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 Orange, 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 Orange County – including who is eligible for Medi-Cal, Medi-Cal income limits, how to apply for benefits, Social Services Agency (SSA) contact information, and Medi-Cal providers in Orange County, including CalOptima.
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 Orange County.
Additionally, we will provide SSA contact information, including the phone number and hours of operation.
Lastly, we will answer the most frequently asked questions about Medi-Cal in Orange County, including what Medi-Cal covers.
Table of Contents:
- What is Medi-Cal
- What services are covered by Medi-Cal?
- Medi-Cal in Orange County
- Medi-Cal Expansion in California
- Who is Eligible for Medi-Cal?
- Orange County Medi-Cal Income Limits
- How to Apply for California Medi-Cal in Orange County
- Apply for and Manage Medi-Cal Benefits Online
- Orange County Medi-Cal Office Locations
- Orange County Medi-Cal Phone Number
- Medi-Cal Managed Care Health Plans in Orange County
- Medi-Cal Providers in Orange County, California
- Orange 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
What services are covered by Medi-Cal?
- Outpatient (ambulatory) services
- Emergency services
- 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 Orange County
In Orange County, the Medi-Cal program is managed by the Social Services Agency (SSA).
In addition to Medi-Cal benefits, the SSA also handles CalFresh, CalWORKs, and General Relief applications and benefits.
Furthermore, MyBenefits Calwin is the website for Orange County Residents to apply for and to view their benefits online.
Continue reading below for MyBenefits Calwin 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
- 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
Orange County Medi-Cal Income Limits
The Orange 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|
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 Medi-Cal in Orange County
There are three ways to apply for Medi-Cal in Orange County:
- Online at MyBenefits CalWIN
- Online through Covered California, at or by calling 1-800-300-1506.
- Call the Social Services Agency (SSA) during business hours Monday – Friday 7:00 am – 5:00 pm at 1-800-281-9799.
- Apply in person at one of the SSA office locations listed below.
Apply for and Manage Medi-Cal Benefits Online
The MyBenefits CalWIN website is a fast, easy way for Orange County residents to apply for and manage public assistance services online, including Medi-Cal.
With a MyBenefits CalWIN 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 MyBenefits CalWIN account, click here to log in and apply for or manage your Medi-Cal benefits.
However, if you do not currently have a MyBenefits CalWIN, 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 MyBenefits CalWIN account, and apply for and manage your benefits online.
We recommend watching the video in order to save time in navigating the MyBenefits CalWIN website.
Orange County Medi-Cal Office Locations
Applications for the Medi-Cal Program can be completed in person at an SSA office location.
To begin the process you will need to locate the Social Services Regional Center that serves your area.
You should be prepared to spend a minimum of two hours at the Social Services Regional Center
Unless there is an emergent need for medical care, benefits may not be issued 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 SSA office locations in Orange County:
Anaheim Regional Center
3320 E. La Palma Ave.
Anaheim, CA 92806
Laguna Hills Regional Center
23330 Moulton Parkway
Laguna Hills, CA 92653
Cypress Regional Center
6100 Chip Ave.
Cypress, CA 90630
Santa Ana Regional Center
1928 S. Grand Ave.
Santa Ana, CA 92705
Garden Grove Regional Center
12912 Brookhurst St.
Garden Grove, CA 92840
Orange County Medi-Cal Phone Number
Here’s the phone number to call to speak to a live person regarding Medi-Cal in Orange County:
Call the Social Services Agency (SSA) during business hours Monday – Friday 7:00 am – 5:00 pm at 1-800-281-9799.
Medi-Cal Managed Care Health Plans in Orange 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 Orange County, California.
TTY/TDD (714) 246-8523
|Special Health Plan|||
|Altamed PACE||(855) 252-7223|
TTY/TDD (800) 735-2922
|Orange County (OC) PACE||TTY: (714) 798-9046|
See our guide on getting Medi-Cal plan through Kaiser Permanente.
Medi-Cal Providers in Orange 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 Orange County FAQs
Here are some of the most frequently asked questions about Medi-Cal in Orange County:
Which low-income children and adults may be eligible for Medi-Cal in Orange County?
The following groups are eligible:
- Adults ages 26-64
- Children and young adults under 26
- Former foster youth under 21
- Pregnant individuals
Who is Eligible for Long Term Care Medi-Cal?
The following groups are eligible for Long Term Care Medi-Cal benefits:
First, a single individual with property/resources of $2000 and under is eligible.
For a married individual with a spouse still living at home, the spouse at home may keep a predetermined amount of community property/resources.
This amount is established by the State and it is referred to as the Community Spouse Resource Allowance (CSRA).
Although the Community Spouse Resource Allowance may change annually, the only time the property/resources would be reevaluated is if the person leaves the facility and then reenters.
The Community Spouse Resource Allowance may be increased by an Administrative Law Judge through the appeals process.
However, the institutionalized spouse may keep up to $2000 of the countable property in their name.
Also, individuals under age 65 receiving Modified Adjusted Gross Income (MAGI) Medi-Cal are also eligible for Long Term Care services.
What is included in Teen Medi-Cal services?
Confidential sensitive services for minors include:
- Pregnancy/pregnancy related care
- Family planning
- Sexual assault
- Sexually transmitted diseases (only for child 12 years or older)
- Drug abuse treatment/counseling (only for child 12 years or older)
- Alcohol abuse treatment/counseling (only for child 12 years or older)
- Mental Health outpatient care (only for child 12 years or older)
How do I apply for Long Term Care Medi-Cal in Orange County?
For information on how to obtain a Medi-Cal application for Long Term Care, contact the Orange County Call & Processing Center at 714-645-3093.
Does Orange County Have an IHSS Program?
Yes. In Orange County, the In-Home Supportive Services (IHSS) program is managed by the Orange Social Services Agency.
The purpose of the Orange County IHSS program is to provide supportive services to persons who are aged, blind, or disabled, and who are limited in their ability to care for themselves and cannot live at home safely without assistance.
If you would like to become an IHSS Provider in Orange County, see the pay rate for IHSS in Orange County and other FAQs.
Medi-Cal in Orange County Summary
We hope this post on Medi-Cal in Orange County was helpful.
If you have further questions about Medi-Cal in Orange 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: