Medi-Cal Expands Eligibility
On May 1, Medi-Cal, California’s health coverage program for low-income individuals and families, is extending eligibility for full coverage to more than 185,000 individuals who are 50 years of age or older, regardless of immigration status. Medi-Cal is health insurance provided by the State of California for individuals and families. Medi-Cal covers:
- Emergency Services
- Many Others
“We’re delivering concrete results for Californians, continuing to fulfill the promise of a Healthy California for All, and I encourage all those eligible to take advantage of these essential health services,” said Governor Newsom.
The expansion population includes individuals 50 years of age or older who are eligible for Medi-Cal, who do not have satisfactory immigration status or are unable to establish satisfactory immigration status for full-scope Medi-Cal and are not yet enrolled in Medi-Cal. It also includes individuals 50 years of age or older who are currently enrolled in restricted scope Medi-Cal.
Individuals ages 50 and over, regardless of their immigration status, who have not applied for Medi-Cal can apply starting May 1, 2022.
Need Help Applying For Medi-Cal?
If you are currently uninsured and need help applying or have questions about Medi-Cal coverage or how to qualify for Medi-Cal, Golden Valley Health Centers’ Medi-Cal Assistance Team is ready to help. Our team can help you apply for Medi-Cal or answer any questions you have about the program.
Frequently Asked Questions
Yes. You still have Medi‑Cal. The state is adding more health care benefits to your Medi‑Cal coverage. You may get more benefits soon.
Starting May 1, 2022, a new law in California will give full-scope Medi-Cal to Californians ages 50 and older who qualify for Medi-Cal. Immigration status does not matter.
No. Your Medi-Cal benefits are not changing right now. You do not need to do anything yet. You already have restricted scope Medi-Cal, so you do not need to fill out a new application for full-scope Medi-Cal. If you get a packet in the mail to renew your Medi-Cal, fill it out and return it. You can call your county office for help.
Medi-Cal has free or low-cost health care for people who live in California and qualify. Full scope Medi-Cal is different from the restricted scope Medi-Cal you have now. Restricted scope Medi-Cal only covers some services. It does not cover things like medicine and primary care. Full scope Medi-Cal covers more. You will have a primary care doctor (PCP). You will have these benefits:
- Alcohol and drug use treatment
- Dental care
- Emergency care
- Family planning
- Foot care
- Hearing aids
- Medical care
- Medicine your doctor orders
- Medical supplies
- Mental health care
- Personal attendant care and other services that help people stay out of nursing homes
- Referrals to specialists, if needed
- Tests your doctor orders
- Transportation to doctor and dental visits and to get your medicine at the pharmacy
- Vision care (eyeglasses)
If you have pregnancy-related Medi-Cal now, you have all the medically necessary services that Medi-Cal covers.
To learn more about full-scope Medi-Cal benefits, go to https://bit.ly/medi-cal-ehb-benefits.
An SOC is the monthly amount you must pay for health care before Medi-Cal pays. Once you meet your SOC, Medi-Cal pays for the rest of your health care costs for the month. Your SOC is based on your income. If you have an SOC now and your income is the same, you will have an SOC when you get full-scope Medi-Cal. You will get full scope benefits through Fee-for-Service (regular) Medi-Cal. In Fee-for-Service Medi-Cal, you can see any doctor who accepts Fee-for-Service.
If you do not have an SOC, you will need to enroll in a Medi-Cal Managed Care Plan once you have full-scope Medi-Cal. You can then go to doctors who work with the plan in their service area. You can get checkups, go to a specialist, get care for a chronic condition like diabetes, or have surgery. Your Medi-Cal Managed Care Plan will cover any medically necessary service covered under Medi-Cal.
If you live in a county that provides Medi-Cal through a County Organized Health System (COHS), you will be enrolled in the Medi-Cal Managed Care Plan in that county automatically. If your county has more than one Medi-Cal Managed Care Plan, you will get information on how to choose a plan.
