How do I Determine Medi-Cal Eligibility?

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  • Written By: wiseGEEK Writer
  • Edited By: O. Wallace
  • Last Modified Date: 16 October 2019
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The question of how to determine Medi-Cal eligibility is slightly difficult. There are many different ways to qualify for Medi-Cal (the California Medicaid program). In all instances, the California state government determines eligibility, not the individual. The best most people considering applying for Medicaid can do is look at the potential ways to qualify in order to see if they may be eligible.

There are certain qualifying factors. Usually people have a low income, not much more than poverty level, which fluctuates. It’s best to simply ask the office where application occurs what the income levels are. This is not the only potential requirement, and income levels may be different depending on circumstances.

Medi-Cal eligibility also may occur by maintaining a certain status. For instance a person with permanent disability or total blindness qualifies, as do most people participating in food stamps or welfare programs. Being over 65, receiving supplemental security income, or being part of the state foster care program are other ways to qualify. Those with low income under the age of 21 generally are eligible, too.


There is special Medi-Cal eligibility attached to receiving supplemental security income (SSI). This is usually given to those in a certain income level deemed disabled by the state. If a person gets SSI, even $1 US Dollar (USD) a month of it, they automatically receive Medi-Cal. In these cases application for Medi-Cal goes directly through the social security department, and the person remains eligible for it, provided they continue to receive SSI.

The state may also determine Medi-Cal eligibility by looking at some specific factors. Women who have breast or cervical cancer or men, who have breast cancer, may automatically qualify for health services if they meet income requirements. Pregnant women in appropriate income groups are usually accepted, so they get the prenatal care they need. Some refugees to California might receive Medi-Cal, and low-income seniors or people in long-term care facilities can potentially qualify.

Another qualification exists to be eligible. It’s usually necessary to live in the state of California in order to have Medi-Cal eligibility. Residence doesn’t have to be of long duration, but since this program is for Californians, it does have to be established. This is usually simply provided by filling in a California address on the application. If a person is homeless, the address can be a post office box, but in other instances it must be a physical address.

For those applying for Medi-Cal for children, it is possible that income levels will make people ineligible. It isn’t hard to exceed income requirements since they are very low. However, there is another state run program that can help get good medical coverage for kids at very low prices. This is the SCHIP (State Children’s Health Insurance Program).

In California, the SCHIP is called Healthy Families, and it allows for much higher income. It does ask for some contribution by parents, but this is minimal, and far less than a parent would pay for private health insurance. Applications for Medi-Cal do inquire if parents want information about Healthy Families. When people are unsure whether they have Medi-Cal eligibility it may be wise to check the box that directs the Medi-Cal program to send information about Healthy Families if Medicaid is denied.



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