MEDI-CAL EXPANSION: COVERING MORE CALIFORNIANS
Medi-Cal, as a health insurance program, has been covering Californians who couldn’t afford health care since 1966. DHCS programs serve more than 11 million Californians. Nearly 1 out of 3 Californians in the state receive health care services financed or organized by DHCS, making the department the largest health care purchaser in California. Under the Affordable Care Act (ACA), Medi-Cal coverage expanded in 2014. DHCS invests more than $91 billion in public funds to provide health care services for low-income families, children, pregnant women, seniors, and persons with disabilities, while helping to maintain the health care delivery safety net.
Adults without children, ages 19-64, are eligible for Medi-Cal. Enrollment for Medi-Cal coverage is open all year.
For all Medi-Cal applicants, there are new, simplified procedures for Medi-Cal eligibility. Eligibility is based upon income, as required by the ACA. To verify income and other eligibility data, we will rely on faster, more convenient electronic methods whenever possible. Medi-Cal will still accept applications and enroll individuals who qualify using today’s eligibility procedures. Periodic redetermination of eligibility for those who are enrolled will also be much simpler and will be done electronically whenever possible.
Once enrolled you will need to renew your coverage annually. You can find more information about Medi-Cal renewal here.
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 through either a fee-for-service or managed care delivery system. For a majority of enrollees, Medi-Cal provides covered services through
managed health plans in all 58 counties. The ACA ensures all Medi-Cal health plans offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include:
• Outpatient (Ambulatory) services
• Emergency services
• 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 & chronic disease management
• Pediatric services (including oral and vision care)
The array of mental health and substance use disorder services has expanded to better meet the needs of individuals eligible for Medi-Cal. The following mental health benefits are available through Medi-Cal managed care plans or the fee-for-service delivery system:
• 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.
The following substance use disorder services benefits will also be made available to eligible Medi-Cal beneficiaries:
• 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 is available to all adults.
• For more information on dental services through Medi-Cal fee-for-service, please visit the Medi-Cal Dental website.
• For more information on dental services in Sacramento or Los Angeles County through dental managed care plans, please visit the
Medi-Cal Dental website.
Many of these services are covered by Medi-Cal today, or will be added in 2014, and will be available for both current and new enrollees.
The Medi-Cal expansion opened 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 lower than 138 percent of the federal poverty level.
View the 2014 annual income amounts and see if you qualify.
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.
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 will help Californians learn their eligibility for subsidized health benefits, compare insurance plan options, and enroll to receive coverage. It’s important to note that California will also maintain existing pathways in which individuals enroll. All counties will still process applications at local county social services departments as well as accept applications by mail.
In addition, locally based enrollment assistors will be available to help. Please log on to Covered California at
www.coveredca.com or call 1 (800) 300-1506 for more information.