Medi-Cal (Children)

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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 SERVICES 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 CAN BE COVERED?

Children up to their 19th birthday.

IS THERE AN INCOME LIMIT?

Ages 0 to 1 at or below 200% of the federal poverty level (FPL) Ages 1 to 6 at or below 133% of the FPL Ages 6 to 19 at or below 100% of the FPL

IS THERE A PROPERTY LIMIT?

No.

CAN SERVICES BE RECEIVED IF THERE IS OTHER HEALTH INSURANCE?

Yes.

HOW MUCH DOES IT COST?

No 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?

Call toll free 1(877) 597-4777 for a mail-in application. Applications are also available at many neighborhood clinics and hospitals.

Click here for more information.

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

MED-CAL for FAMILIES

WHAT SERVICES 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 CAN BE COVERED?

Parents or needy caretakers, who meet the "family deprivation" requirements such as absence, disability, unemployment or under-employment (countable family earnings up to 100% of the FPL) and children up to their 21st birthday.

IS THERE AN INCOME LIMIT?

Free Medi-Cal is based on monthly income after allowances for child care and working expenses.

Family size
1 person $797
2 $1,069
3 $1,340
4 $1,612
5 $1,884
6 $2,155

Families with income above these limits may have to pay a share of cost for medical services. Note: Other rules may apply which might allow free Medi-Cal in some cases.

IS THERE A PROPERTY LIMIT?

Yes, depending on family size:

Family size
1 person $3000*
2 $3000
3 $3150
4 $3300
5 $3450
6 $3600
7 $3750
8 $3900
9 $4050
10 $4200
  • $3000 for single Parent in the 1931(b) Program
CAN SERVICES BE RECEIVED IF THERE IS OTHER HEALTH INSURANCE?

Yes.

HOW MUCH DOES IT COST?

The family's share of cost depends on the amount of monthly income over the income limits shown.

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?

Mail-In applications are now available. Call the Health & Nutrition Hot Line at 1-877-597-4777 to request an application or apply at a Department of Public Social Service office listed below. Note: A face to face interview is no longer required.

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.

- 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

- 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.

Share of Cost

Some people must pay, or agree to pay, a "Share of Cost" for each month that you have a medical expense. Medi-Cal will then pay the rest of the bills for covered medical services that month.

You do NOT have to pay a Share of Cost if you are in one of the groups that receive free Medi-Cal, in addition to CalWORKs, SSI foster care, adoption assistance, IHSS, 1931(b) Medi-Cal, or several Medi-Cal aged and disabled programs.

Resource Limits

Unless the resource test does not apply to you, your family's resources must be below the following limits to receive Medi-Cal:

# In Family Resource Limit
1 $2,000
2 $3,000
3 $3,150
4 $3,300
5 $3,450
6 $3,600
7 $3,750
8 $3,900
9 $4,050
10 or more $4,200

Some assets do not count. The home you live in, furnishings, personal items, one car, and some non-term life insurance policies do not count. Other real estate with a value under a certain limit is not counted if it is sold or rented.

The Resource Limit does not apply to pregnant women for care related to their pregnancy. The Resource Limit does not apply to children under age 19.

Autos are more restricted in this program. Like CalWORKs, the first car is not automatically exempt from the resource limit. A vehicle, regardless of its value, does not count if is worth less than $1500 after deducting what you still owe on it and the cost of repairs and damages. Also, a vehicle worth less than $4650 does not count. If an auto is worth more than that, the extra amount counts against the $3000 resource limit.

Section 1931(B) Medi-Cal

You are probably receiving "Section 1931(b)" Medi-Cal if you are caring for a child or children under 19, and you are getting free Medi-Cal which is not based on a disability. For this program, the resource limit for either one or for two persons is $3000. Otherwise, the limits are the same as on the above chart.

Autos are more restricted in this program. Like CalWORKs, the first car is not automatically exempt from the resource limit. A vehicle, regardless of its value, does not count if is worth less than $1500 after deducting what you still owe on it and the cost of repairs and damages. Also, a vehicle worth less than $4650 does not count. If an auto is worth more than that, the extra amount counts against the $3000 resource limit.

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.

Transitional Medi-Cal

You might be eligible for up to 2 years of free (no Share of Cost) Medi-Cal (called transitional Medi-Cal or TMC) if you lost CalWORKs or Section 1931(b) Medi-Cal because you started to work and are earning too much money. To be eligible, you must have received CalWORKs or Section 1931(b) Medi-Cal during at least 3 of the last 6 months, and you lost CalWORKs or Section 1931(b) Medi-Cal because you started making too much money.

During the first six months of TMC, if you are eligible, you and your family qualify for free Medi-Cal no matter how much income you have. After that, you remain eligible if your income is not more than the limits in the chart below.

