Who Qualifies for MCAP? | En Español
To qualify for MCAP, you must be:
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Pregnant: You must be pregnant. The application date is the date the
complete and eligible application is received by MCAP from Covered California.
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A California resident: A person living in California who plans to stay;
and
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Not enrolled in other programs: You cannot be receiving no-cost Medi-Cal or Medicare Part A and Part B benefits as of the application date;
and
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Not covered by any other health insurance plan: You cannot have other health insurance, unless your other health insurance plan doesn't cover maternity services or has a maternity-only deductible or copayment greater than $500 as of your date of application. MCAP will be the primary insurance and when using MCAP services you will need to choose a Managed Health Care Plan. MCAP does not pay the other insurance co pay or deductible.
and
-
Within the MCAP income guidelines: You must have a Federal Modified Adjusted Gross Income within the MCAP income guidelines.
Income Guidelines
Effective January 1, 2025
| 2 | $3,756- $5,677
|
|---|
3
| $4,731- $7,152
|
|---|
4
| $5,709-$8,630
|
|---|
5
| $6,684 -$10,105
|
|---|
6
| $7,660 - $11,580
|
|---|
7
| $8,638- $13,058
|
|---|
8
| $9,613 -$14,532
|
|---|
9
| $10,589 - $16,007
|
|---|
10
| $11,566-$17,485
|
|---|
Each Additional Family Member
| $978 -$1,478
|
|---|
* For purpose of the MCAP program, a pregnant member is counted as two family members.
Meeting the MCAP Income Guidelines
To see if you meet the MCAP Modified Adjusted Gross Income (MAGI) guidelines, we look at your federal income tax for household:
What is Modified Adjusted Gross Income (MAGI)?
MAGI counts income and people in your household who are claimed on your federal tax form. MCAP then compares your MAGI to the Federal Poverty Level (FPL) for the household size claimed on your tax form.
Whose income should be counted?
To see if you meet the
MCAP guidelines, only count the income of the family members included or who will be included in your federal income tax form.
What income should be counted?
Only list the income that you will report on your federal tax form for individuals that will be included on your federal tax form.
Family Size
The family size is the Tax filer plus all persons expected to be claimed as tax dependents on your federal tax form. A pregnant individual counts as one PLUS the number of expected child(ren).
Do you meet the MCAP eligibility guidelines?
Based on federal tax household and the family size of that tax household, MCAP will determine if you meet the MCAP eligibility guidelines. If not eligible, you have other options for health coverage that you may qualify for including Medi-Cal or Covered CA coverage.
If your income is below the MCAP eligibility guidelines, you may qualify for no-cost Medi-Cal.
If you do not qualify for MCAP because your income for your family size is below the MCAP eligibility guidelines, you may qualify for no-cost Medi-Cal. We will forward your application to Medi-Cal for an eligibility determination. Presumptive Eligibility is available to any individual whose family income is at or below 213% of the federal income guidelines. Presumptive Eligibility is a federal/state program designed to provide access to prenatal care for pregnant individuals by offering immediate Medi-Cal coverage pending a formal Medi-Cal application. For more information about Presumptive Eligibility please call (800) 824-0088.
If your income is above the MCAP eligibility guidelines, you may qualify for Covered CA and may be eligible for tax credits to help you pay your Covered CA premiums.
If you do not qualify for MCAP, because your income for your family size is too high for the MCAP eligibility guidelines, you may qualify for Covered CA. For more information about Covered CA, visit www.coveredca.com, or call 1-800-300-1506.
Medi-Cal Privacy Notice
Federal and State law requires us to provide the following information: Welfare and Institutions Code §14011 requires Medi-Cal applicants to provide the information requested in the application. It may be shared with federal, state, and local agencies for purposes of verifying eligibility, and for verification of the immigration status of those persons seeking full scope Medi-Cal benefits. (Federal law says the U.S. Citizenship and Immigration Services [CIS], formerly the Immigration and Naturalization Service [INS] cannot use the information for anything else except cases of fraud.) It will also be used to process Medi-Cal claims and make Benefits Identification Cards (BICs). Failure to provide the required information may result in denial of the application. Information required by this form is mandatory. Social Security Numbers are required by §1144(a)(1) of the Social Security Act unless applying for emergency or pregnancy-related benefits only.
You have a right to access your Medi-Cal records. Contact your county Medi-Cal office.
