Steps to Medi-Cal
Medi-Cal is California's Medicaid program. This is a public health insurance program that provides free or low cost medical services for children and adults with limited income and resources. Visit each topic below to learn more about the Medi-Cal process:
Are you Eligible?
Medi-Cal eligibility is based primarily on your income and, sometimes, your "countable property
". Effective January 1, 2014, Medi-Cal has been expanded to offer coverage to a larger group of Californians. To learn more about this, visit the Medi-Cal Expansion Information page
To find out if you and your family may be eligible based on income, use the Covered California Income Guidelines chart
Pregnant women, children, and disabled persons are allowed to have a higher income on the Federal Poverty Level scale and are urged to apply.
How to Apply
There is no wrong door when applying for health coverage in California. Please choose one of the following ways to apply:
- In person
- By mail
- By phone
Apply online at www.CoveredCA.com
. Applications are securely transferred directly to your local county social services office, since Medi-Cal is provided at the county level.
If you need additional help applying or have additional questions, you can contact a trained Certified Enrollment Counselor (CEC) for free.
Search a list of local CECs or call 1-800-300-1506. If you have already submitted an application online and haven’t been contacted yet, please don’t submit a duplicate application.
Verify your Eligibility
Due to the high volume of new applications, the process is taking longer than normal and the steps mentioned below may be done out of order if it will help in expediting coverage.
The process for verifying your Medi-Cal eligibility, from the time your completed application is received to when you receive your Benefits Identification Card (BIC), normally takes 45 days. The general process for verification is as follows:
Apply – complete the application, and submit either in person, by mail, by phone, or online
Receive a Notification of Likely Eligibility by mail
Your county's social services office may contact you by mail or by phone to request paper verification if income, citizenship, and other criteria cannot be verified electronically
Receive Final Notice of Action notifying you of whether or not you can receive Medi-Cal
Receive your BIC – when you receive your BIC in the mail, you are able to use the many Medi-Cal benefits available to you.
Enroll in a Plan
When you first qualify for Medi-Cal and receive your BIC, you are covered under Fee-for-Service (also called Regular Medi-Cal). Within 45 days of receiving your BIC, you will be mailed information explaining your health plan options.
However, you must choose a health plan within 30 days of receiving your health plan information mailer. If you do not choose a plan within 30 days, Medi-Cal will choose a plan for you. The health plans available to you depend on what county you live in.
- If you see
only one health plan listed, the county has chosen this plan for you. Please wait for your health plan information in the mail.
- If you see
multiple health plans
listed, please explore each plan, and choose the one that suits you and your family's needs.
Remember, if you do not choose a plan within 30 days of receiving your health plan information mailer, Medi-Cal will choose a plan for you.
- If you live in
San Benito County, there is only one health plan available and you may enroll in this health plan. However, you may choose to stay with Fee-for-Service Medi-Cal.
Start Using your Benefits
Medi-Cal currently provides a core set of health benefits, including doctor visits, hospital care, immunization, pregnancy-related services and nursing home care. The Affordable Care Act ensures all Medi-Cal health plans offer what is known as Essential Health Benefits (EHB). These ten comprehensive services include the following categories:
- Outpatient (ambulatory) services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder (SUD) services, including behavioral health treatment
- Prescription drugs
- Programs such as physical and occupational therapy (known as rehabilitative and habilitative services) and devices
- Laboratory services
- Preventative and wellness services and chronic disease management
- Children's (pediatric) services, including oral and vision care.
Medi-Cal Health Benefits Chart to learn more about the services in each category. The Federal
Healthcare.gov Glossary provides a definitions for all the terms used.
Dental benefits are available as of May 1, 2014
Dental benefits for adults 21 and older have been restored by the Center for Medicare and Medicaid Services.** You can find a Medi-Cal dentist on the
Medi-Cal Dental Provider Directory. For more information on children's dental services, visit the
Medi-Cal Dental website.
The following benefits have now been restored:
- Exams and x-rays
- Fluoride treatments
- Anterior (front teeth) root canals
- Prefabricated crowns
- Full dentures
- Other medically necessary dental services
Medi-Cal Dental adult benefits that will remain in place and
do not change as a result of the restoration:
- Pregnancy-related services
- Emergency services
- Services provided to residents of an Intermediate Care Facility/Skilled Nursing Facility
- Services provided to consumers of the Department of Developmental Services (DDS).
**Dental and vision services are available with some limitation. Learn more about dental benefits, and get further clarification by calling 1-800-322-6384 or visiting the
Mental Health and Substance Use Disorder (SUD) Services Benefits
The following mental health benefits are now available 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 service for the purposes of monitoring drug therapy
- Outpatient laboratory, drugs, supplies, and supplements
- Psychiatric consultation
- All specialty mental health services currently provided by County Mental Health Care Plans will continue to be available.
The following substance use disorder services are now available through Medi-Cal:
- Voluntary inpatient detoxification
- Intensive outpatient treatment services
- Residential treatment services
- Outpatient drug free services
- Narcotic treatment services
These are all services that Medi-Cal covers today, and will continue to cover for current and new enrollees.