Medi-Cal (Senior)

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Medi-Cal is California's program to pay for medical care for low-income people, especially families, children, and the elderly.

Contents

Frequently Asked Questions

WHAT SERVICE ARE OFFERED?
  • Comprehensive preventive care services, primary and specialty care.
  • Medical office visits, vision care, dental care and mental health services.
  • Hospitalization and prescription medicines.
WHO AND BE COVERED?
Persons age 65 or older OR disabled by Social Security standards.
IS THERE AN INCOME LIMIT?
100% of the Poverty Level plus a special deduction
  • Qualified Individual: $1,060
  • Qualified Couple: $1,421
IS THERE A PROPERTY LIMIT?
Yes, same as regular Medi-Cal, depending on family size:
  • 1 Person $2000
  • 2 Person $3000
CAN SERVICES BE RECEIVED IF THERE IS OTHER HEALTH INSURANCE?
Yes.
HOW MUCH DOES IT COST?
Qualified individuals or couples receive zero Share of Cost.
IS CITIZENSHIP OR LEGAL RESIDENCY REQUIRED?
Yes, for full coverage.
If not a legal resident, the person may be eligible for emergency services only.
WHERE TO APPLY?
Apply at a Departmental of Public Social Services office listed below.

Click here to find your DPSS Office information in the Los Angeles County.

Department of Public Social Services Medi-Cal District Offices

City Address Phone
Belvedere 5445 E. Whittier Blvd., LA 90022 (323)727-4542
Civic Center 813 E. 4th Place, LA 90013 (213)974-0222
Compton 211 E. Alondra Blvd., LA 90220 (310)603-8411
Cudahy 8130 S. Atlantic Blvd., Cudahy 90201 (323)560-5112
East Valley 14545 Lanark St., Panorama City 90201 (818)901-4134
El Monte 3350 Aerojet Ave., El Monte 91731 (626)569-3155
Florence 1740 E. Gage Ave., LA 90001 (323)586-7299
Glendale 4680 San Fernando Rd., Glendale 91204 (818)546-6286
Lancaster 349-B. Avenue K-6, Lancaster 93535 (661)951-3450
Lincoln Heights 4077 N. Mission Rd., LA 90032 (323)342-8180
Metro Special 2707 S. Grand Ave., LA 90007 (213)744-5611
Norwalk 12727 Norwalk Blvd., Norwalk 90650 (562)807-7820
Paramount 2961 E. Victoria Ave., Rancho Dominguez 90221 (562)603-2038
Pomona 2040 W. Holt Ave., Pomona 91768 (909)868-6499
Rancho Park Special 11110 W. Pico Blvd., LA 90064 (310)481-5309
South Central 10728 S. Central Ave., LA 90059 (323)357-3035
South Family 17600 "A" Santa Fe, Rancho Dominguez 90211 (310)761-2261
Southwest Special 1326 W. Imperial Hwy., LA 90044 (323)418-2200
West Valley 21415 Plummer St., Chatsworth, 91311 (818)718-5356
Wilshire Special 2415 W. 6th St., LA 90057 (213)738-4505
Orange County
2020 W Walnut Street (First St & Walnut St), Santa Ana 92703; Phone 714-834-8892
Riverside County
Magnolia Ave., Riverside; Phone 951-358-3400
San Diego County
7947 Mission Center; Phone 619-531-4703

APPLYING FOR Medi-Cal

How do you apply?

You can get an application form mailed to you by calling the DPSS toll-free number at (877) 597-4777. You can also get one at a DPSS Office at most hospitals and clinics, private or County-run.

  1. Provide needed papers, which include:
    • Identification with your name and current address on it. For example, a birth certificate, driver's license, or California ID card. If you lack ID, you can also fill out a form called "PA853" and swear that you are who you say you are
    • Social Security Number or Card (or proof of application for the card)
    • Proof of income (like check stubs, a W2, a copy of your tax return, or monthly bank statements if you have a bank account)
    • Proof that you live in Los Angeles County (a document that has your name and an address on it, school attendance records, pay stubs, etc.) for each adult on the application. To be eligible, you must live in the state and intend to stay. THE "RESIDENCY" QUESTION DOES NOT REFER TO IMMIGRATION STATUS AT ALL! You can be both undocumented and a "resident."
    • Proof of citizenship or acceptable immigration status for each person on the application that has citizenship or acceptable immigration status.
    • Auto payment papers and registration
    • Any papers having to do with marriage, divorce, child support, or other circumstances that apply to your family
  2. Wait for Approval

Normally, the Medi-Cal office will approve or deny your application within 45 days of receiving your documents. If the state must evaluate a disability, the approval or denial can be delayed up to 90 days. Call (877) 597-4777 or a legal aid office for help if you are not contacted about your Medi-Cal within these 45 days.

