Medi-Cal in Imperial County (2022 Guide)

Medi-Cal is the Medicaid program in California. It provides health coverage to people with low income and asset levels who meet certain eligibility requirements. If you live in the County of Imperial, California, and need help with Medi-Cal, we can help. In this post, we will review everything you need to know about Medi-Cal in Imperial County – including who is eligible for Medi-Cal, Medi-Cal income limits, how to apply for benefits, Department of Social Services (DSS) contact information, and Medi-Cal providers in Imperial County, including California Health & Wellness Plan.

Before we get into Medi-Cal eligibility guidelines, first, we will explain what Medi-Cal is about and California’s Medicaid expansion.

Next, we will explain the Medi-Cal eligibility guidelines in detail, including the income limit, which is the most important.

We will then walk you through the 3 ways you can apply for Medi-Cal in Imperial County.

Additionally, we will provide DSS contact information, including the phone number and hours of operation.

Lastly, we will answer the most frequently asked questions about Medi-Cal in Imperial County, including what Medi-Cal covers.

Table of Contents:

• What is Medi-Cal
• What services are covered by Medi-Cal?
• Medi-Cal in Imperial County
• Medi-Cal Expansion in California
• Who is Eligible for Medi-Cal?
• Imperial County Medi-Cal Income Limits
• How to Apply for California Medi-Cal in Imperial County
• Apply for and Manage Medi-Cal Benefits Online
• Imperial County Medi-Cal Office Locations
• Imperial County Medi-Cal Phone Number
• Medi-Cal Managed Care Health Plans in Imperial County
• Medi-Cal Providers in Imperial County, California
• Imperial County Medi-Cal FAQs

What is Medi-Cal

Medi-Cal is California’s Medicaid public health insurance program. Medi-Cal provides free or low-cost medical services for children and adults with limited income (and limited resources for some Medi-Cal programs).

The program is supported by federal and state taxes.

Effective January 1, 2014, the Affordable Care Act (ACA) expanded Medi-Cal coverage to previously ineligible adults (childless, non-disabled, non-elderly).

Medi-Cal Program and Services include:

• Children and Adults
• Seniors and Persons with Disabilities
• Teen Services
• Newborn Referral
• Long Term Care
• Dental

What services are covered by Medi-Cal?

• Outpatient (ambulatory) services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services/devices (physical and occupational therapy)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Certain adult dental services
• Pediatric services, including dental and vision care

Medi-Cal in Imperial County

In Imperial County, the Medi-Cal program is managed by the Department of Social Services (DSS).

In addition to Medi-Cal benefits, the DSS also handles CalFresh, CalWORKs, and General Relief applications and benefits.

Furthermore, BenefitsCal is the website for Imperial County Residents to apply for and to view their benefits online.

Continue reading below for BenefitsCal account information.

Medi-Cal Expansion in California

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.

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

Imperial County Medi-Cal Income Limits

The Imperial County Medi-Cal income limit follows the California Medi-Cal Income Limit and is calculated as a percentage of the Federal Poverty Line (FPL).

To be eligible for Medi-Cal, 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

Medi-Cal income limit charts

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.

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.

How to Apply for California Medi-Cal in Imperial County

There are three ways to apply for Medi-Cal in Imperial County:

• Online at BenefitsCal.com.
• Online through Covered California, at or by calling 1-800-300-1506.
• Call the Department of Social Services (DSS) during business hours Monday – Friday 8:00 am – 5:00 pm at (760)337-6800. 
• Apply in person at one of the DSS office locations listed below.

Apply for and Manage Medi-Cal Benefits Online

The BenefitsCal website is the fast, easy way for Imperial County residents to apply for and manage public assistance services online, including Medi-Cal.

With a BenefitsCal account, you can perform the following tasks online:

• See if you are eligible for Medi-Cal and other benefits
• Apply for Medi-Cal, CalFresh, and Cash Assistance Benefits
• Report Changes in your Household situation that may affect your benefits
• Renew your Medi-Cal, CalFresh, and Cash Assistance Benefits

If you currently have a BenefitsCal account, click here to log in and apply for or manage your Medi-Cal benefits.

However, if you do not currently have a BenefitsCal, click here to sign up for one. It only takes a few minutes.

The video below does a great job of explaining in detail how to sign up for a BenefitsCal account, and apply for and manage your benefits online.

We recommend watching the video in order to save time in navigating the BenefitsCal website.

Imperial County Medi-Cal Office Locations

Applications for the Medi-Cal Program can be completed in person at a DSS office location.

To begin the process you will need to locate the DSS that serves your area.

Unless there is an emergent need for medical care, benefits may not be issued on the same day.

In addition to Medi-Cal, households can apply for CalFresh, General Relief, and CalWORKs at the following locations, which are open from 8 a.m. to 5 p.m. Monday through Friday:

See below for a list of DSS office locations in Imperial County:

Department of Social Services
2895 S. 4th St. Bldg C
El Centro, CA 92243

Department of Social Services
2995 S. 4th St Suite#105
El Centro, CA 92243

Brawley One Stop
860 Main St
Brawley, CA 92227

Imperial County Medi-Cal Phone Number

Here’s the phone number to call to speak to a live person regarding Medi-Cal in Imperial County:

Call the Department of Social Services (DSS) during business hours Monday – Friday 8:00 am – 5:00 pm at (760)337-6800.

