"Can you get California Medi-Cal through Kaiser Permanente"

Medi-Cal through Kaiser Permanente – Guide

Can you get Medi-Cal through Kaiser Permanente? What is the phone number for Kaiser Permanente Medi-Cal plan? If you have these questions and others about Medi-Cal through Kaiser Permanente, we can help. In this post, we are going to review everything you need to know to enroll in a Medi-Cal plan through Kaiser Permanente and what you need to do to keep your benefits.

First, we will walk you through Medi-Cal and who is eligible, including income limits.

Second, we will provide details on the four ways you can apply for Medi-Cal.

Additionally, after you are approved for Medi-Cal, you are required to pick a Medi-Cal plan/provider that services your county. We will walk you through that.

Also, we will explain the process for choosing Kaiser Permanente as your Medi-Cal provider and the steps involved.

Lastly, we will answer the most frequently asked questions about Medi-Cal through Kaiser Permanente.

This includes how to switch plans to Kaiser Permanente and counties where Kaiser Permanente provides Medi-Cal Plans.

"How to Get Medi-Cal through Kaiser Permanente"

Table of Contents:

  • What is Medi-Cal?
  • Who is Eligible for Medi-Cal?
  • Medi-Cal Income Limits
  • What does Medi-Cal Cover?
  • Apply for Medi-Cal
  • How to join a Medi-Cal health plan
  • How to Get Medi-Cal through Kaiser Permanente
  • Contact Kaiser Permanente about Medi-Cal
  • FAQs about Medi-Cal through Kaiser Permanente

What is Medi-Cal?

Medi-Cal is California’s Medicaid public health insurance program.

The program provides medical, dental, and vision insurance to low-income families in California.

The state of California has been expanding Medi-Cal to a larger and more diverse group of people.

For more on Medi-Cal expansion in California, click here.

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 monthly 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

Medi-Cal Income Limits

To qualify for Medi-Cal based on income, you cannot make more than the income guidelines for that year.

Adults ages 21-64 whose income is at or below 138% of the Federal Poverty Level may qualify for Medi-Cal under Medicaid Expansion.

The Medi-Cal income limits for 2022 based on household size are:

​Family Size​Monthly Income LimitAnnual Income Limit
​1$1,564$18,755
2$2,106$25,268
2 Adults$2,106$25,268
3$2,650$31,782
4$3,192$38,295
5$3,735$44,809
6$4,278$51,323
​7$4,821$57,836
​8$5,363$64,350

What does Medi-Cal Cover?

The Medi-Cal program offers many covered benefits to members, including:

  • Most doctor visits with contracted providers for covered benefit services
  • Preventive care and immunizations
  • Prescriptions
  • Hospital stays
  • Emergency services, including ambulance
  • Family planning
  • OB-GYN services and pregnancy care
  • Lab and x-ray services
  • Health education
  • Vision care (some restrictions apply, available through VSP)
  • Dental care (available through Denti-Cal)
  • Behavioral health (mental health and substance abuse) services
  • Transportation to medical appointments
  • Long-term services and supports (LTSS), including long-term care in a nursing facility, Community-Based Adult Services (CBAS), In-Home Supportive Services (IHSS), and Multipurpose Senior Services Program (MSSP).

How to Apply for Medi-Cal

There are four ways to apply for Medi-Cal in California:

Option 1 – In Person

Apply for Medi-Cal at your Local County Services Office, where you can get personal help completing your application.

Option 2 – By Mail

Download a Medi-Cal application, available in English and other languages, through the Single Streamlined Application, which you can find here.

Send the completed and signed application to the address provided on the form.

Option 3 – By Phone

You can also apply for Medi-Cal over the phone, by calling your Local County Services Office.

Option 4 – Online

The fastest way to apply for Medi-Cal is online. Here, you have two options:

You can apply for Medi-Cal online through Benefitscal.com.

In addition, you can sign up for Medi-Cal online through Covered California.

CoveredCA.com is a joint partnership between Covered California and the Department of Health Care Services.​

In addition to completing your Medi-Cal application, you may be asked to provide additional documents such as:

  • Identification
  • Proof of residency (you must live in the state in which you apply)
  • Proof of Household income

Receive approval for Medi-Cal

Your Medi-Cal application will be reviewed by the county to determine if you qualify for Medi-Cal.

Generally, it takes up to 45 days for a decision to be made on an application.

