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Medi-Cal Health Insurance

Attention: All Alameda County Medi-Cal Recipients

  • In response to COVID-19 (Coronavirus), if your Medi-Cal annual renewal was due in March, or will be due in April, May, or June 2020, please continue to submit your annual Medi-Cal renewal as it will be processed at a later date.
  • If you currently pay a premium for your Medi-Cal and you are affected by COVID-19, please contact MAXIMUS at 1-800-880-5305 for a premium waiver.

For more information, click here.

Medi-Cal is California's Medicaid program. This is a public health insurance program which provides health care services for low-income individuals, including families with children, seniors, persons with disabilities, foster care, pregnant women, and low-income people with specific diseases such as tuberculosis, breast cancer, or HIV/AIDS.

The Medi-Cal programs have different eligibility requirements and fall under two main categories: MAGI and Non-MAGI. Following the implementation of Health Care Reform in 2014, Medi-Cal expanded to include a larger population. An Eligibility Services Technician (EST) will assess your Medi-Cal eligibility and evaluate which program is the best fit for you.

Modified Adjusted Gross Income (MAGI) Medi-Cal

Modified Adjusted Gross Income (MAGI) Medi-Cal provides free health care for those that meet the income requirements. MAGI Medi-Cal does not require property verification. The following groups may be eligible for MAGI Medi-Cal under the new program rules:

  • Adults (age 19-64)
  • Parents/Caretaker Relatives
  • Children (up to age 19)

Eligibility for Modified Adjusted Gross Income (MAGI) Medi-Cal depends on the following criteria:

Residency

California residency is a requirement for the Medi-Cal program. Residency requirements are met when the applicant:

  • Is physically present and is living in California with the intent to remain permanently, or for an indefinite period
  • Provides acceptable verification of California residency

Income

MAGI Medi-Cal utilizes the adjusted income reported to the IRS on the 1040 to determine eligibility. Income is limited to 138% of the Federal Poverty Level (FPL) for adults and 266% for children. Generally, the income is based on the tax filing household.

Children with parents whose income is between 160% and 266% will have a monthly premium for MAGI Medi-Cal.

Citizenship/Immigration Status

MAGI Medi-Cal benefits are split into two categories of eligibility: Full Scope and Restricted. The table below applies to Non-MAGI Medi-Cal as well.

 

Medi-cal Full Scope Restricted Scope
Who is eligible?
  • U.S. Citizens
  • Eligible Immigrants
  • Undocumented Children
  • Adults aged 19-25 regardless of immigration status*
  • Adults over the age of 25 without Satisfactory Immigration Status
What is covered?
  • Doctor visits
  • Hospital care
  • Vision
  • Mental health
  • Pregnancy
  • Family planning
  • X-Rays and mammograms
  • Tuberculosis
  • Renal Dialysis
  • Emergency care
  • Pregnancy and postpartum
  • Tuberculosis
  • Renal dialysis

*Effective January 1, 2020, a new law in California will give full scope Medi-Cal to young adults under the age of 26 who qualify for Medi-Cal regardless of immigration status

Non-MAGI Medi-Cal

Non-MAGI Medi-Cal provides health care to all groups who were eligible for Medi-Cal before healthcare reform.

Eligibility for Non-MAGI Medi-Cal includes:

  • Aged
  • Disabled
  • Blind
  • Long Term Care (LTC)
  • Refugee
  • Confidential youth medical services
  • Families with children
  • Children

Eligibility for Non-MAGI Medi-Cal eligibility depends on the following criteria:

Residency

California residency is a requirement for the Medi-Cal program. Residency requirements are met when the applicant:

  • Is physically present and is living in California with the intent to remain permanently, or for an indefinite period
  • Provides acceptable verification of California residency

Age

Eligibility for Non-MAGI Medi-Cal includes:

  • Children age 0-19 and their parent/caretaker relatives
  • Adults age 19-64 who are aged, disabled, blind, in long term care, or are a refugee
  • Adults over age 65

Citizenship/Immigration Status

Non-MAGI Medi-Cal benefits are split into two categories of eligibility: Full Scope and Restricted.

Property

There are two types of property counted for Non-MAGI Medi-Cal:

  • Personal Property: Includes bank accounts (checking and savings), stocks, bonds, cash on hand, etc.
  • Real Property: Land, houses, other buildings, etc.

Income

The income limits for Non-MAGI vary according to family size and program category. Income is used to determine if an individual/family is eligible for free Medi-Cal or Medi-Cal with a Share of Cost (SOC). Income over the limit becomes the monthly SOC, which is like a monthly deductible. It is the amount of medical expenses that a Medi-Cal beneficiary must pay before Medi-Cal will cover any medical expenses. If Medi-Cal is not used in a given month, no SOC will need to be paid that month.

