How Does MediCal Work? A Comprehensive Guide

Did you know that over 13 million Californians rely on MediCal for their healthcare coverage? As the state’s Medicaid program, MediCal offers vital medical services to individuals and families with low incomes. If you’re considering applying for this program or want to understand how does MediCal work, this article is for you! We’ll will walk you through everything you need to know, from eligibility requirements to the benefits it covers 

1. What Is MediCal? 

MediCal, also called Med-Cal, is the California version of the federal’s Medicaid healthcare program. It helps provide vital medical services to individuals and families with limited income and resources. The program serves both children and adults to ensure they have access to necessary healthcare.  

Funded by both federal and state taxes, MediCal is one of the largest health insurance programs in California. In fact, it offers coverage to millions of residents each year. 

Back in time, the program was established in 1965, shortly after the national Medicaid program was introduced under the Social Security Act. It was initially known as the California Medical Assistance Program.   

Over the years, Medi-Cal has evolved and expanded coverage to a much broader range. Today, Medi-Cal helps California residents get affordable, comprehensive medical care. In addition, it serves as a critical safety net for those who may otherwise be unable to afford health insurance.

2. How Does MediCal Work? 

Now that you have a basic understanding of MediCal, let’s dive deeper. In this section, we’ll guide you through the key aspects of the program, including eligibility, the application process, benefits, and how to renew your coverage.

Also read: Benefits For Low-Income Single Person California: How to Access These Exclusive Benefits?

Explore eligibility requirements to get MediCal  

To qualify for Medi-Cal, your eligibility primarily depends on income and other factors.  

Firstly, let’s start with income-based qualifications. For adults, you may qualify if your income is at or below 138% of the Federal Poverty Level (FPL). For children, the income limit is higher, up to 266% of the FPL. 

You may also qualify if you are enrolled in programs like CalFresh, SSI/SSP, CalWORKs (AFDC), Refugee Assistance, or the Foster Care and Adoption Assistance Program. 

Additionally, Medi-Cal considers several other eligibility factors, such as: 

• Seniors (65 years or older) 
• Individuals who are blind or disabled 
• Children under the age of 21 
• Pregnant women 
• Residents of skilled nursing or intermediate care homes 
• People with refugee status, depending on how long they have been in the U.S. 
• Parents or caretakers of children under 21 who are disadvantaged 
• Individuals diagnosed with breast or cervical cancer 

Explore the application stage 

There are several ways you can apply for Medi-Cal: 

• By mail: Use the Medi-Cal Single Streamlined Application, which is available in multiple languages. 
• In person: Instead, you can visit your local County Social Services Office to apply in person. Find the nearest office for assistance. 
• Online: Most conveniently, you can apply through the Covered California website. It is a partnership between Covered California and the Department of Health Care Services. 

No matter your method, you should prepare these documents:  

• Social Security Numbers (if available) 
• Federal Tax Information for tax filers 
• Immigration Documents for non-citizens 
• Employer and Income Information for all family members 

Important note: It may take up to 45 days for your Medi-Cal application to be processed. If applying based on disability, the process may take up to 90 days.

In California, what does Medicaid cover? 

You might be wondering what benefits MediCal offers when you apply for the program. This section provides the answers. 

Medi-Cal offers a comprehensive coverage for a wide range of medical services as the follow: 

• Primary medical care: Doctor visits, diagnostic tests, emergency services, hospital stays, prescription drugs, and maternity and newborn care.  
• Mental health and substance use treatment: Medi-Cal supports counseling and therapy services.  
• Additional benefits: Denti-Cal (dental services), vision care, and long-term care for daily living assistance.  
• Ongoing care: Services like occupational and physical therapy, in-home supportive services, and nursing facility care. 
• Medical supplies: Durable medical equipment and transportation for medical visits. 

Depending on your eligibility, Medi-Cal may provide full-scope coverage, which includes all these services, or partial-scope coverage for specific needs. However, some services, like cosmetic surgery, may require prior approval or not be covered at all.

Medi-Cal renewal  

To keep your MediCal benefits, you must complete an annual renewal process. In some cases, your local county office may be unable to renew your coverage electronically so they will send you a renewal form. 

During this process, it’s important to update any information that has changed, such as your income or household details, to ensure continued eligibility. You can submit the renewal form online, by phone, or in person, depending on the services available in your area. 

3. Maximize Your MediCal Benefits at AirTalk Wireless

Did you know that being a Medi-Cal recipient, you can receive more than just health benefits? Let us show you how. 

As a Medi-Cal recipient, you automatically qualify for the Lifeline program, which provides discounted phone and internet services. At AirTalk Wireless, we make it simple to maximize these benefits. By applying through us, you can access affordable service plans and even receive a free device. 

AirTalk Wireless has been a trusted Lifeline service provider since 1999. We’re committed to providing reliable communication solutions to individuals and families across the country. Our discounted plans and free devices help you stay connected with ease, whether you need it for personal, professional or educational purposes.

Read more: How To Get A MediCal Free Phone: A Comprehensive Guide

FAQs

Here are some of the most asked questions that will clarify on how does MediCal work.

1. Can I have Medi-Cal and private insurance? 

Yes, you can have both Medi-Cal and private insurance. Medi-Cal may cover services not paid for by your private insurance. However, benefits coordination is required to avoid overlaps or duplicate payments. 

2. What is the difference between Medi-Cal vs Medicare? 

Medi-Cal and Medicare are both government programs, but they serve different purposes. Medi-Cal is California’s Medicaid program that provides health coverage for low-income individuals and families. It’s available to people of all ages, including children, adults, and seniors. On the other hand, Medicare is a federal program primarily for individuals aged 65 and older, or younger people with disabilities. Medi-Cal may help cover gaps in Medicare services for eligible individuals.

Also read: Medicare vs Medi-Cal: Understanding The Differences & Making The Right Choice

3. What is PRUCOL Medi-Cal? 

PRUCOL stands for “Permanently Residing in the U.S. Under Color Of Law.” It’s a status for immigrants who may not have permanent legal status but are not likely to be deported.  

People with PRUCOL status may qualify for Medi-Cal benefits if they meet other eligibility criteria. Examples of PRUCOL status include asylum seekers, refugees, and individuals with deferred action status. 

4. Can Medi-Cal take my inheritance? 

No. However, while Medi-Cal can’t take your inheritance directly, it will affect your eligibility. 

It’s because Inheritance is considered income in the month it’s received, which may make you temporarily ineligible for coverage if it exceeds the income limits. The following month, it counts as an asset. In case your total assets exceed the income limit, you may lose eligibility unless the money is spent accordingly. If you inherit money, you are legally obligated to report it to Medicaid (generally within 10 – 30 days). If you inherit money and don’t report it, you may have to repay Medicaid for the benefits you received while you were not eligible. 

5. Does Medi-Cal cover glasses for adults? 

No, Medi-Cal does not cover eyeglasses for adults. However, children under 21 and residents in nursing homes are eligible for eyeglass coverage under Medi-Cal. 

6. Does Medi-Cal cover dental implants? 

No. However, this program offers dental benefits, both preventative and restorative, to both children and adults. 

7. What is Medi-Cal transportation phone number? 

(800) 541-5555 

Final Words

We hope this article has shown you clearly how does MediCal work. If you or a loved one qualify for MediCal, don’t hesitate to apply and take advantage of the comprehensive coverage it offers. The MediCal program can significantly reduce your medical expenses by providing access to essential health care services. 

And remember, as a Medi-Cal recipient, you’re also eligible for additional perks through the Lifeline program. Apply today and take full advantage of these benefits to stay connected effortlessly!