The Medi-Cal card

Once you have been "approved," you can ask your DPSS worker for a Medi-Cal card for the current month. This paper card is called a "current month" or "immediate need" card. DPSS must give you one the same day you ask for it. You do not need to have a medical emergency to get your "current month" card.

Your permanent white plastic Medi-Cal card is mailed to your address. It has been re-named a "Benefit Identification Card" or BIC. Each person listed on your application will receive one, even if they are not eligible for Medi-Cal --- if the family must pay a monthly Share of Cost, the medical expenses of every person listed on the application can be used to meet the Share of Cost.

If you do not receive your plastic card by the end of the month, or if you lose your card, contact your DPSS worker.

Authorization for service

Before many medical services can be performed for you, the state has to give an authorization for the service. (This does NOT apply to emergency care, office visits, and most drugs). It is the job of the doctor, pharmacist, or other service provider --- not the patient --- to get this authorization from the state. However, if the state denies or changes the authorization, the state will notify you and your doctor. You can appeal any unreasonable delay, denial, reduction, or termination of care.

Income Limits

Your countable income determines whether or not you can get Medi-Cal for free, or whether or not you have to pay a monthly "Share of Cost." Certain types of income do not count or can be subtracted. The several different Medi-Cal programs count the income limits differently.

As described below, in some Medi-Cal programs, hundreds of dollars of your gross total income will not be counted. Medi-Cal can only count the income of the family unit being given the Medi-Cal benefit. Do not count the income of your grandparents, brothers, sisters, uncles, aunts, cousins, friends or others who live in the house but are not part of the application.

As a general rule, families applying for Medi-Cal can deduct from total monthly income:

  • $90 for each working adult
  • Up to $175 for childcare for each child age two and over
  • Court-ordered child and spousal support paid
  • Educational expenses
  • Business expenses of self-employed parents

After qualifying there are other deductions that also apply in figuring monthly share of cost, such as the first $240 of income plus half the remaining earned income.

Elderly (65 and older), blind or disabled persons applying for Medi-Cal can deduct from total monthly income:

  • $20
  • $65 from earned income
  • Half of any remaining earned income
  • Health insurance premiums paid by you

STAYING ON Medi-Cal

Once a Year Eligibility Form

People receiving Medi-Cal must have their eligibility rechecked (or "redetermined") every 12 months. As part of the budget cutbacks as of July 1, 2003, the state has been debating about making you redetermine eligibility every 3 months.

You receive a form in the mail, fill it out, and then send it back. You do not have to send in copies of documents with your redetermination form. Until his or her 19th birthday, a child only has to report changes in income or who is in the household at this annual eligibility review.

Reporting Changes for Adults

Adults must report to DPSS any significant changes that may affect eligibility within 10 days after the change. You must quickly report to your DPSS worker if you move, begin making more money (or less money), some one moves in or out of your house, or you are pregnant. Even if you report a change that hurts your eligibility, you have important rights before the DPSS cuts your Medi-Cal.

Losing welfare does not mean that you lose Medi-Cal Cal WORKs and Medi-Cal have different eligibility rules. While you automatically receive Medi-Cal when you participate in CalWORKs, a loss of CalWORKs cash aid (for example because of a sanction or time-limit) does not mean that you lose free Medi-Cal.

PROBLEMS WITH YOUR Medi-Cal

Lost or Stolen Cards

Replacement cards are available the same day. If you applied for Medi-Cal through DPSS, you may receive cards at your welfare office.

Hearings, Grievances, and Leaving a HMO

If your HMO denies services, or you are not satisfied with the HMO, you have many options. You can file a grievance with the HMO. Your HMO must tell you how to file a grievance. The HMO must resolve your grievance within 30 days, or less if you have an emergency. If you are still not satisfied, you can file a complaint in writing to the Department of Managed Health Care, HMO Help Center, IMR Unit, 980 Ninth Street, Suite 500, Sacramento, CA 95814-2725. The phone number is (888) HMO-2219, TDD (877) 688-9891. You can also go to the website at www.hmohelp.ca.gov.

Mandatory participants in HMOs can change to a different HMO for any reason. Voluntary participants can change HMOs or go back to regular Medi-Cal for any reason. To change or leave an HMO, call Health Care Options at (800) 430-4263 and request a "choice form."

If you want help with complaints and grievances, call an advocacy group for assistance, or call the Health Care Consumer Center at (800) 896-3203 or the Managed Care Ombudsman at (888) 452-8609. You can also find information online at www.dmhc.ca.gov/gethelp/complaint.asp.

You can call (800) 400-0815 if your HMO gives you problems. For more information on HMOs, call the Medi-cal Managed Care Education Project at (213) 532-3919

If your HMO is denying you care because it does not think it is medically necessary, but you disagree, you can ask for an independent medical review. An independent medical review is done by a group of doctors and professionals who do not work or accept money from your HMO.

You also have the right to ask for a fair hearing.

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