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 Marin, 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 Marin County – including who is eligible for Medi-Cal, Medi-Cal income limits, how to apply for benefits, Department of Health and Human Services (HHS) Public Assistance Office contact information, and Medi-Cal providers in Marin County, including Partnership Health Plan of California.
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 Marin County.
Additionally, we will provide HHS contact information, including the phone number and hours of operation.
Lastly, we will answer the most frequently asked questions about Medi-Cal in Marin County, including what Medi-Cal covers.
Table of Contents:
- What is Medi-Cal
- What services are covered by Medi-Cal?
- Medi-Cal in Marin County
- Medi-Cal Expansion in California
- Who is Eligible for Medi-Cal?
- Marin County Medi-Cal Income Limits
- How to Apply for California Medi-Cal in Marin County
- Apply for and Manage Medi-Cal Benefits Online
- Marin County Medi-Cal Office Locations
- Marin County Medi-Cal Phone Number
- Medi-Cal Managed Care Health Plans in Marin County
- Medi-Cal Providers in Marin County, California
- Marin 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 Marin County
In Marin County, the Medi-Cal program is managed by the Department of Health and Human Services (HHS).
In addition to Medi-Cal benefits, the HHS also handles CalFresh, CalWORKs, and General Relief applications and benefits.
Furthermore, BenefitsCal is the website for Marin 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
Marin County Medi-Cal Income Limits
The Marin 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.
| California Medicaid Income Limit – Children | ||||||
| Children Medicaid Ages 0-1 | Children Medicaid Ages 1-5 | Children Medicaid Ages 6-18 | Children Separate CHIP | |||
| % FPL | 100% | 266% | 266% | 266% | 322% | |
|
Household Size
|
1 | $13,590 | $36,149 | $36,149 | $36,149 | $43,760 |
| 2 | $18,310 | $48,705 | $48,705 | $48,705 | $58,958 | |
| 3 | $23,030 | $61,260 | $61,260 | $61,260 | $74,157 | |
| 4 | $27,750 | $73,815 | $73,815 | $73,815 | $89,355 | |
| 5 | $32,470 | $86,370 | $86,370 | $86,370 | $104,553 | |
| 6 | $37,190 | $98,925 | $98,925 | $98,925 | $119,752 | |
| 7 | $41,910 | $111,481 | $111,481 | $111,481 | $134,950 | |
| 8 | $46,630 | $124,036 | $124,036 | $124,036 | $150,149 | |
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 | |||
| % FPL | 100% | 213% | 114% | 100% | 138% | |
|
Household Size
|
1 | $13,590 | $28,947 | $15,493 | $13,590 | $18,754 |
| 2 | $18,310 | $39,000 | $20,873 | $18,310 | $25,268 | |
| 3 | $23,030 | $49,054 | $26,254 | $23,030 | $31,781 | |
| 4 | $27,750 | $59,108 | $31,635 | $27,750 | $38,295 | |
| 5 | $32,470 | $69,161 | $37,016 | $32,470 | $44,809 | |
| 6 | $37,190 | $79,215 | $42,397 | $37,190 | $51,322 | |
| 7 | $41,910 | $89,268 | $47,777 | $41,910 | $57,836 | |
| 8 | $46,630 | $99,322 | $53,158 | $46,630 | $64,349 | |
How to Apply for California Medi-Cal in Marin County
There are three ways to apply for Medi-Cal in Marin County:
- Online at BenefitsCal.com.
- Online through Covered California, at or by calling 1-800-300-1506.
- Call the Department of Health and Human Services (HHS) during business hours Monday – Friday 7:00 am – 5:00 pm at (877) 410-8817.
- Apply in person at one of the HHS office locations listed below.
Apply for and Manage Medi-Cal Benefits Online
The BenefitsCal website is the fast, easy way for Marin 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.
Marin County Medi-Cal Office Locations
Applications for the Medi-Cal Program can be completed in person at an HHS Public Assistance office location.
To begin the process you will need to locate the HHS 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 HHS Public Assistance office locations in Marin County:
San Rafael – Public Assistance Office
120 N Redwood Dr
San Rafael, CA 94903
Tel: (877) 410-8817
Hours: Hours: 8:00 AM – 12:00 PM and 1:00 PM – 4:30 PM
3240 Kerner Blvd
San Rafael, CA 94901
Tel: (877) 410-8817
Hours: 8:00 AM – 4:30 PM
West Marin – Public Assistance Office
Point Reyes Station
1 6th St
Petaluma, CA 94952
Tel:(415) 473-3800
Hours: 9:00 AM – 12:00 PM and 1:00 PM – 4:30 PM
Marin County Medi-Cal Phone Number
Here’s the phone number to call to speak to a live person regarding Medi-Cal in Marin County:
Call the Department of Health and Human Services (HHS) Public Assistance Office during business hours Monday – Friday 9:00 am – 5:00 pm at 1-(877) 410-8817.
