Medi-Cal in San Diego (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 San Diego, 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 San Diego County – including who is eligible for Medi-Cal, Medi-Cal income limits, how to apply for benefits, Health and Human Services Agency (HHSA) contact information, and Medi-Cal providers in San Diego 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 San Diego County.

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

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

Table of Contents:

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

In San Diego County, the Medi-Cal program is managed by the Health and Human Services Agency (HHSA).

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

Furthermore, MyBenefits Calwin is the website for San Diego 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
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

San Diego County Medi-Cal Income Limits

The San Diego 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	$14,580	$38,783	$38,783	$38,783	$46,948
	2	$19,720	$52,455	$52,455	$52,455	$63,498
	3	$24,860	$66,128	$66,128	$66,128	$80,049
	4	$30,000	$79,800	$79,800	$79,800	$96,600
	5	$35,140	$93,472	$93,472	$93,472	$113,151
	6	$40,280	$107,145	$107,145	$107,145	$129,702
	7	$45,420	$120,817	$120,817	$120,817	$146,252
	8	$50,560	$134,490	$134,490	$134,490	$162,803

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	$14,580	$31,055	$16,621	$14,580	$20,120
	2	$19,720	$42,004	$22,481	$19,720	$27,214
	3	$24,860	$52,952	$28,340	$24,860	$34,307
	4	$30,000	$63,900	$34,200	$30,000	$41,400
	5	$35,140	$74,848	$40,060	$35,140	$48,493
	6	$40,280	$85,796	$45,919	$40,280	$55,586
	7	$45,420	$96,745	$51,779	$45,420	$62,680
	8	$50,560	$107,693	$57,638	$50,560	$69,773

How to Apply for California Medi-Cal in San Diego County

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

Online at MyBenefits CalWIN
Online through Covered California, at or by calling 1-800-300-1506.
Call the Access Call Center at 866-262-9881.
Apply in person at one of the HHSA office locations listed below.

Additionally, you can mail in completed applications and verification documents to the following address:

County of San Diego
Health and Human Services Agency
APPLICATIONS
P.O. Box 939044
San Diego, CA 92193-9005

Apply for and Manage Medi-Cal Benefits Online

The MyBenefits CalWIN website is a fast, easy way for San Diego 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.

San Diego County Medi-Cal Office Locations

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

To begin the process you will need to locate the HHSA Family Resource Center that serves your area.

You should be prepared to spend a minimum of two hours at the Family Resource Center.

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 HHSA office locations in San Diego County:

You can pick up a Medi-Cal application at the following HHSA Family Resource Centers: