"Questions and Answers about Medi-Cal Benefits in California"

We know readers have various questions regarding the Medi-Cal. We decided to set up this California Medi-Cal FAQs page to address the most common questions we get.

Medi-Cal is the California version of the Federal Medicaid program. The Medi-Cal program provides health care coverage for low-income residents of California.

See the most frequently asked questions about Medi-Cal Benefits below.

"California Medi-Cal FAQs"

Who is Eligible for Medi-Cal?

There are three ways you can qualify for Medi-Cal:

First, you can qualify if you meet the income limits.

To see if you qualify based on income, look at the chart below. Income numbers are based on your annual or yearly earnings.

Second, you can also get Medi-Cal if you are:

  • 65 or older
  • Blind
  • Disabled
  • Under 21
  • Pregnant
  • In a skilled nursing or intermediate care home
  • On refugee status for a limited time, depending on how long you have been in the United States
  • A parent or caretaker relative of an age-eligible child
  • Have been screened for breast and/or cervical cancer (Breast and Cervical Cancer Treatment Program)

Third, if you are enrolled in one of the following programs, you can also get Medi-Cal:

  • CalFresh
  • SSI/SSP
  • CalWorks (AFDC)
  • Refugee Assistance
  • Foster Care or Adoption Assistance Program

What is the Maximum Income to Qualify for Medi-Cal?

Medi-Cal income limits are calculated as a percentage of the Federal Poverty Line (FPL).

To qualify for Medi-Cal based on income, you cannot make more than the income guidelines below.

  • Children up to age 1 with family income up to 266 percent of FPL
  • Any child age 1-5 with a family income up to 266 percent of FPL
  • Children ages 6- 18 with family income up to 266 percent of FPL
  • CHIP for children with family income up to 266%-322% percent of FPL
  • Pregnant women with family income up to 213 percent of FPL
  • Parents of minor children with family income up to 114 percent of FPL
  • Individuals who are elderly, blind, and disabled with family income up to 100% of the FPL
  • Adults without dependents under Medicaid expansion with income up to 138% of the FPL

As shown above, Adults (ages 21-64) whose income is at or below 138% of the Federal Poverty Level may qualify for Medi-Cal under the Affordable Care Act Medicaid expansion.

Below are the 2022 California Medi-Cal income limits for adults based on household size.

​Family Size​Monthly Income Limit (138% of FPL)Annual Income Limit (138% of FPL)
​1$1,564$18,755
2$2,106$25,268
2 Adults$2,106$25,268
3$2,650$31,782
4$3,192$38,295
5$3,735$44,809
6$4,278$51,323
​7$4,821$57,836
​8$5,363$64,350

For income limits for other Medi-Cal eligible groups in California, see our Medi-Cal income limit guide.

What is California Medi-Cal Expansion?

Effective January 1, 2014, The Affordable Care Act (ACA) expanded Medicaid benefits to low-income, childless adults between the ages of 19-64 who meet the low or no income requirements.

Also, starting on January 1, 2020, a new law in California gave full-scope Medi-Cal to young adults under the age of 26, and immigration status does not matter.

This is referred to as the Young Adult Expansion. All other Medi-Cal eligibility rules, including income limits, will still apply.

Furthermore, beginning May 1, 2022, a new law in California will give full-scope Medi-Cal to adults 50 years of age or older and immigration status does not matter.

This is referred to as the Older Adult Expansion. All other Medi-Cal eligibility rules, including income limits, will still apply to this new group.

Do I have Any Co-Pays, Premiums, or out-of-pocket expenses with Medi-Cal?

If you have a Share-of-cost (SOC) with your Medi-Cal, you will need to pay that amount each month to your health provider.

There are no other co-payment, premiums or out of pocket expenses if you see and receive Medi-Cal covered benefits through a Medi-Cal provider.

What is Share-of-Cost (SOC)?

Share-of-cost (SOC) is a set amount you will need to pay your providers each month when receiving Medi-Cal covered services.

The SOC amount is determined by your County Medi-Cal office.

After you meet your SOC, you are eligible to receive Medi-Cal covered services for the month with no out of pocket expenses.

How do I choose a Medi-Cal Plan?

Your Medi-Cal health plan choices depend on the county you live in.

After you change to full-scope Medi-Cal, you will get a letter in the mail from the county Medi-Cal office.

The letter will tell you about your Medi-Cal health plan choices and how to enroll.

If you have a doctor or clinic now, ask them if they work with a Medi-Cal health plan in your county.

Additionally, if you want to stay with that doctor or clinic, you can choose that Medi-Cal health plan.

