Many low-income Californians get free or low-cost health care through Medi-Cal. This program helps pay for doctor visits, prescription drugs and other medical services. Pandemic-era protections are ending, and millions will soon face a shift back to annual eligibility checks. It means some will lose their coverage if they don’t act.
What is Medi-Cal?
Medi-Cal is California’s health care program for low-income families. It provides free or low-cost healthcare services for children, parents and pregnant women. It also covers seniors and people with disabilities and provides long-term care and other support for those in need. It’s financed equally by federal and state funds. The number of people enrolled in Medi-Cal has grown significantly since the Affordable Care Act allowed states to open up their programs to a more expansive group of individuals who are eligible for aid based on income alone without regard to family status, disability or other factors that were historically taken into consideration when determining eligibility. This expansion has resulted in millions of additional Californians receiving assistance.
Over the past few years, California has transitioned progressively more enrollees into managed care, with over 10 million children, adults and seniors (three-quarters of all Medi-Cal beneficiaries) enrolled in plans. At the same time, California has implemented new models for managing a wider range of benefits and services, including introducing managed mental health for mild to moderate cases and implementing a behavioral health demonstration, in addition to expanding community health center and Federally Qualified Health Center managed care contracts. Many of these changes are occurring at once and require significant effort to implement, especially in a short amount of time. The result has been several data issues that make it challenging for plans to contact and assess enrollees promptly and deliver the promised integrated care they were designed to offer.
How do I apply?
Many low-income families are eligible for Medi-Cal. Adults, kids, older people, and those with disabilities are all covered for health, dental, and vision* expenses. There are no monthly premiums and copays for most covered services. In 2021, the federal government mandated California reopen its managed care procurement process for enrollees in the county-run Medi-Cal program (known as “Fee-for-Service” Medi-Cal in some counties). Over the next 14 months, the state must redetermine eligibility for its current managed care beneficiaries. This process will allow millions of current enrollees to choose a new plan and provider. To determine if you are eligible for free or low-cost health care through the Medi-Cal program, complete an application online or at your local county office. You must verify income (e.g., check stubs or employer statements) and other documents. Once you have completed the application, you will be mailed a health plan information mailer with a list of available health plans. You must choose a plan within 30 days of receiving the health plan information mailer. If you do not choose a plan, the county will select one for you. You can also find more information about your Medi-Cal insurance options online. In addition to choosing a health plan, you must select a doctor and group.
How do I get my BIC?
After you are enrolled in Medi-Cal, you’ll get a BIC that you need to show when you get health care or prescriptions. Once you’re a member, you can get free or low-cost health and dental services with Medi-Cal. The program covers children, adults and seniors with incomes below certain limits. Additionally, it includes former foster youngsters up to age 26, pregnant mothers, and those with impairments. If you’re a member of Medi-Cal, you’ll receive information in the mail about the health plans you can choose from. You’ll have 30 days to select a plan, or your county will choose one.
How do I get Health Care?
If you qualify for Medi-Cal, your eligibility worker will screen you for all the programs that may be right for you. Your worker will also help you enroll in the best program available. If your worker decides you are eligible for Medi-Cal Managed Care, they will mail you a packet of health plan information. This packet will include lists of all the health plans available in your county. You will have 30 days from receiving your health plan information packet to choose a health plan. If you don’t choose a health plan within 30 days, your county will select one for you. You can learn about the health care covered by each plan by reviewing the list of health benefits. Some services require your doctor to approve them before you can get them. Those services are marked with an asterisk.
Suppose you have a low income and are not eligible for Medi-Cal. In that case, your worker can tell you about the County Medical Services Program (CMSP) or other insurance options through Covered California. You should report any changes to your application or coverage to your county office as soon as they happen. It includes moving, getting married or divorced, having children, getting a new job and other life events.