date, the soonest your Covered California health plan can start will be the 1st of the month following your QHP selection and premium payment.  Any QHP selections not completed within 60 days of the qualifying life event date will result in a gap in health coverage and cannot be completed until Covered California’s next Open Enrollment Period. You may contact Covered California online at CoveredCA.com or call 800-300-1506 or contact your County Eligibility Worker for assistance in selecting your QHP.  You may reach your County Eligibility Worker at the county social services agency via  http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx.

16. I previously applied for Medi-Cal, but was denied because of my “property” (such as owning a car to drive to work). Can I qualify?

You may now be eligible for Medi-Cal. The Affordable Care Act made the financial requirements for Medi-Cal simpler. Now, “property,” such as a car, is no longer counted. You should apply through Covered California for health coverage even if you did not qualify for Medi-Cal coverage before, and even if you think your financial situation has not changed.

17. If I sign up for Medi-Cal, will anything happen to my assets after I die?

For most people who are covered by Medi-Cal, nothing will happen to their assets after death – Medi-Cal will never seek to file a claim against their estates. This group includes all children, as well as adults under 55, who qualify under the new rules of the Affordable Care Act. For those who are 55 or older, Medi-Cal may, in some cases, seek to recover the cost of health expenses from their estates after death. For details, visit the Estate Recovery page

18. I submitted my application and have not received any more information.

Due to the large number of Medi-Cal applications received through the Covered California website, it is taking longer than expected to verify all of the applications.  You do not need to submit another application to receive coverage.  We are currently working on processing all applications we have received as quickly as possible. You will not be penalized if your application is still pending on March 31.

If you would like more information about your application and whether you are eligible, contact your county human services agency.

19. I applied though Covered California and was told I would be contacted by a Medi-Cal county representative. I have not heard anything.

Due to the large number of Medi-Cal applications received through the Covered California website, it is taking longer than expected to verify all of the applications. Once an application is found likely eligible for Medi-Cal, it is sent to the applicant’s county of residence for processing.  You do not need to submit another application to the county if you already submitted one using Covered California. 

If you would like more information about your application and whether you are eligible, contact your county human services agency.

20. I received my blue and white BIC card in the mail, but there was no additional information with it. Does this mean I have Medi-Cal? And how do I enroll in a health plan?

Since you have received your Medi-Cal Benefits Identification Card (BIC), your coverage began the first day of the month your application was received by the State.  You can now get health care services from an enrolled Medi-Cal health care provider. Please remember that only providers who are enrolled as Medi-Cal health care providers will be paid by Medi-Cal for treating you.  Others who are not Medi-Cal providers may ask you to pay for their services.  The best way to make sure that you won’t have to pay is to ask the provider if they accept  "Straight Medi-Cal" or “Medi-Cal fee-for-service” before your appointment.

Here are some ways you can find a Medi-Cal provider in the meantime:

Public hospitals
Some counties have a public hospital system that lets you get care at a hospital.  You can find out which counties and which hospitals are in this program at the California Public Hospitals and Clinics website
Community Health Centers/Clinics
Another way to get medical care is to go to a clinic called a Federally Qualified Health Center. You can see a list of these health centers in your area on the Find A Health Center website.

Find a doctor on a managed care health plan website
When your Medi-Cal application is finalized, you will be able to join a managed care health plan.  Until then, you can find a doctor on the websites of those Medi-Cal managed care health plans.  Click the name of your county to find the plans that serve your area from the directory of Medi-Cal health plans.  When you find a doctor, call and make sure that they accept Medi-Cal fee-for-service.  If they do not, you should contact another doctor on the list.

Health Care Options website 
This DHCS-run website has information to help you make choices about Medi-Cal benefits and how you can access them. Visit the Health Care Options website for help finding a doctor or dentist and for more information about Medi-Cal managed care health and dental plans.

County Human Services Offices
Your county human services agency may be able to help you find a doctor in your area.  For more infomation, please contact your local county services office.
Dental Providers
To find a dental provider, go to www.denti-cal.ca.gov  and click the “Find a Dentist” link, or call 1-800-322-6384.

Emergency Rooms
As stated above, if you have an emergency and you cannot find a doctor right away, you can go to the emergency room at any hospital.  If you show your BIC to staff at the emergency room, Medi-Cal will pay for your services.

Pharmacy Benefits
If you need a prescription filled, you can contact your local pharmacy to see if it accepts Medi-Cal. Learn more at frequently asked questions about Medi-Cal pharmacy benefits

Yellow Pages
The Yellow Pages contain lists of local health care providers.  Only health care providers who are enrolled as Medi-Cal providers will be paid by Medi-Cal for treating you.  Ask the provider if they accept Medi-Cal fee-for-service before you make your appointment.

For now, you have what is called temporary Medi-Cal eligibility. You will have this until your county verifies that you are eligible for Medi-Cal. When that happens, you will receive information that will help you choose a Medi-Cal managed care plan in your county.

If you have specific questions about Medi-Cal managed care, please contact the Office of the Ombudsman by phone at 1-888-452-8609 or by email at MMCDOmbudsmanOffice@dhcs.ca.gov .

21. I received my BIC and would like to enroll into a health plan.  How do I select the plan I want?

You will be sent a health plan choice packet in the mail. It will help you pick a health plan of your choice and view different providers that accept Medi-Cal near you.  In the meantime, since you received your Benefits Identification Card (BIC), you can still receive services while you wait for your health plan choice packet.

You can learn more about your health plan options on the Health Care Options website.  Please click on the name of your county for a list of health plans you can choose from in Medi-Cal managed care. 

Here are some ways you can access the care you need while your application for Medi-Cal is finalized

22. I received a letter saying I can opt in to Medi-Cal though the Express Lane enrollment program. What does that mean?

Since you currently receive CalFresh benefits, you also qualify for Medi-Cal coverage. You do not need to submit an application or income and residency verifications due to your CalFresh enrollment. To obtain Medi-Cal coverage, please follow the instruction on the notification you received in the mail. We just need your permission to give you Medi-Cal coverage.

You can also go to your county human services agency to enroll into the Express Lane program.

23. In the past I received my annual renewal packet by now but nothing has arrived. Is there a new process this year?

Annual redetermination packets have been slightly delayed this year. Your coverage will not be disrupted due to you receiving your annual redetermination packet late. You will notice the process this year has changed. You will be sent your renewal form to obtain the required information to make your eligibility determination in the near future. Once you receive the form, you can return it to your local county welfare department in person, via mail, over the phone, or by fax.  For additional questions, please contact your local county services office.
Last modified on: 4/6/2016 8:40 AM