Also, if you have a complex medical condition and see a doctor or clinic that does not work with a
Medi-Cal health plan in your county, fill out and send the “Medical Exemption Request” form
that comes with the packet of notices.

Note that if you do not choose a Medi-Cal health plan, Medi-Cal will choose a Medi-Cal health plan in
your county for you.

However, each month, you have the right to change your Medi-Cal health plan.

If you want to change your plan, call Health Care Options at 1-800-430-4263 (TTY 1-800-430-7077).

You can also visit https://www.healthcareoptions.dhcs.ca.gov.

If you change your Medi-Cal health plan, you must enroll in another Medi-Cal health plan in the same
county.

However, you cannot go back to fee-for-service.

What if I am not eligible for Medi-Cal?

If the county Medi-Cal office determines that you don’t qualify for Medi-Cal, your information will be sent to Covered California to be reviewed for financial assistance through Covered California.

You will receive more information letting you know what your next steps are.

You do not need to fill out another Covered California application.

To check on your transition status, call Covered California at 1-800-300-1506.

What can I do if I move out of your service area?

If you move outside of your county, but still live in California, call your county Medi-Cal eligibility worker right away.

This is the person at your local county social services office who can help you.

They can help you find out what Medi-Cal services are available in your new community.

Does Medi-Cal cover Emergency Room Visits?

Yes. If you have an emergency when you are not in our service area, you can go to the nearest emergency facility (doctor’s office, clinic, or hospital).

Emergency services do not need an okay from your primary care physician.

Additionally, under Medi-Cal, you can get urgent or emergency care anywhere in the United States, Canada, or Mexico when you need it.

How do I see a specialist under Medi-Cal?

If you need to see a specialist, your primary care physician (PCP) will refer you.

The services must be approved before you receive them. This is also known as a referral.

However, you do not need a referral for the following:

  • PCP visits
  • Network Certified Nurse Midwife OB/GYN visits
  • Urgent or emergency care visits
  • Family planning
  • Basic prenatal care from a provider who works with your health plan
  • HIV testing and counseling (only minors 12 years or older)
  • Treatment for sexually transmitted infections (only minors 12 years or older)

Additionally, minors also do not need a referral for:

  • Outpatient mental health for:
    – Sexual or physical abuse
    – When you may hurt yourself or others
  • Pregnancy care
  • Sexual assault care
  • Drug and alcohol abuse treatment

What is Covered California Website?

Covered California helps Californians to buy private health insurance and provides subsidies to help cover the costs.

People that have income between 138% and 400% of the federal poverty level will qualify and can get subsidies to help cover the cost.

To be eligible for Covered California as an adult, here are the income limits based on the federal poverty level (FPL):

  • 0% – 138% of FPL: You qualify for Medi-Cal.
  • 138% – 400% of FPL: You qualify for a subsidy on a Covered California plan.
  • 138% to 150%: You also qualify for the Silver Enhanced 94 Plan.
  • 150% to 200%: You also qualify for the Silver Enhanced 87 Plan.
  • 200% to 250%: You qualify for the Silver Enhanced 73 Plan.

How do I renew my Medi-Cal Benefits?

When a Medi-Cal application is approved, the first annual Re-Evaluation (RE) will be due in the 12th benefit month.

The Re-Evaluation packet will be mailed by the county Medi-Cal office to the beneficiary during the 10th month from the initial application date or most recent annual re-evaluation effective date.

Does Medi-Cal Cover Dental?

Yes, Medi-Cal offers comprehensive preventative and restorative dental benefits to both children and adults.

For details about what dental benefits are covered by Medi-Cal, see our Medi-Cal Dental Guide.

What is IHSS Program?

The IHSS program provides those with limited income who are disabled, blind, or over the age of 65 with in-home care services to help them remain safely at home.

How do I Contact Medi-Cal?

Here’s how to contact Medi-Cal:

Call 1- (800) 541-5555

If you are outside of California, please call (916) ​636-1980) for the Telephone Service Center.

The Service Center can help with:

1. Learning how to apply for Medi-Cal
2. Learning about Medi-Cal services
3. Finding a health care provider
4. Filing a complaint

For questions specific to Mental Health Services call 1-800-896-4042. TTY Line: 1-800-896-2512.

Monday through Friday 8 a.m. – 5 p.m. ( Except State Holidays and CA only)

California Medi-Cal FAQs Summary

We hope this post on California Medi-Cal FAQs was helpful.

Questions?

If you have further questions about Medi-Cal, please let us know in the comments section below.

Be sure to check out our other articles about Medi-Cal and California Medicaid program, including:

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