A Guide to Medi-Cal - California Medicaid Program

Medical bills, especially after hospitalization or with regular disease management or treatment, can prove too much for an individual or family to handle. Without the appropriate funds, one can lose quality care, jeopardizing their health and well-being.

Medicaid covers those with lower incomes, leaving them with little to no out-of-pocket costs. Below, we’ll uncover who’s eligible for Medicaid, how to apply for Medi-Cal, and how this and extended coverage can assist your situation.

    What Is Medi-Cal?

    For those wondering, “what is Medi-Cal?” Medi-Cal, which stands for California Medicaid, is a federal health coverage program overseen by The Department of Health Care Services or DHCS. Although it offers the same Essential Health Benefits (EHB) as Covered California, most enrollees don’t have a monthly premium or co-pays for each visit and have zero out-of-pocket costs. It facilitates basic healthcare for those who cannot afford private health insurance.

    While certain factors may cause some families to pay up to $39 monthly, it’s still the more cost-effective healthcare solution for many. Medi-Cal receives 69% of its funding from the federal government, with 20% assistance from the General Fund and 11% help from California’s state and local government funds.

    While funding changes yearly, it’s usually enough to serve more than 14 million state residents. However, low-income families can only receive assistance after qualifying for and receiving a Benefits ID.

    What Is a Medi-Cal Card?

    California Medi-Cal Card

    The Medi-Cal Benefits ID Card or BIC is a California-specific Medicaid card that allows enrollees to receive necessary care with government funding, whether for prescriptions, dentist and doctor appointments, or alcohol and drug abuse.

    Being an enrollee alone won’t suffice without a valid or available card, so you must have your card with you at all times for the health specialist to service you and bill Medi-Cal. Cards with inaccurate information may not be valid.

    Wrong information could include not only an old address or misspelled name but an incorrect Medi-Cal number. Your blue-and-white card, which usually takes 45 days to process after completing your application, has a unique 14-digit ID number that allows only you to use it. If you file for a replacement card, this number changes, voiding the old card and giving you a new distinctive number.

    Applying for California Medicaid

    California makes it simple for those at or slightly above the poverty line to enroll in California Medicaid by allowing applications in person, online, or by phone, mail, or fax.

    If you’re applying in person, locate your nearby social services county office to receive assistance while filling out a form. You can also contact an insurance agent or Covered California Certified Enrollment Counselor on the Covered California website to help you determine your eligibility and how to proceed.

    You can also reach your social services county office by:

    • Mail: Print the Single Streamlined Application in your preferred language, fill in all required boxes, and send it via USPS.
    • Online application: Fill out the form directly on the Covered California website, which instantly and securely transfers your application to the office.
    • Phone or fax: Determine your local county office online and use their respective number to call and apply over the phone. You may also find a fax number on their website, allowing you to send a physical copy of your document straight to the office if applicable.

    Eligibility Requirements

    Knowing how to apply for Medi-Cal begins with checking your eligibility status. First, you must be a California resident and provide your annual income alongside every other household member’s income. Your assets’ value is also an indicator of your net worth, so prepare to answer questions about your property.

    While filing taxes is not a qualifying factor for receiving California Medicaid, your filing status is necessary for determining your residence’s yearly earnings and how close you fall to the poverty level. For instance, if you’re a sole resident, making $20,121 qualifies you for benefits. For each additional resident, add $7,094 to the total income to determine the maximum yearly earnings that allow you to become eligible.

    You’re also eligible if you:

    • Are under 21 or 65 and older
    • Have an impairment like blindness, deafness, or another disability
    • Have a refugee status (immigration status is confidential, meaning Immigration Services cannot use this information to enforce deportation and other immigration rules)
    • Are filing for an underaged child
    • Have received screenings for cervical or breast cancer
    • Are in the care of an intermediate or skilled nursing home

    Getting a California Medicaid Card

    If you fall under one or more of the above scenarios, you can fill out and send in your application using one of the above methods. Your local county office will mail you a Notification of Likely Eligibility to confirm whether you can receive benefits. It will reach out for physical verification copies of your income, immigration or citizenship status, and other vital information.

    Once all the details are in and your application is complete, the office will send a Final Notice of Action explaining whether it granted or denied you for enrollment. Since the county-level court makes this decision, you can overrule its judgment by appealing to the State Superior Court. Otherwise, if it accepts your application, it’ll send a BIC in the mail within 45 days and relay your available benefits.

    Renewing or Replacing Your California Medicaid Card

    Once you receive your California Medicaid ID card, you can immediately begin using it by showing your healthcare providers your unique ID number so they can bill Medi-Cal rather than you. However, if you use your card frequently, it’s not uncommon for it to become stolen, lost, or damaged. If this occurs, contact your local county office as you did before to request a new card.

    You’ll also receive a new card if inaccurate information is on your current card or your card never appeared in the mail after the 45-to-90-day window.

    Depending on how long you’ve had your original card, you’ll likely notice different appearances amongst cards. While the older cards are simple, with blue writing on a white background, newer ones include pictures of California poppies lining the bottom edge. Both types of cards are still acceptable, but each cardholder may only have one valid card at a time.