Other Marin County Medi-Cal Phone Numbers
Additionally, you can call the following phone numbers for these specific Medi-Cal programs:
- Medi-Cal Access Program (MCAP)
- 1-800-433-2611
- Monday to Friday 9 a.m. to 7 p.m. or on Saturday from 8 a.m. to 12 p.m.
- Medi-Cal Access Infant Program (MCAIP)
- 1-800-880-5305
- Optional Targeted Low-Income Children’s Program (OTLICP)
- Monday to Friday 8 a.m. to 8 p.m. or on Saturday from 8 a.m. to 12 p.m.
- Working Disabled Program
- Call 1-916-445-9891
- Medi-Cal members in the 250% Working Disabled Program should call 1-916-445-9891, or
- fax 1-916-440-5676,
- or request a waiver and credits online here.
- County Children’s Health Initiative (CCHIP)
- 1-800-912-2447
- Monday to Friday 8 a.m. to 7 p.m. or on Saturday from 8 a.m. to 12 p.m.
Medi-Cal Managed Care Health Plans in Marin 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 Marin County, California.
| Plan Name | Phone Number |
|---|---|
| Partnership Health Plan of California | (800) 863-4155 TTY/TDD (800) 226-2140 |
Medi-Cal Providers in Marin 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 Marin County FAQs
Here are some of the most frequently asked questions about Medi-Cal in Marin County:
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 know if I am eligible for Medi-Cal?
How do I use my Partnership Healthplan of California Plan (PHC)?
If you’ve just signed up for Medi-Cal in Marin County, here are tips on how to use your health plan as provided by Partnership Healthplan of California:
- Make an appointment to see your doctor for a check-up within 120 days after your Medi-Cal benefit starts.
- When you go to the doctor, bring your Medi-Cal card and your PHC I.D. card with you.
- Always try to keep your appointments and try to get there 15 minutes early.
- If you must cancel your appointment call at least 24 hours in advance.
- Make a list of questions to ask your doctor. Bring your list with you.
- If something is not clear, tell your doctor.
- Tell your doctor about all the medicine you are taking, even over-the-counter medicines. You can make a list of your medicines to give to your doctor.
- Only use the emergency room when a delay in treatment could cause death or serious injury.
Can I cancel my enrollment in PHC?
It depends. Enrollment in PHC is required for you to get Medi-Cal benefits in Marin County.
If you are on Medi-Cal in Marin County, you do not have the option to leave PHC to go to State Medi-Cal.
Additionally, you can only cancel your enrollment in PHC for one of the following reasons:
- You have moved to a county not covered by PHC
- You have lost your Medi-Cal eligibility
- Your Medi-Cal coverage changes to a category not covered by PHC
What Medi-Cal Health Plans are available to Children?
Marin County children enrolled in or eligible for Medi-Cal will receive care through Partnership Healthplan of California’s Whole Child Model program.
Additionally, children with other forms of health insurance receive services through Marin Family Health Programs.
What is Covered California Website?
Covered California is an easy-to-use marketplace where you and your family may get financial assistance to make health care coverage more affordable.
In addition, it offers you the ability to compare plans, apply for coverage, and enroll for coverage.
What is Covered Marin Website?
Covered Marin provides access to local health resources, news, and information for residents of Marin County.
Does MarinHealth Medical Center Accept Partnership Healthplan of California?
Yes, MarinHealth Medical Center accepts the Partnership Healthplan of California plan.
Additionally, the MarinHealth Medical Center accepts the following health insurance plans:
- Aetna
- Anthem
- Beech Street
- Blue Shield
- Brown + Toland (Medicare Advantage only)
- California Department of Managed Care for PRIME
- Canopy Health
- Cigna
- County of Marin
- Health Net
- Health Net for the CA Department of Corrections
- Health Net Managed Care Network
- Humana
- Kaiser
- Magellan
- Medi-Cal
- Medicare
- Multiplan
- Network by Design
- Optum
- PHCS
- San Francisco Health Plan
- Sutter Select
- TriCare
- United
- Veterans Administration
What is Retroactive Medi-Cal?
If you have unpaid medical or dental bills when you apply for Medi-Cal, you can ask for retroactive Medi-Cal.
Retroactive Medi-Cal may help pay medical or dental bills in any of the three months before the application date.
For example, if you applied for Medi-Cal in July, you may be able to get help with bills for medical or dental services you got in April, May, and June.
To get retroactive Medi-Cal you must:
- Qualify for Medi-Cal in the month you got the medical services
- Have received medical or dental services that Medi-Cal covers
- Ask for it within one year of the month in which you received the covered services
- You must contact your local county office to request retroactive Medi-Cal
Medi-Cal in Marin County Summary
We hope this post on Medi-Cal in Marin County was helpful.
Questions?
If you have further questions about Medi-Cal in Marin 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:
