Medi-Cal in Napa 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 Napa, 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 Napa County – including who is eligible for Medi-Cal, Medi-Cal income limits, how to apply for benefits, Health & Human Service’s (HHSA) Self Sufficiency Services contact information, and Medi-Cal providers in Napa 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 Napa County.

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

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

Table of Contents:

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

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 Napa County

In Napa County, the Medi-Cal program is managed by the Health & Human Service’s (HHSA) Office of Self Sufficiency Services.

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

Furthermore, BenefitsCal is the website for Napa 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

Napa County Medi-Cal Income Limits

The Napa 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 Napa County

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

• Online at BenefitsCal.com.
• Online through Covered California, at or by calling 1-800-300-1506.
• Call the Self Sufficiency Services during business hours Monday – Friday 8:00 am – 5:00 pm at 707-253-4511 and Toll-Free: 800-464-4214. 
• Apply in person at one of the Self Sufficiency Services office locations listed below.

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

2751 Napa Valley Corporate Drive
Napa, CA 94558

Apply for and Manage Medi-Cal Benefits Online

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

Napa County Medi-Cal Office Locations

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

To begin the process you will need to locate the Self Sufficiency Services 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 Self Sufficiency Services office locations in Napa County:

Napa Office

2751 Napa Valley Corporate Drive
Building A
Napa, CA 94558

American Canyon Office

4381 Broadway
Suites 100 and 101
American Canyon, CA 94503

Calistoga Office

1705 Washington Street
Calistoga, CA 94515

Napa County Medi-Cal Phone Number

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

Call the Self Sufficiency Services during business hours Monday – Friday 8:00 am – 5:00 pm at 707-253-4511 and Toll-Free: 800-464-4214.

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

Medi-Cal Providers in Napa 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 Napa County FAQs

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

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

I am an immigrant. Can I get Medi-Cal?

It depends on your immigration status. Here’s what you need to know:

Most Immigrants Qualify for Health Coverage.

Under the Affordable Care Act, most immigrants qualify for health coverage, including the following groups:

• Lawful permanent residents or (“green card holders”).
• Lawful temporary residents.
• Persons fleeing persecution, including refugees and asylees.
• Other humanitarian immigrants, including those granted temporary protected status.
• Non-immigrant status holders (including worker visas and student visas).

All children 0-18 that are able to get Medi-Cal can get complete health care through Medi-Cal.

Their immigration status does not matter.

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.

See our detailed post on California Medi-Cal transportation.

What are the consequences of Medi-Cal fraud?

Most forms of Medi-Cal fraud are charged as either misdemeanors or felonies under California law.

The potential felony prison sentence for most forms of Medi-Cal fraud is anywhere from sixteen (16) months to five (5) years.

Additionally, felony fines can go up to fifty thousand dollars ($50,000), or double or triple the amount of the fraud.

In most cases, Medi-Cal fraud as a misdemeanor carries a potential county jail sentence of up to one (1) year.

How much will IHSS pay in 2022?

How much IHSS pays per hour varies by county. In 2022, the minimum hourly wage for an IHSS provider is $15 and the maximum is $18.

For a list of IHSS hourly wages for 2022 by county, click here.

Medi-Cal in Napa County Summary

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

Questions?

If you have further questions about Medi-Cal in Napa 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