Who can become a Medi-Cal Beneficiary? A Guide for California Residents

Are you wondering who can get Medi-Cal benefits? In general, Medi-Cal is a program that is intended for families with children, adults with low income, pregnant women, people with disabilities, elderly, former foster youth (up to 26 years old), and children in foster care.

But even though you have a house, a spouse, and a job, you may qualify for Medi-Cal services. Before you apply for one, you have to check first if you are eligible. Here are the categories identified as eligible patients under the Medi-Cal program:

Public assistance groups

  • Seniors aged 65 and above and persons with disability who get Supplemental Security Income/State Supplementary Payment programs
  • People who get California Work Opportunity and Responsibility to Kids
  • California residents who are beneficiaries of other kinds of public assistance programs

Medically needy groups

  • Seniors aged 65 and above and persons with disability
  • California residents who meet the requirements for CalWORKS, e.g., children under 21 who are not supported by at least one parent because of death, absence, incapacity, and other reasons

Medically indigent groups

  • Adults aged 21 to 65 who are in a nursing care facility
  • Pregnant women without connection to a public assistance program
  • Children under 21, including kids in foster care
  • Children who qualify for the State-only Aid for Adoption Assistance Program

Special programs

  • Children aged 1 to 18
  • Children under age 21 who receive assistance from the Former Foster Child Program
  • Pregnant women who cannot afford the cost of health care for themselves and their unborn child
  • Refugees who are not eligible for the medically needy or medically indigent programs
  • Non-U.S. citizens who are victims of human trafficking and other serious crimes
  • People under the age of 21, unmarried, and living with parents can avail of confidential medical services relating to pregnancy, family planning, drug abuse, mental health, sexually transmitted diseases, and sexual assault.
  • People who need parenteral hyperalimentation services or dialysis treatment
  • Immigrants who satisfy all Medi-Cal eligibility requirements

For more information regarding your eligibility, you can contact your county eligibility worker.

How to Apply for Medi-Cal Program: A Guide for Health Care in California

Looking for information on Medi-Cal application procedures? You can apply personally in the social services office of your county or in a hospital or health clinic where Medi-Cal county eligibility workers are based.

Typically, here are the steps you need to take to apply for the Medi-Cal program:

1. Get a Medi-Cal application.

Contact or visit the social services office of your county to request for sending a Medi-Cal application to your home address. If you have an urgent need or medical emergency, you will have to fill out the form and bring it to the nearest social services office in your county. Inform the office that you are in need of immediate medical attention. Your Medi-Cal application will then be processed as soon as possible.

2. Complete the application form.

Make sure you answer all entries and check out the list of required documents for Medi-Cal applications.

3. Request for a Medi-Cal retroactive coverage.

This step is applicable to if you have unpaid medical bills within 3 months before you apply for Medi-Cal, and you need funding assistance for those bills. If you have paid the bills already, you can ask for reimbursement.

4. Send the completed application form and required documents.

You can do so personally or via mail to the county social services office.

5. Wait for your Medi-Cal application processing to be completed.

It may take a maximum of 45 days to process your application. It may take longer (90 days) if your Medi-Cal application is based on disability.

6. You will receive the results of your application via mail.

The letter will inform you whether your Medi-Cal application is approved or declined. However, if you have not received a feedback about your application after 45 days, contact the county social services office.

If you need more information regarding Medi-Cal applications, call the social services office in your county.

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