Under the Affordable Care Act, California expanded Medi-Cal eligibility to single individuals ages 19- 64 with a low income. Many consumers may be eligible for expanded Medi-Cal without knowing that they qualify. This guide provides an overview of expanded Medi-Cal eligibility, Medi-Cal’s application process, and contact information to attain more information.
What is Expanded Medi-Cal and Who is Eligible?
What is Medi-Cal?
Medi-Cal is California’s free or low-cost health insurance Medicaid Program.
What is expanded Medi-Cal and who is eligible?
Single, low-income individuals ages 19-64 may enroll in expanded Medi-Cal. You do not have to have children or a disability.
What health care coverage does expanded Medi-Cal offer?
Medi-Cal covers a core set of services, including doctor visits, hospital care, and pregnancy-related services. For a majority of enrollees, Medi-Cal provides covered services through managed care health plans. All Medi-Cal health plans offer essential health benefits:
• Outpatient (Ambulatory) services
• Preventive and wellness services
• Emergency services
• Maternity and newborn care
• Laboratory services
• Rehabilitative and habilitative services
• Prescription drugs
• Mental health & substance use disorder services
• Pediatric services
What are the eligibility requirements for expanded Medi-Cal?
There are three main requirements:
Satisfactory immigration status (Note: Many immigrants qualify.)
How do I know if I qualify as low income?
Income level is calculated by looking at both your income and family size. Your income must be at or below 138% of the Federal Poverty Level for your family size. Mental Health Advocacy Services can help you calculate your income and family size for purposes of qualifying for expanded Medi-Cal.
How do I prove my income if I do not file taxes?
You can show proof of income through pay stubs or a benefits award letter. If you have no income, or receive in-kind income, you can sign an affidavit explaining your income situation. Mental Health Advocacy Services can help you complete an income affidavit.
What if someone claims me as a dependent on their taxes?
If someone claims you as a dependent on their taxes then their income and family size will usually be used as yours on the application. There are some exceptions to this. Mental Health Advocacy Services can help you determine if the exceptions apply to you.
If I apply, will I have to disclose my bank account information or that I own a car?
There are no resource limits for expanded Medi-Cal. Expanded Medi-Cal applicants are not required to disclose their assets to determine their eligibility.
How do I prove California residency?
For expanded Medi-Cal, to be a California resident you must live in California and intend to remain here. You can prove this with a California driver’s license or identification card, a piece of mail sent to you at your home address (like a utility bill), proof of school enrollment for your children, or proof of voter registration.
What if I am homeless?
You can still establish California residency by signing an affidavit explaining where you are living in California and that you intend to stay. Mental Health Advocacy Services can help you complete a residency affidavit.
What is “satisfactory immigration status”?
Those with satisfactory immigration status include:
United States Citizens
Lawful Permanent Residents
What is PRUCOL?
PRUCOL stands for Permanently Residing in the United States Under Color Of Law. A person may claim to be PRUCOL when he has a good faith belief that United States Citizenship & Immigration Services (USCIS) knows of his presence and is not pursuing deportation. If you decide to apply as PRUCOL, then you will need to complete form MC 13. This form cannot be submitted online and is available only in English. Mental Health Advocacy Services can help you complete form MC 13.
What if I am undocumented?
Even if you do not meet the immigration status requirements for expanded Medi-Cal, you may be eligible for other healthcare programs provided by Los Angeles County. These include restricted MediCal, Ability to Pay, Healthy Kids, and the County Pre-Pay Program. If you are interested in these programs, you should contact the Department of Social Services at 877-597-4777. Los Angeles County has also implemented My Health LA, a no cost health care program for low-income residents of Los Angeles County who do not have health insurance. If you are interested in My Health LA, you should contact My Health LA Member Services at 844-744-6452.
When can I apply for Expanded Medi-Cal?
You can apply at any time; there is no enrollment period for expanded Medi-Cal.
What happens after I apply?
After you send in your application, an eligibility worker may contact you for more information. After you are approved, you should receive an enrollment packet in the mail. In this packet you will receive information about your managed care plan options and have the opportunity to select a managed care plan. If you fail to select a managed care plan, you will be defaulted into a managed care plan.
How do I apply?
Mental Health Advocacy Services can help you with your application. Call us at 213-389-2077.