    Although the Medi-Cal card itself doesn’t expire, meaning you don’t receive a new one in the mail unless you ask for one, your coverage needs renewal yearly to remain active. You’ll receive letters alerting you to upcoming deadlines, and you can renew your application with an in-person office visit or by phone, email, mail, or fax. You also keep your card unless you miss your deadline and reapply for benefits.

    Medi-Cal Coverage

    With Medi-Cal coverage, it’s vital to understand what Medi-Cal covers so you receive assistance when and where you need it. This program offers the same EHB as California Medicaid, meaning it aids with the ambulatory and emergency services alongside the following:

    • Maternity, infant care, and pediatrics for mothers and underaged individuals
    • Hospitalization
    • Substance Use Disorder or SUD
    • Behavioral and mental health treatments
    • Chronic disease management and wellness services
    • Prescriptions
    • Laboratory services
    • PT and OT

    Below, we’ll delve further into some of these care services and how you can benefit from them.


    California Medicaid originally offered Dental Fee-For-Service (FFS) alone across all 58 California counties, which entails showing your dentist your BIC during each visit. In 1995, Dental Managed Care (DMC) became available in Sacramento County with three Geographic Managed Care plans (GMC) and in Los Angeles County with three Prepaid Health Plans (PHP). However, they offer the same services as FFS.

    Outside of regularly scheduled semi-annual cleanings, X-rays, and exams, these benefits comprise common and necessary dental procedures like fluoride treatments for sensitive teeth, fillings and anterior root canals, prefabricated crowns, dentures, and more.

    Adult benefits also include pregnancy-related and emergency services and any services for intermediate or nursing facility residents and Department of Developmental Services consumers. For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in California is advisable.

    Prescription Drugs

    The Medi-Cal program must cover a minimum of one drug from under each U.S. Pharmacopeia drug category to service enrollees. That includes legend drugs or prescription medication in which a medical practitioner prescribes an FDA-approved drug, along with non-legend OTC drugs that don’t require a prescription. If Medi-Cal doesn’t list your medication, contact a consultant for authorization.

    OTC products like antihistamines, decongestants, and combination medications are also on the Contract Drugs List alongside compounded drugs that combine two or more substances, which are not FDA-approved.

    This California Medicaid program also provides HIV drug treatments and controlled substance policies, the latter providing a 35-day supply automatically for any drug, including opioids. For a larger supply, you’ll need to receive prior authorization.

    Extended Health Care

    Although some California residents use this program as their primary insurance, others use it as an extended healthcare option, since what Medi-Cal covers, regular insurance may not. For instance, extended healthcare usually covers vision, dental, prescription drugs, professional services and equipment, and various forms of therapy.

    If you qualify for Medi-Cal on top of your primary healthcare insurance, the latter receives billing first, and the California Medicaid program covers the remaining costs. It is vital as a beneficiary to report to the federal and state government alongside your local county office that you’re receiving private insurance assistance, so contact them and your healthcare provider if you’re eligible for both.

    Travel and Out-of-State Coverage

    What is Medi-Cal coverage like outside of the Golden State? If you get into an accident or another emergency once you’re outside the state, you’ll most likely receive assistance after showing your BIC to a healthcare provider. Unfortunately, the program doesn’t cover regular services like picking up prescriptions or having X-rays done, meaning you’ll have to pay out-of-pocket without reimbursement. If you are traveling outside of California for leisure, invest in proper travelers insurance.

    Students and Seniors

    Anyone under 21 is eligible to apply for Medi-Cal, meaning California students in grades K-12 can receive coverage under their parents. Underaged college students still financially dependent on their families are also eligible, although students don’t need a parent or parental guidance when applying.

    Likewise, most residents 65 or older can receive assistance but must acquire full-scope Medi-Cal approval and follow all program rules to gain at-home or institutional care, including from nursing homes. Some long-term care includes nutritional, habilitation, and respite services alongside nursing, personal care, and homemaker services, to name a few.

    Coverage for Subgroups

    Certain subgroups that qualify for California Medicaid may receive additional benefits under the Medi-Cal program.


    Those with a disability can receive Medi-Cal even with a higher income. As long as you meet the program’s income rules, receive a disability income, and Social Security defines you as someone with a disability, you may be eligible. If your family income falls below the 250% federal poverty line, you’re also eligible.

    Anyone enrolled in the 250% WDP used to pay a low monthly premium of between $20 and $250, but after July 1, 2022, you can pay as little as $0 in premiums with the same benefits available to you.

    It’s important to note that Medi-Cal may not provide enough coverage in an instance where someone becomes temporarily or permanently disabled. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work, and to help with the cost of medical needs.


    The DHCS Veterans Benefits Enhancement Project allows all who have served and their families to receive federal benefits under Medi-Cal in the form of pensions or compensation, medical and prescription drug coverage, family benefits, and medical equipment.