If you have an SOC and live in a county that does not provide Medi-Cal through a COHS, you will get full scope benefits through Fee-for-Service (regular) Medi-Cal. To find out if you live in a COHS county, go to https://bit.ly/mmcd-county-map.
A Medi-Cal Managed Care Plan is a health plan. It works with doctors, hospitals, pharmacies, and other health care providers in the plan’s service area. They work together to give you the medically necessary Medi-Cal services you need. It will:
- Help manage your Medi-Cal benefits and services
- Help you find doctors and specialists in the plan network (group)
- Have a 24-hour nurse advice line you can call for medical advice
- Have member services to help you answer your questions about health care
- Help you with rides to medical visits and pharmacies
- Help you get services you may need that the plan does not cover
- Give you language assistance services you need
Your Medi-Cal Managed Care Plan choices depend on the county you live in. Health Care Options will send you a My Medi-Cal Choice It will list Medi-Cal Managed Care Plans in your county. It tells you how to sign up.
If you have a doctor or clinic now, ask them if they work with a Medi-Cal Managed Care Plan in your county. If you want to stay with that doctor or clinic, you can choose any Medi-Cal Managed Care Plan your doctor or clinic accepts.
If you have a doctor or clinic that does not work with a Medi-Cal Managed Care Plan in your county, you might be able to keep your Fee-for-Service (regular) Medi-Cal. People with complex medical conditions like HIV/AIDS, pregnancy in the third trimester, ongoing cancer treatment, dialysis treatments, and more may qualify to keep Fee-for-Service Medi-Cal. If you think this applies to you, fill out and send the “Medical Exemption Request” form that comes with the My Medi-Cal Choice packet.
If you do not choose a Medi-Cal Managed Care Plan, Medi-Cal will choose a Medi-Cal Managed Care Plan in your county for you. You have the right to ask to change your Medi-Cal Managed Care Plan at any time. Call Health Care Options at 1-800-430-4263 (TTY 1-800-430-7077), Monday – Friday, 8 a.m. to 6 p.m. Or, go to https://www.healthcareoptions.dhcs.ca.gov.
If you change your Medi-Cal Managed Care Plan, you must enroll in another Medi-Cal Managed Care Plan in the same county. You cannot go back to Fee-for-Service Medi-Cal if you have been enrolled in a Medi-Cal Managed Care Plan for more than 90 days.
Health Care Options is a DHCS service. It helps beneficiaries learn about Medi-Cal Managed Care Plans. This helps you make the right choices about Medi-Cal coverage and services. Plans may include medical and dental care services. The Health Care Options website is at https://www.healthcareoptions.dhcs.ca.gov. Health Care Options has information only for non-COHS counties. If you live in a COHS county, contact your county social service agency to learn more.
People in Fee-for-Service (regular) Medi-Cal and some who will be enrolled in a Medi-Cal Managed Care Plan in June 2022 can go to any doctor who accepts regular Medi-Cal. To find a new doctor, use the online list of doctors in the Medi-Cal Fee-For-Service program at https://bit.ly/profile-enrolled-ffs-providers.
When you call a doctor’s office, ask if they take new “Medi-Cal Fee-For-Service” patients. To get help choosing a Fee-For-Service Medi-Cal doctor, call the Department of Health Care Services (DHCS) Medi-Cal Helpline at 1-800-541-5555 (TTY 1-800-430-7077). The call is free.
If you live in a county that provides Medi-Cal through a COHS, you will get care from your Medi-Cal Managed Care Plan starting on May 1, 2022.
Once you are enrolled in a Medi-Cal Managed Care Plan, you need to choose a primary care doctor (PCP) in your Medi-Cal Managed Care Plan network. You can ask your current doctor if they are in a Medi-Cal Managed Care Plan in your county. If you choose a plan they work with, you may be able to keep your doctor.
Your Medi-Cal Managed Care Plan has an online list of doctors to choose from. You can also ask them to mail you a list of doctors. If you do not choose a doctor, the plan will choose one for you. You can change anytime to a doctor in your Medi-Cal Managed Care Plan network. For help finding a doctor or to change your doctor, call your Medi-Cal Managed Care Plan’s member services after you join.
