Medi-Cal in Madera County (2023 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 Madera, 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 Madera 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 Madera County, including CalViva Health.

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 Madera 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 Madera County, including what Medi-Cal covers.

Table of Contents:

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

In Madera 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 Madera 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

Madera County Medi-Cal Income Limits

The Madera 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

2023 Medi-Cal Income Limits for Adults

In 2023, a single adult earning $1,677 or less per month (138% FPL) is eligible for Medi-Cal, or $20,120 a year.

That’s approximately a 6.70 percent increase from the 2022 income limit.

For 2 adults, the household income limit is $2,269 per month for Medi-Cal eligibility, or $27,214 a year.

Find the category you fall into and you will see the income limit by household size.

2023 Medi-Cal Income Limits for Children

Next 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.

How to Apply for California Medi-Cal in Madera County

There are three ways to apply for Medi-Cal in Madera 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 1 (800) 300-1506. 
• Apply in person at one of the DSS office locations listed below.

If you are applying by mail, you can send the completed and signed application to:

Madera County Department of Social Services
PO Box 569
Madera, CA 93639
Fax: 559-675-7690

Apply for and Manage Medi-Cal Benefits Online

The BenefitsCal website is the fast, easy way for Madera 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.

Madera 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 Madera County:

Madera County Department of Social Services
1620 Sunrise Ave
Madera, CA 93638

Madera County Medi-Cal Phone Number

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

Call the Department of Social Services (DSS) during business hours Monday – Friday 8:00 am – 5:00 pm at 559) 675-2300 or Toll-Free at 1 (800) 300-1506.

Medi-Cal Managed Care Health Plans in Madera 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 Madera County, California.

Medi-Cal Providers in Madera 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 Madera County FAQs

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

How do I choose a Medi-Cal Health Plan in Madera 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.

Does Medi-Cal in Madera County cover Dental Benefits?

Yes. As a Medi-Cal member, your benefits and your child’s benefits include dental coverage at little or no cost to you.

To learn more about the dental benefits available to you and your family and to find a local dentist visit the Medi-Cal Dental Program website or the Smile California website.

What Dental Services are covered for Kids?

Below is a list of Dental Services covered by Medi-Cal for kids based on age:

Kids 5-12

The Medi-Cal Dental Program provides the following free or low-cost services for kids:

• Dental exams (every 6 months)
• X-rays
• Teeth cleaning (every 6 months)
• Fluoride varnish (every 6 months)
• Molar sealants
• Fillings
• Root canals
• Tooth removal
• Emergency services
• Outpatient services
• Sedation (if medically necessary)

Teens 13-17

The Medi‑Cal Dental Program provides the following free or low-cost services for teens:

• Dental exams (every 6 months)
• X-rays
• Fluoride varnish (every 6 months)
• Molar sealants
• Teeth cleaning (every 6 months)
• Orthodontics (braces) for those who qualify
• Fillings
• Crowns (Crowns on molars or premolars (back teeth) may be covered in some cases)
• Root canals
• Partial and full dentures
• Scaling and root planing
• Tooth removal
• Emergency services
• Outpatient services
• Sedation (if medically necessary)

What is Covered California?

Covered California is a marketplace where individuals can compare and select private health insurance plans as well as determine if they are eligible for financial assistance to make coverage more affordable.

What type of insurance will I get through Covered California?

Covered California health plans have 4 different levels of coverage:

• Bronze (60%)
• Silver (70%)
• Gold (80%)
• Platinum (90%)

Additionally, there are enhanced silver plans available for those with eligible income, with coverage at 73%, 87%, and 94%.

Who is Eligible for Medi-Cal Transportation in California?

If you’re covered by a Medi-Cal plan, your benefits include free transportation to and from health care appointments.

To qualify, you must have no other way to get to the appointment.

This benefit applies to:

• Medical appointments
• Dental appointments
• Mental health appointments
• Substance use disorder appointments
• Trips to pick up prescriptions or medical supplies
• Transportation by wheelchair van, litter van, or ambulance is also covered if needed.

Where can I get Free Breast Pumps for Medi-Cal Recipients?

You can get a FREE breast pump if you are pregnant and receiving Medi-Cal in Madera County.

Visit simplymamabreastpumps.com for more information.

You can also contact your Health Navigators at:

1620 Sunrise Ave Madera CA 93637
(559)395-0825
[email protected]

How do I report Medi-Cal Fraud?

You can report any suspected Medi-Cal fraud or waste to the California Department of Health Care Services (DHCS) by calling the DHCS Medi-Cal Fraud Hotline at 1(800) 822-6222.

Medi-Cal in Madera County Summary

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

Questions?

If you have further questions about Medi-Cal in Madera 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:

• IHSS Program in California Explained
• California Medi-Cal Income Guidelines
• Medi-Cal Phone Number for Customer Service
• California Medi-Cal Eligibility
• Medi-Cal in San Bernardino County 
• California Medi-Cal Questions and Answers