Adults can get TMC for up to two years, and children can receive it for up to one year. There is no lifetime limit on TMC. If your income goes down, you can qualify again for regular Medi-Cal. If your income then goes up again, you can return to TMC with new time limits.

There are no "resource" or property limits of TMC. During the first year, TMC requires regular reports like a CW-7, but on a different form.

Income Limit for Transitional Medi-Cal

# In Family Gross Income Limit
1 $1,395
2 $1,871
3 $2,346
4 $2,821
5 $3,297
6 $3,772

Four-Month Continuing Medi-Cal=

If you lose CalWORKs or Section 1931(b) because you start receiving more child or spousal support, an adult can receive free Continuing Medi-Cal, regardless of income, but just for 4 months. It is important that you turn in a CW-7 or any other change reporting form explaining why you are leaving CalWORKs or Section 1931(b), to help make sure you get Transitional or Continuing Medi-Cal.

The children's free Medi-Cal continues until their next scheduled annual redetermination, perhaps as long as a year, because of "CEC" (Continuous Eligibility for Children.)

"Bridge" for children from Medi-cal to Healthy Families

If Medi-cal determines that your child is no longer eligible for no-cost Medi-Cal because of a change in family circumstances (e.g. because your family income has increased), DPSS is supposed to continue your child's Medi-Cal for at least one month while the county sends the information (with your permission) to Healthy Families to see if your child qualifies for that program. This is called the "Bridging Program."

You should not be required to apply separately for Healthy Families or to provide any information again, unless Healthy Families needs more information from you to find you eligible.

You keep your Medi-Cal until DPSS proves you are no longer eligible DPSS must send you a written notice of action at least 10 days before it cuts off, denies, delays or reduces your Medi-Cal benefits. The notice explains its action and your right to ask for a fair hearing.

Once you start receiving Medi-Cal benefits, you have a special right called redetermination. That means that when a change occurs affecting your Medi-Cal eligibility, DPSS must determine whether you are eligible for any other type of Medi-cal, before sending you a notice of action cutting off your benefits. They have to look in your available records, including CalWORKs, Food Stamps and other records for any missing necessary information.

DPSS can send you a form that only asks for the information it needs; it can not ask for information it already has or does not need to determine whether you are still eligible for Medi-Cal.

DPSS must give you at least 20 days to complete the form. If you do not send in a completed form, DPSS will send you a written notice of action that you will lose your Medi-Cal benefits. If your form is incomplete, DPSS must first try to contact you by telephone and in writing to get missing information before it cuts your benefits.

If you send in your form within 30 days of being cut from Medi-Cal, and that information show you were still eligible, DPSS must restore Medi-Cal benefits without making you reapply.

You keep your Medi-Cal if you move within California

You should have no redetermination or interruption of service if you move. Keep using your BIC (Medi-Cal) card. If you move to a new county, report if you can to DPSS and also to the welfare office in the new county, and the counties will manage the transferring of your case.

If You Were Billed Twice

The doctor or health service provider cannot bill both you and Medi-Cal for the same care. If you think your doctor has billed you unfairly, you should contact your local health Consumer Center or legal aid.

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.

MINOR CONSENT Medi-Cal

If you are between 12 and 21 years old, you can apply for " Minor Consent Services" to get free and confidential medical treatment without parental consent related to:

  • Drug or alcohol abuse (except methadone treatment)
  • Sexually transmitted diseases
  • Pregnancy and abortion
  • Family planning
  • Outpatient mental health (not overnight in a hospital)
  • Sexual abuse.

If you are under 21 and living with your parents, or temporarily away such as in school, you may apply for Medi-Cal to cover those specific services without your parents' consent or knowledge. Your parents will not be required to give information about their income or resources or pay toward the medical services, unless you want Medi-cal for services other than those listed above. The DPSS will not tell your parents or send Medi-Cal mailings to your home without your permission. "Minor Consent Services" are available regardless of your immigration status. They provide more services than Medi-Cal that is restricted due to immigration status.

To apply, fill out the regular Medi-Cal application and another short form for Minor Consent Services at DOSS or with an Eligibility Worker at the site where you are receiving care. You will have to fill out a new short form each month you need treatment, except for mental health services. For mental health services, you need a letter from a mental health professional explaining that you meet certain conditions for receiving mental health services and how long you will need treatment. You will then be able to obtain a paper Medi-Cal card that cover up to six months. You will still have to pick up a new card or have it mailed to you each month.

Do not throw away your paper Medi-Cal cards because if you remain eligible for Minor Consent Services, you can use them for up to 12 months from the date they were issued. If you already receive Medi-Cal through your parents' case, you may already have a plastic Medi-Cal card. Do not use the plastic card for Minor Consent Services.

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