To check on the status of your application, contact your Local County Services Office.

Benefit Identification Card (BIC)

If you are approved for Medi-Cal, you’ll receive a packet in the mail with your Medi-Cal ID card called a Benefit Identification Card (BIC) from the county.

Once you receive your BIC you can start using your Medi-Cal benefits.

Choose a Health Plan and/or Provider

You must choose a health care plan and/or provider within 30 days of receiving your packet.

If you do not choose a plan and/or provider within 30 days, one will be assigned to you.

The health care plans and/or providers available to you depend on what county you live in.

After you’ve been approved for Medi-Cal, you may be able to choose Kaiser Permanente as your Medi-Cal managed care plan.

Follow the steps below on how to join a medical plan.

How to join a Medi-Cal health plan

  • You must qualify for Medi-Cal to join a medical plan.
  • To join a medical plan, call Health Care Options at 1-800-430-4263. Or you can complete a Medi-Cal Choice Form. You can find the form on the Download forms page.
  • You can use your Medi-Cal Benefits Identification Card (BIC) for services through Regular (Fee-for-Service) Medi-Cal until you are a medical plan member.
  • Health Care Options will send you a letter telling you that your medical plan has changed.
  • Your medical plan will send you information about its services and a medical plan member card.
  • Take your medical plan member card and BIC card with you when you get all medical services, including pharmacy, x-rays, and office visits.

"Choose Kaiser Permanente for Medi-Cal"

How to Get Medi-Cal through Kaiser Permanente

Here’s how to choose Kaiser Permanente as your health care plan and/or provider:

If Kaiser Permanente Medi-Cal is available in your area and you meet one of the following criteria, you can choose Kaiser Permanente as your plan and/or provider:

Either have or had coverage with Kaiser Permanente in the last 6 to 12 months (coverage period depends on your county), OR if you have an immediate family member who is currently a Kaiser Permanente member.

Inside the packet you received in the mail from the county, you’ll find more forms to fill out, including a form that lets you choose Kaiser Permanente.

Once you’ve filled out all the forms in the packet, send them to the return address specified.

What is an immediate family member?

An immediate family member is a family member who lives in the home of a current Kaiser Permanente member and is one of the following:

  • Spouse (including Domestic Partners)
  • An unmarried dependent child under age 21
  • A disabled dependent over the age of 21
  • Married/Stepparents of children under age 21
  • Foster child or stepchild
  • Legal guardian
  • A grandparent, parent, guardian, or another relative who applied on behalf of a child under 21 is eligible to enroll in KP as a qualified family addition based on having the same Medi-Cal Case Number as the child.

Find out if Kaiser Permanente is Available in Your County

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), provider type, and then by address, zip code, or by county.

"how to find Medi-Cal provider in your area"

Receive Your Member Packet from Kaiser Permanente

If you qualify to have Kaiser Permanente as your health care plan and/or provider, it can take an additional 30 days to become enrolled in Kaiser Permanente Medi-Cal.

Please continue to bring your Medi-Cal BIC to your appointments even after you receive your Kaiser Permanente ID card.

Contact Kaiser Permanente about Medi-Cal

If you have questions about enrolling in Kaiser Permanente Medi-Cal plan in your area or you are already enrolled and have questions, here’s the number to call:

Call the Kaiser Permanente Medicaid Assistance Center at:

1-800-557-4515 (toll free) or 711 (TTY),
8 a.m. to 5 p.m., Monday through Friday.
Español: 1-800-545-7263

FAQs about Medi-Cal through Kaiser Permanente

Here are the most frequently asked questions about Medi-Cal through Kaiser Permanente:

Can you get Medi-Cal through Kaiser Permanente?

Yes, you can get Medi-Cal through Kaiser Permanente.

First, you must qualify for Medi-Cal and live in a county where Kaiser Permanente provides Medi-Cal Managed Care services.

However, in order to choose Kaiser Permanente as a provider, you must also meet one of the following two requirements:

1. Have been a Kaiser Permanente member in the last six (6) to twelve (12) months, depending on the county where you live.
OR
2. Be an immediate family member living in the same home as a current Kaiser Permanente member.

How many people does Kaiser Permanente cover through Medi-Cal?

Kaiser Permanente participates in Medi-Cal in many counties.

As of 2022, it had  900,000 Medi-Cal members.

Can I choose my own Kaiser Permanente doctor?

