Medi-Cal Facts

Who can get Medi-Cal?

The Medi-Cal Program is California’s version of Medicaid.  It is a public health insurance program funded by the State and Federal governments.  Medi-Cal provides health coverage for low-income individuals including families with children, seniors, individuals with disabilities, children in foster care, pregnant women, and low-income people with specific diseases such as tuberculosis, breast cancer, or HIV/AIDS.

Who may be eligible for Medi-Cal?

• Families with children
• Persons under 21 years or 65 years of age and older
• Pregnant women
• Blind or disabled persons
• Recipients of nursing home or long term care facility
• Refugees

Is Medi-Cal free or is there a co-payment?

Medi-Cal is not always free. Income is used to determine if an individual or a family is eligible for free Medi-Cal or Medi-Cal with a "share of cost" (also called a "co-payment" and is similar to a "deductible"). If your income exceeds the Medi-Cal income limit, then there will be a monthly share of cost. A share of cost is the amount of medical expenses that a person receiving Medi-Cal benefits must pay, or is required to pay, before Medi-Cal will cover any medical expenses.

NOTE: If Medi-Cal is not used in a given month, no share of cost will need to be paid in that month.

Will I have a share of cost?

• If your income is less than the Medi-Cal income limits for your family size, you will receive Medi-Cal services at no cost to you.
• If your income is more than the Medi-Cal income limits for your family size, you will have to pay a certain amount, but only in the month you have medical expenses. The amount that you pay is called your share of cost. Once you have met your share of cost, Medi-Cal will pay the rest of your covered medical bills for that month.

What is considered Income?

Income is important to determine eligibility and includes income such as:

• earnings from a job
• unemployment benefits
• disability benefits
• self-employment income
• retirement benefits
• child or spousal support
• free rent, utilities, food, and/or clothing
• and other means of income or support.

What about my resources?

Property is a factor in determining eligibility for Medi-Cal and can not be worth more than the specific Medi-Cal property limits.

Property includes:

• land
• houses
• bank accounts
• Insurance policies
• retirement accounts
• stocks
• bonds
• cash on hand
• trusts
• vehicles

Property limits vary according to family size and program category.

Property limits for most Medi-Cal programs are

*Note - Certain types of property are excluded, such as the home you live in. Certain motor vehicles may also be exempt depending upon the specific Medi-Cal program for which you quality.”

What documents are needed?

• Personal identification
• Proof of residency
• Proof of household income and assets
• U.S. Citizenship documentation for certain U.S. Citizens and U.S. Nationals

Can I have private insurance?

Yes, but you are required to report any private health insurance coverage you have to the county department. Generally, your private insurance will be billed before Medi-Cal, because your private insurance becomes the “primary” insurance and Medi-Cal the “secondary” insurance.

What are Medi-Cal special programs?

Medi-Cal is made up of a variety of programs for specific groups of people with certain attributes and income levels.

• Certain adults and children with higher income property limits may be eligible for special programs.
• Pregnant women and children may be eligible for special programs which allow higher income limits and have no property limits.
• Seniors and disabled individuals may be eligible for programs that allow special income deductions and higher income limits, and programs that help pay Medicare expenses.
• Youth under 21 years old may be eligible for the Minor Consent program which provides confidential services.

What is retroactive coverage?

An applicant may be eligible for Medi-Cal coverage in any of the three months immediately proceeding the month of application or re-application, if all requirements are met for those past months. An individual, family or child who is eligible for benefits on any day of the month is entitled to services for that entire month.

Interview language

Applicants may be interviewed in the following languages: English, Spanish, and others if necessary.  TTY is also available.

Your Rights

Whether you are eligible or not, you have the right to be treated with dignity, respect, and courtesy when you apply for Medi-Cal. The Human Services Department will not discriminate against anyone because of race, color, national origin, political affiliation, religion, age, sex, marital status, sexual orientation, or condition of physical or mental disability. If you believe you have not been treated equally, contact the Human Services Department Civil Rights Coordinator at (831) 454-4117.

Where do I apply?

Apply online by visiting:  www.benefitscalwin.org  OR

Visit us at our two Human Services Department application centers located at:

You may download an application from the internet, or call one of our application centers to have one mailed to you, or you may begin the process in by phone.

• If you cannot come to the application center, you may authorize someone who knows your circumstances. They can apply and be interviewed for you.
• If you are disabled and and need help to apply, you can apply by mail or phone by calling the Benefits Call Center toll free at 1 (888) 421-8080.

If you currently receive Food Stamps and/or Medi-Cal benefits and have questions, please contact the Benefits Call Center toll free at 1 (888) 421-8080

This Fact Sheet is not to be used as a substitute for state Medi-Cal regulations. The Santa Cruz Department of Human Services has copies of the state regulations you may review.