Eligibility Requirements

To see if you may qualify for Medi-Cal benefits visit: Do I qualify for Medi-Cal Benefits?

If you are not eligible for Medi-Cal, we can help refer you to affordable private health insurance offered by Covered California.

For other health care programs click below:

How to Apply for Medi-Cal

You can enroll in Medi-Cal during any month of the year. You have several options to apply for Medi-Cal. Remember, no matter which option you choose, you should not pay anyone to help you with the completion of this application.

Apply Online

To apply for Medi-Cal online, visit MyBenefitsCalWIN. Here you may apply for cash aid (CalWORKs), Medi-Cal, and CalFresh.

We recommend that you create a MyBenefitsCalWIN account so you can save your information and return to it later.

You may also apply at Coveredca.com.

Apply by Phone

To apply by phone, please call (510) 777-2300 or 1-800-698-1118 (toll free) to request a Medi-Cal Mail-In Application and Instructions booklet.

Apply by Mail

To apply for Medi-Cal by mail, you can mail your Medi-Cal Mail-In Application to any of our office locations.

You may click here for a Medi-Cal Printable Application: Medi-Cal Single Streamlined Application. PDF fill-and-print forms may be completed online and printed to hardcopy to be signed and mailed. Translated forms can be found here.

If applying for Medi-Cal and other programs, such as CalFresh, CalWORKs, or Refugee Cash Assistance use the Form SAWS 2 Plus.

Apply in Person

If you wish to apply for Medi-Cal in person, you may go to one of the following Alameda County Social Services Agency public contact offices Monday through Friday between 8:30 a.m. and 5:00 p.m.

Required Documents

You may be asked to provide certain documentation before your Medi-Cal can be approved if the information cannot be verified electronically. The eligibility worker will tell you what proof is needed. You may apply without the proof, but you may have to provide it later.

It will be easier to process your application if you have the following ready:

  • Proof of income - Pay stubs, Social Security award letter, child support and alimony, unemployment/disability stubs, or veteran benefits
  • Proof of residency - Rent or mortgage receipt or utility bill

You may also be asked to provide information about:

  • Proof of income - Pay stubs, Social Security award letter, child support and alimony, unemployment/disability stubs, or veteran benefits
  • Resources - Checking and savings account statements, savings bonds, stock certificates, retirement accounts, vehicle registration

Medi-Cal Services

Health Plan Options

If approved for Medi-Cal, you will need to visit or call a Health Care Options (HCO) representative at 1(800) 430 - 4263 to help you choose a health plan and complete the necessary forms.

The following health plans are available for you to choose from:

  • Alameda Alliance; or,
  • Anthem Blue Cross.

You may also visit the California Medi-Cal Managed Care Health Care Options website to view or download Alameda County Plan materials and to view how Medi-Cal plans compare on quality of care.

Health Service Options

Mental Health

Medi-Cal Services for Children and Young Adults: Early & Periodic Screening, Diagnosis & Treatment

Medical and Dental Health Check-Ups

Child Health and Disability Prevention (CHDP) Program

Confidential Youth Medical Services

Confidential medical services are available to minors under 21 years of age through Medi-Cal Minor Consent Program. Confidential medical services, regardless of citizenship or immigration status are offered for the following:

  • Sexual assault
  • Pregnancy or family planning
  • Sexually transmitted diseases
  • Drug or alcohol abuse
  • Outpatient mental health

Requirements

  • Under 21 years of age
  • Living with parents (they will not be notified or contacted)
  • In pregnancy cases, must have income under 200% of the Federal Poverty Level (FPL)
  • Must apply in person

Important

  • Property and income of parents are not counted
  • Parental consent is not required, and they are not notified of the child’s participation in the Medi-Cal Minor Consent Program

Apply in person at one of our office locations.

How to Keep Benefits

Reporting Requirements

Individuals or families receiving Medi-Cal benefits must report any life changes that affect their eligibility for Medi-Cal within 10 days after the change happened. This applies to both MAGI and Non-MAGI Medi-Cal. You may report changes in person or by mail, fax, phone or electronically.

Reported changes may be completed online through MyBenefitsCalWIN.

Redetermination

Medi-Cal benefits must be renewed at least once every 12 months. Some benefits are renewed automatically. If your benefits cannot be renewed automatically, we will mail you forms that you need to submit. If you received a renewal packet, please submit the renewal application back to the Social Services Agency along with verifications by the deadline or you may lose your health coverage.

If you enrolled in a private health insurance plan with Covered CA, you will receive a notification from Covered CA and you may renew your health coverage on their website at www.coveredca.com.

Other Medi-Cal Resources




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