Are you trying to apply for California Medicaid (Medi-Cal) and want to know if your income qualifies? In this post, we will review the California Medi-Cal Income Limits to help you determine if you qualify for benefits.
To be eligible for Medi-Cal, you must meet the income limits for your household size. Most families and individuals who meet the income guidelines for Medi-Cal are eligible to apply.
After reading this post, you will be able to determine the Medical income limits for a family of 2, 3, 5, and more. Continue reading below.
Table of Contents:
- What is Medi-Cal?
- Who is Eligible for Medicaid in California?
- What does California Medi-Cal Cover?
- 2022 California Medicaid Income Limit
- How to Apply for Medicaid in California
- Medi-Cal Application Guide By County
- Medi-Cal FAQs
What is Medi-Cal
This includes individuals including families with children, seniors (65 or older), individuals with disabilities, children in foster care, pregnant women, and low-income people with specific diseases such as tuberculosis, breast cancer or HIV/AIDS.
Additionally, 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.
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
- Under 21
- 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:
- CalWorks (AFDC)
- Refugee Assistance
- Foster Care or Adoption Assistance Program
What does Medi-Cal Cover?
Medi-Cal pays for a wide variety of medically necessary care, including:
Primary Medical Care
- Doctor visits
- Diagnostic testing
- Emergency services
- Pregnancy-related care
- Prescription drugs
- Dental services
- Health screenings for kids
- Vision care
- Preventative care
Ongoing Care & Recovery
- Personal care services (IHSS)
- Occupational & physical therapy
- Outpatient drug abuse services
- Nursing facility stays
- Adult day health care
Other medical-related costs
- Medical supplies
- Durable medical equipment
- Transportation to doctor visits
- Transportation costs for children with disabilities
California Medi-Cal Income Limits
The California Medicaid Income Limit is calculated as a percentage of the Federal Poverty Line (FPL).
To be eligible for Medicaid, you cannot make more than the income guidelines outlined 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
Below are the California Medi-Cal income limit charts, one showing eligibility for children and the other showing eligibility for adults.
First is the income limit for children by age category.
Find the age category your child falls into and you will see the income limit by household size.
|California Medicaid Income Limit – Children|
|Children Medicaid Ages 0-1||Children Medicaid Ages 1-5||Children Medicaid Ages 6-18||Children Separate CHIP|
Next, you will find below the income limit for adults by category.
Find the category you fall into and you will see the income limit by household size.
|California Medicaid Income Limit – Adults|
|Pregnant Women Medicaid||Adults (Medicaid) Parent/ Caretaker||Seniors & People w/ Disabilities (Medicaid)||Adults (Medicaid) Expansion to Adults|
How to Apply for California Medicaid
Californians have three ways to apply for Medi-Cal:
- Online: It takes about 30 minutes to sign up for Medi-Cal online through Covered California.
- In-person: You can enroll in person at a County Social Services Office. Additionally, California has hundreds of Medi-Cal enrollment centers and thousands of certified enrollers ready to help you apply for Medicaid.
- Over the phone: You can request a phone call from an enroller to get free advice and apply for Medi-Cal over the phone or call 1‑800‑300‑1506.
Medi-Cal Application Guide By County
See the Medi-Cal guides below for application information by county:
Here are some of the most frequently asked questions about Medi-Cal:
Do I have to pay for Medi-Cal?
You may have a share of the cost, similar to a “Co-Payment”, for medical/dental treatment based on your income and family size.
However, you can find out how much you will have to pay through your Medi-Cal provider. Here’s how it works:
When your provider uses your Benefits Identification Card (BIC) to verify your Medi-Cal eligibility, your provider will know if Medi-Cal will pay for a medical/dental treatment or if you need to make a “Co-Payment” for any treatment.
Can I get Medi-Cal if I am disabled?
To get Medi-Cal as a disabled person, you must have severe physical and/or mental problem(s) which will:
- Last at least 12 months in a row and,
- Stop you from working during those 12 months, OR
- Possibly result in death.
Additionally, you must prove your disabling physical and/or mental problem(s) with medical records, tests, and other medical findings.
What is retroactive Medi-Cal and who can apply?
Retroactive Medi-Cal covers unpaid medical expenses from the three months prior to the
the month you apply for Medi-Cal.
If you have unpaid bills from the three previous months, enter that information during the Medi-Cal application process.
Additionally, if you qualify for Medi-Cal, you will also be evaluated for retroactive coverage.
However, you will be required to provide some basic information about the past months to qualify.
A Medi-Cal representative in your county of application will contact you and explain the process.
Do I have to be a U.S. citizen to get Medi-Cal?
No. U.S. Citizenship and immigration status is not a condition of eligibility.
Assuming all eligibility requirements are met, U.S. citizens, and individuals with Satisfactory Immigration status are entitled to receive full-scope Medi-Cal benefits.
Additionally, undocumented eligible adults will have access to Emergency and Pregnancy-related services.
Furthermore, in the state of California, all eligible children (up to 19 years old) are entitled to receive full-scope Medi-Cal benefits, regardless of immigration status.
Does my Medi-Cal card expire?
No, your Medi-Cal card will not expire.
However, you must comply with the Annual Redetermination process and/or request for information for your case to remain in good standing.
If you do not comply with the Annual Redetermination process and/or request for information for your case, then your Medi-Cal plan may be terminated.
What are the Medi-Cal Manage Care Models?
California currently uses six different models to deliver care to Medi-Cal beneficiaries.
The six Medi-Cal managed care models that counties use are:
- County Organized Health Systems (COHS)
- Geographic Managed Care (GMC)
- Regional Model (RM)
- San Benito
California Medi-Cal Income Limits Summary
We hope this post on California Medi-Cal Income Limits was helpful to you.
If you have any questions about Medicaid in the state of California, you can ask us in the comments section below.
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Be sure to check out our other articles about Medicaid.