Yes, you can choose your own primary care doctor from Kaiser Permanente’s wide network of doctors.

Additionally, you can also switch to a new Kaiser Permanente doctor at any time.

All available Kaiser Permanente doctors take Kaiser Permanent Medi-Cal members.

To find a Kaiser Permanent doctor, visit kp.org/chooseyourdoctor.

Can I switch my Medi-Cal to Kaiser Permanente?

Yes, you can switch your Medi-Cal plan to Kaiser Permanente.

However, how and when you can do that depends on the type of health plan you:

There are rules around when and how you can switch plans depending on if the plan was purchased through a health exchange or not.

Here’s an overview of your options:

Plan type

What to do

KP Individual and Family plans not purchased from a Health Insurance ExchangeMost plan or account changes may only be made during an annual open enrollment period or in a special enrollment period.

Details on the next open enrollment period and special enrollment periods are available in the “Apply now” section of the Kaiser Permanente Individual and Families page.

KP Individual and Family Plans purchased from a Health Insurance ExchangeMost plan or account changes may only be made during an annual open enrollment period or in a special enrollment period.

To change your current plan, contact the Health Insurance Exchange in your area:

California
Covered California
800-300-1506

What Counties does Kaiser Permanente provide Medi-Cal Plans?

Kaiser Permanente participates in Medi-Cal Managed Care in the following counties.

  • Alameda County
  • Amador County
  • Contra Costa County
  • El Dorado County
  • Fresno County
  • Kern County
  • Kings County
  • Los Angeles County
  • Madera County
  • Marin County
  • Napa County
  • Orange County
  • Placer County
  • Riverside County
  • Sacramento County
  • San Bernardino County
  • San Diego County
  • City & County of San Francisco
  • San Joaquin County
  • San Mateo County
  • Santa Clara County
  • Solano County
  • Sonoma County
  • Ventura County
  • Yolo County

Which drugs are covered under Medi-Cal?

Prescription drugs are covered by the Medi-Cal Rx program.

The Medi-Cal Contract Drug List describes what drugs are covered.

You can get more information from the Medi-Cal Rx Customer Service Line at 1-800-977-2273 (TTY 711), 24 hours a day, 7 days a week.

How long will I receive Medi-Cal with Kaiser Permanente?

Your Medi-Cal benefits will stay active for 1 year if you have no change in circumstances.

A change of circumstances includes a change in income, moving, adding a family member, or divorce.

Every year, your county Medi-Cal office will check whether you meet the Medi-Cal requirements before your Medi-Cal benefits can be renewed.

To learn more about the Medi-Cal annual renewal process, click here.

Can I continue to be a Kaiser Permanente member if I no longer qualify for Medi-Cal?

Yes, if the county determines that you and/or your family no longer qualify for Medi-Cal, here’s what will happen:

Your information will be sent to Covered California to be reviewed for financial assistance through Covered California, and you may be able to stay with Kaiser Permanente.

The county Medi-Cal office will send you more information letting you know what your next steps are.

You do not need to fill out another Covered California application.

What if I am not eligible for Medi-Cal?

If the county determines that you don’t qualify for Medi-Cal, here’s what will happen:

Your information will be sent to Covered California to be reviewed for financial assistance through Covered California. 

CoveredCA.com is a joint partnership between Covered California and the Department of Health Care Services.​

You do not need to fill out another Covered California application.

To check on your transition status, call Covered California at 1-800-300-1506.

What is the difference between Medi-Cal benefits and Covered California health plans?

Medi-Cal and Covered California both offer health coverage.

The maximum income an individual and/or family can have to be eligible for Medi-Cal is lower than for Covered California health plans.

If you qualify for Medi-Cal, most of your health care will be free or low-cost to you and your eligible family members.

Families with higher incomes may find that their children qualify for Medi-Cal coverage while the parents qualify to receive financial assistance on a Covered California health plan.

Medi-Cal through Kaiser Permanente Summary

We hope this post on Medi-Cal through Kaiser Permanente was helpful to you.

If you have any questions about Medicaid in the state of California, or about Kaiser Permanente Medi-Cal plans specifically, you can ask us in the comments section below.

Help us spread the word! If you found this post on California Medi-Cal Eligibility helpful, help us spread the word by sharing it using the “Share this” button below.

Be sure to check out our other articles about Medicaid:

Related Posts

Leave a Reply

Your email address will not be published.