Medicaid and Medi-Cal

Medicaid began in 1965 as part of the Social Security Act. It is a health care program that is paid for by both the states and the federal government. Each state administers its own Medicaid program and determines the benefits it will provide. The federal government makes sure states provide certain mandatory benefits, and in addition to these, the state may offer other optional benefits. Federal law also requires states to cover certain groups of people in its Medicaid program including children, parents and pregnant women with low income, as well as older adults and people with disabilities with low income. States can choose to further their coverage to cover other groups.

Medi-Cal is the name of the Medicaid program in California. Medi-Cal is a program that assists low income families and individuals with medically necessary procedures, treatment and services. In order to qualify for Medi-Cal you must:

  • Live in California
  • Be in the U.S. legally or be a citizen
  • Meet the income requirements
  • Meet the age requirements for particular Medi-Cal programs

There are three ways to apply for Medi-Cal :

  • Online (www.benefitscal.org)
  • In person (Call 1-800-541-5555 to find where the nearest County Social Services office is located)
  • By mail (download a Medi-Cal application HERE

When you apply for Medi-Cal, you will be asked to present the proper documentation to determine your eligibility such as income verification, paycheck stubs and other resources.

If you are not eligible for Medicaid/Medi-Cal and have children, your children can still be covered. The Children’s Health Insurance Program (CHIP) was created in 1997 to provide health coverage to low-income children in working families who make too much money to be eligible for Medicaid but not enough to afford private insurance. Despite the program’s success in California, there are still many children that are not enrolled and remain without health coverage.

In 2009 the Children’s Health Insurance Program Reauthorization Act (CHIPRA) was implemented, it allows states to cover more children and help close the gaps in the original program. One of the most important components of CHIPRA was the elimination of the federal requirement that new immigrant children, otherwise eligible for the program, had to wait five years before enrolling in either Medicaid or CHIP. The removal of the bar means that eligible children can be enrolled regardless of how long they have been in the United States.

California community clinics and health centers (CCHCs) have partnered with the Centers for Medicare and Medicaid Services (CMS) to enroll children into these federally-funded insurance programs. The community clinics and health centers offer outreach and enrollment assistance to families, but they also provide a variety of health care services including primary care check-ups, vaccinations and immunizations, dental care, and nutrition and health education.

Your child may be eligible for coverage under these insurance programs and can be enrolled today! To find a community clinic or health center in your area to help you with enrollment call 1-888-895-0808 (toll free) or visit www.cpca.org/cpca/index.cfm/finda-clinic/.