It depends. If you have gone to a doctor in the past 12 months and that doctor does not work with a Medi‑Cal Managed Care Plan, you may be able to keep your doctor if you ask your plan for “continuity of care.” Your doctor has to agree to work with the Medi-Cal Managed Care Plan. This can last up to 12 months or more in some cases. If you want continuity of care, call your Medi-Cal Managed Care Plan’s member services once you join the plan.
If you have a complex medical condition and your doctor or clinic does not work with a Medi-Cal Managed Care Plan in your county but accepts Fee-For-Service (regular) Medi-Cal, you might be able to keep going to them for up to 12 months. You will have to ask for a medical exemption.
If you live in a county that does not have a County Organized Health System (COHS) and want to ask for a temporary medical exemption, use the “Medical Exemption Request” form. It came in the My Medi-Cal Choice Packet in April. Your doctor will need to fill out part of the form. Once you and your doctor fill out the form, you must return it to Health Care Options. You can get help from your doctor or clinic or from an advocate.
If you get a Medical Exemption Request, you will stay in Fee-For-Service Medi-Cal. You will keep your doctor until your exemption ends. If you have certain health conditions, you may be able to ask to keep your doctor for more than 12 months. You must ask for a longer extension 11 months or more after the date your exemption starts.
Health Care Options will tell you their decision 45 days before your exemption ends. They will tell you how to ask for an extension. If you want to stay in Fee-for-Service Medi-Cal, fill out the exemption form right away. Usually, you cannot qualify for an exemption from managed care once you have been in a plan for more than 90 days.
If you live in a COHS county or a county with a Coordinated Care Initiative (CCI) program, you may not be able to ask for a Medical Exemption.
To learn more about exemptions and how to ask for one, go to the Health Care Options website at https://www.healthcareoptions.dhcs.ca.gov.
No. There are no co‑payments for medical care. The Medi‑Cal Managed Care Plan covers all medical costs that are medically necessary.
You can get:
Dental services These include partial and full dentures, teeth cleanings, x-rays, fillings, crowns, root canals, and more.
- If you live in Sacramento County, you will get services through a Medi-Cal Dental Managed Care Plan. To learn more about Medi-Cal Dental Managed Care plans, call Health Care Options at 1-800-430-4263 (TTY 1-800-430-7077). Or fill out the Dental Choice Form in your My Medi-Cal Choice
- If you live in Los Angeles County, you can get services through the Medi-Cal Dental Program. This is Fee-for-Service dental. Or you can choose a Medi-Cal Dental Managed Care Plan. To learn more about enrolling in a Medi-Cal Dental Managed Care Plan, call Health Care Options at 1-800-430-4263 (TTY 1-800-430-7077). Or fill out the Dental Choice Form in your My Medi-Cal Choice
- If you live in San Mateo County, you will get dental services through Health Plan San Mateo. This is a Managed Care Plan. To learn more about dental services through Health Plan San Mateo, call Monday – Friday, 8 a.m. to 6 p.m. at 1-800-750-4776 or 650-616-2133. TTY: Call California Relay Service (CRS) at 1-800-735-2929 or 7-1-1.
- For all other counties, you will get Fee-for-Service (regular) Medi-Cal dental services through the Medi-Cal Dental Program. You will need to go to a dental provider that accepts Medi-Cal Dental. To find a dental provider, call the Medi-Cal Dental Telephone Services Center at 1-800-322-6384 (TTY 1-800-735-2922), Monday – Friday, 8 a.m. to 5 p.m. The call is free. You can also find a dental provider and learn about dental services on the Medi-Cal Dental Program’s “Smile, California” website at http://smilecalifornia.org/.
Preventive care services
These include screenings for medical, dental, vision, hearing, mental health, and substance use disorders. All preventive care and screening services are free. To learn more, contact your Medi-Cal Managed Care Plan member services.