Medi-Cal Managed Care Health Plans in Imperial County

When you first qualify for Medi-Cal, you are covered under Medi-Cal Fee-for-Service.

However, you must choose a health plan within 30 days. If you do not choose a plan within 30 days, the State will choose a plan for you.

If you find only one health plan, the county has chosen this plan for you. Please wait for your health plan information mailer in the mail.

If you find multiple health plans listed, please explore each plan and choose the one that suits you and your family’s needs.

Below is a list of Medi-Cal Managed Care Health Plan options available in Imperial County, California.

Medi-Cal Providers in Imperial County, California

When you enroll in (join) a Medi-Cal plan, you must choose a primary care provider (PCP).

Your PCP is the doctor or clinic you go to when you are sick or need a checkup.

To locate a Medi-Cal provider near you, click here to search the database of providers.

Once you are on the website, select a program (see image below) to search for doctors, dentists, hospitals, medical clinics, and dental clinics near you.

Medi-Cal Imperial County FAQs

Here are some of the most frequently asked questions about Medi-Cal in Imperial County:

Does Medi-Cal cover Dental Benefits?

Yes. ​The Medi-Cal Dental Program covers a variety of dental services for Medi-Cal beneficiaries, such as:

• Diagnostic and preventive dental hygiene (e.g. examinations, x-rays, and teeth cleanings);
• Emergency services for pain control;
• Tooth extractions;
• Fillings;
• Root canal treatments (anterior/posterior);
• Crowns (prefabricated/laboratory);
• Scaling and root planning;
• Periodontal maintenance;
• Complete and partial dentures; and
• Orthodontics for children who qualify.

For dental coverage for kids, see our Medi-Cal Dental for Kids Guide.

Can I get Behavioral Health Treatment Under Medi-Cal?

Yes. Medi-Cal covers all medically necessary behavioral health treatment (BHT) for eligible beneficiaries under 21 years of age.

This may include children with autism spectrum disorder (ASD) as well as children for whom a physician or psychologist determines it is medically necessary.

However, a physician or a psychologist must recommend BHT services as medically necessary based on whether BHT services will correct or ameliorate any physical and/or behavioral conditions.

What is Medi-Cal Share of Cost (SOC)?

Some Medi-Cal recipients must pay a monthly dollar amount toward their medical expenses before they qualify for Medi-Cal services.

This dollar amount is called Share of Cost (SOC).

A Medi-Cal recipient’s SOC is similar to a private insurance plan’s out-of-pocket deductible.

Medi-cal recipients are not eligible to receive Medi-Cal benefits until their monthly SOC dollar amount has been certified online.

Certifying SOC means that a provider has verified that a recipient has paid or become obligated to pay the entire monthly dollar SOC amount owed.

How do I choose a Medi-Cal Health Plan in Imperial County?

To enroll in a Health Plan, call Health Care Options at 1-800-430-4263 and enroll on the phone.

Alternatively, you can use the enrollment form that came in the envelope that was mailed to you with your Medi-Cal approval notice.

Note that 15 – 45 days after you enroll, your new Health Plan will send you a membership card.

While you are waiting for the membership card, keep using the doctors and hospitals you use now.

What is a Managed Care Plan (MCP)?

The California Department of Health Care Services (DHCS) has implemented several different managed care plans (MCPs) designed to meet the health care needs of Medi-Cal recipients who previously received services through a “fee-for-service” program.

Medi-Cal MCPs are responsible for providing prevention, primary care, and other medically necessary services to Medi-Cal recipients.

Each MCP receives a monthly fee, or per capita rate, from the state for every enrolled recipient.

Medi-Cal recipients enrolled in contracting MCPs must receive Medi-Cal benefits from plan providers and not from providers who bill through the fee-for-service program.

Who Qualifies for Hospital Presumptive Eligibility (HPE) Program

The Affordable Care Act (ACA) established the Hospital Presumptive Eligibility (HPE) program.

The HPE program provides qualified individuals immediate access to temporary, no-cost Medi-Cal services while individuals apply for permanent Medi-Cal coverage or other health coverage.

In California, the HPE program was implemented by the Department of Health Care Services (DHCS) on January 1, 2014.

Qualified HPE providers approved by the DHCS make HPE determinations via the HPE Application Web Portal.

For questions regarding the HPE program, contact the Medi-Cal Telephone Service Center (TSC) at 1-800-541-5555 from 8 a.m. to 5 p.m., Monday through Friday, except holidays.

Medi-Cal in Imperial County Summary

We hope this post on Medi-Cal in Imperial County was helpful.

Questions?

If you have further questions about Medi-Cal in Imperial County, 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:

• California Medi-Cal Income Guidelines
• Medi-Cal Phone Number for Customer Service
• California Medi-Cal Eligibility
• Medi-Cal Services in Orange County
• Medi-Cal in San Bernardino County