California Health Insurance
California’s Medicaid State Plan
The Medicaid State Plan is based on the requirements set forth in Title XIX of the Social Security Act and is a comprehensive written document created by the State Of California that describes the nature and scope of its Medicaid (Medi-Cal) program. It serves as a contractual agreement between the State of California and the federal government and must be administered in conformity with specific requirements of Title XIX of the Social Security Act and regulations outlined in Chapter IV of the Code of Federal Regulations. The State Plan contains all information necessary for the Centers for Medicare and Medicaid Services (CMS) to determine if the State can receive Federal Financial Participation (FFP).
What is Medi-Cal?
Medi-Cal is California’s Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources. Medi-Cal is supported by federal and state taxes. You can apply for Medi-Cal benefits regardless of sex, race, religion, color, national origin, sexual orientation, marital status, age, disability, or veteran status. If you are found (or determined) eligible, you can get Medi-Cal as long as you continue to meet the eligibility requirements
Your local County Welfare/Social Services Department manages Medi-Cal eligibility determinations. If you have questions, you can find the addresses and telephone numbers under County Social Services Office Listing.
How Can Medi-Cal Help You?
The Medi-Cal program assists Californians in various family and medical situations. When you apply, the information you provide on your Medi-Cal Application and any required verification (proof) will be used to determine which program(s) you qualify for, and which program is best for you and your family.
Who Can Get Medi-Cal?
People in many different situations qualify for Medi-Cal. They are listed below. If you are not in one of these groups, call your county social service agency to determine if you qualify for a county-operated medical assistance program.
You may automatically be eligible for Medi-Cal if you receive cash assistance under one of the following programs:
SSI/SSP (Supplemental Security Income/State Supplemental Program)
CalWORKs (California Work Opportunity and Responsibility to Kids). Previously called Aid to Families with Dependent Children (AFDC).
Refugee Assistance
Foster Care or Adoption Assistance Program.
Even if you don’t receive cash assistance, you may be eligible for Medi-Cal if you are one of the following:
65 or older
Blind
Disabled
Under 21
Pregnant
Diagnosed with breast or cervical cancer
In a skilled nursing or intermediate care facility.
Refugee status during a limited period of eligibility. Adult refugees may or may not be eligible depending upon how long they have been in the U.S.
Parent or caretaker relative of a child under 21 and
The child’s parent is deceased or does not live with the child, or
The child’s parent is incapacitated, or
The child’s parent who is the primary wage earner is unemployed or underemployed.
Do I have to Live in California to Get Medi-Cal?
Yes, you must be a resident of California to get Medi-Cal. A California resident is someone who lives here and plans to stay here, or someone who is working or looking for work in California.
How Do I Apply for Medi-Cal?
Call or visit your local county social services office and ask for a Medi-Cal application.
If you need help filling out the forms, call the county social services agency. Mail or take your application with the required verifications (proof) to the nearest social services office in your county. If you do not have all your verifications, or are not sure of what you need, please send what you have. You can send the rest later. The sooner the social services agency receives your application, the sooner your case may be processed and your Medi-Cal benefits can begin.
If you get SSI/SSP payments, your Social Security administration office automatically sets up Medi-Cal for you. No separate application for Medi-Cal is needed. You will get your Medi-Cal card (BIC) in the mail.
If you get CalWORKs payments, the county social services agency automatically sets up Medi-Cal for you. No separate Medi-Cal application is needed. You will get your Medi-Cal card (BIC) in the mail.
How Long Does It Take?
Forty-five (45) days are allowed to process a Medi-Cal application not involving a disability. If you are applying for Medi-Cal based on a disability, your application process may take up to 90 days depending on how quickly you complete the disability information and when your doctors and hospitals submit your medical records. To avoid processing delays, submit all information requested of you as soon as possible. Ask your eligibility worker for help if you cannot get the information. If you have an immediate medical or dental need, such as pregnancy or a severe illness, indicate this need on your application and your application may be processed more quickly
Specific Situations
What If I’m Pregnant?
Many health care providers can offer you immediate, temporary, pregnancy related Medi-Cal services under a program called Presumptive Eligibility for Pregnant Women. If you are pregnant or think you are pregnant, ask if your health care provider participates in this program. If you would like further information, please call 1(800) 824-0088.
General Information
Contact: 916-445-4171
Contact: MCI from TDD 1-800-735-2929
MCI from voice telephone 1-800-735-2922
Contact: Sprint from TDD 1-800-877-5378
Sprint from voice telephone 1-800-877-5379