    What Medi-Cal Does Not Cover

    Medi-Cal covers most dental and doctoral treatments and prescriptions necessary for your health. That means health plans are not likely to cover:

    Cosmetic surgeries and procedures like dermatology, hair removal, and plastic surgery
    Fertility treatments, which comprise numerous testing methods to provide an infertility diagnosis, which you may have to pay for yourself
    Sexual dysfunction prescriptions, like for erectile dysfunction (ED), which was only reimbursable by the Federal Financial Participation (FFP) until January 1, 2006
    Off-label drugs, which means an individual uses a drug for reasons outside of what’s stated on the bottle
    Unlisted compound, legend, or non-legend drugs on the Contract Drugs List (but you can contact a Medi-Cal consultant to ask whether authorization is possible)

    Common Procedures and Medi-Cal Eligibility

    Knowing what California Medicaid services are available to you is important but not always straightforward. Below, we’ll break down common procedures you can expect to receive with Medi-Cal.

    X-Rays and exams Yes (conditions may apply)
    Fillings Yes (conditions may apply)
    Cleanings Yes (conditions may apply)
    Anterior root canals Yes (conditions may apply)
    Wisdom teeth removal Yes (conditions may apply)
    Medi-Cal offers children’s pediatrics, including kids’ oral and vision care.
    Eye Exams Yes
    Glasses Yes (prescription)
    Laser Eye Surgery Yes (for those with an injury or vision impairment)
    Rhinoplasty Yes, if medically necessary.
    Breast Reduction Yes, if medically necessary.
    Hospital stays During their hospital stay, you can take advantage of anesthesiologist, surgical, and organ or tissue transplant services.
    Ambulance transportation Ambulance transportation is available from or to the residence when an individual is giving birth or in the case of another emergency.
    Giving birth Ambulance transportation is also available from or to the residence.
    Therapy and Counselling
    Medi-Cal offers coverage for behavioral healthcare, such as individual or group counseling, inpatient or outpatient mental health services, and treatment for substance use disorders. As of March 2021, the Mental Health Services Division now handles all Medi-Cal-related mental health services.
    Sexual Health
    Medicaid will cover a wide range of sexual health treatments and conditions. The following are a few examples of what it will and will not cover:
    Gynecologist visits Medi-Cal covers Certified Nurse Midwife services to assist with prenatal care, labor, and delivery.
    Erectile Dysfunction No
    Birth Control Yes (conditions may apply)
    Fertility Treatment No
    Specialist Services
    Dermatology Yes (if referred by your primary care physician)
    Physiotherapy Yes (conditions may apply)
    Massage Therapy Yes (conditions may apply)
    Podiatry and Foot Care Yes (conditions may apply)
    Allergy Testing Yes (conditions may apply)
    Sleep Physician Services and CPAP Machines Yes (conditions may apply)

    If the Medi-Cal member owns nothing when they die, there is no estate recovery. Your family will be allowed to deduct certain debts and expenses from the value of the estate, such as funeral expenses. Medi-Cal. getting medical care. It is always wise to ensure that in the event of your passing, your family is secured with comprehensive funeral insurance.

    Extending Medi-Cal Coverage

    While California Medicaid offers diverse healthcare benefits for a wide range of California residents, its coverage is limited. Many Medi-Cal recipients opt to combine their state benefits with a private or third-party insurance plan instead.

    The best way to determine the right private insurance coverage and company is to receive quotes from multiple providers and compare your options. While you can request quotes manually, why not save time by letting Insurdinary do the work for you? Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.

    At Insurdinary, we search the lowest rates depending on the coverage you need, from life and senior life insurance to travel and disability insurance. We compare rates among the top U.S. providers and relay your best options to help you save money. Fill out our Insurdinary form to receive your insurance quotes today.


    How long does it take to get approved for California Medicaid?

    The approval process for California Medicaid, also known as Medi-Cal, varies. It can take about 45 days on average, but the timeline depends on individual circumstances. Expedited processing is available for urgent cases.

    What are the methods to apply for California Medicaid?

    You can apply for California Medicaid (Medi-Cal) through multiple avenues: online, in person, by mail, or at a local county social services office. Make sure to provide necessary documentation like proof of income, household size, and residency when applying.

    Does California Medicaid cover the expenses of funerals?

    No, California Medicaid (Medi-Cal) is focused on providing medical coverage and does not include benefits for funeral expenses. If you're seeking assistance with funeral costs, you may want to explore options like funeral insurance.

    Who is eligible for California Medicaid?

    Eligibility for California Medicaid (Medi-Cal) is determined by various factors, including income and household composition. Generally, Medi-Cal extends coverage to low-income individuals, families, pregnant women, children, elderly adults, and people with disabilities.

    What is California Medicaid (Medi-Cal)?

    California Medicaid, or Medi-Cal, is a state and federally funded program that offers medical coverage to eligible low-income residents of California. It's designed to ensure access to essential healthcare services.

    What other types of insurance does Insurdinary offer?

    Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:


    1. https://lao.ca.gov/Publications/Report/4522#Background
    2. https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/SingleStreamApps.aspx
    3. https://www.coveredca.com/
    4. https://www.dhcs.ca.gov/services/Pages/TPLRD_WD_cont.aspx
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