Eldercare

  Placement

  Assistance

  (916) 723-3038

 

  

      

Directory

Home

Services

Contact Us

Needs Survey

Gallery of Homes

Medi-cal & Medicare

 

Alzheimers

Resources & Forms

Business Directory

Organization Directory

Links and Resources

Facility Sign Up

Update Openings

Link Exchange

Advertising

 

 

Cingular Wireless

1800flowers.com

Hotwire Top Deals

Wal-Mart - Books
     
  1-2    
 

 

Understanding Medi-cal

 

Medi-Cal Information

In California, the federal Medicaid Program is administered by the state as the California Medical Assistance Program (Medi-Cal). This program provides health care services to welfare recipients and other qualified low-income persons (primarily families with children and the aged, blind, or disabled). Expenditures for medical benefits are shared about equally by the General Fund and by federal funds. The Medi-Cal budget also includes federal funds for (1) disproportionate share hospital (DSH) payments, which provide additional funds to hospitals that serve a disproportionate number of Medi-Cal or other low-income patients, and (2) matching funds for state and local funds in other related programs.

Who Can Get Medi-Cal?

People in many different situations qualify for Medi-Cal. They are listed below. If you are not in one of these groups, call your county social service agency to determine if you qualify for a county-operated medical assistance program.

You may automatically be eligible for Medi-Cal if you receive cash assistance under one of the following programs:

  • SSI/SSP (Supplemental Security Income/State Supplemental Program)
  • CalWORKs (California Work Opportunity and Responsibility to Kids). Previously called Aid to Families with Dependent Children (AFDC).
  • Refugee Assistance
  • Foster Care or Adoption Assistance Program.

Even if you don’t receive cash assistance, you may be eligible for Medi-Cal if you are one of the following:

  • 65 or older
  • Blind
  • Disabled
  • Under 21
  • Pregnant
  • Diagnosed with breast or cervical cancer
  • In a skilled nursing or intermediate care facility.
  • Refugee status during a limited period of eligibility. Adult refugees may or may not be eligible depending upon how long they have been in the U.S.
  • Parent or caretaker relative of a child under 21 and
  • The child’s parent is deceased or doesn’t live with the child, or
  • The child’s parent is incapacitated, or

The child’s parent who is the primary wage earner is unemployed or underemployed.

How Do I Apply For Medi-Cal?

  • Call or visit your local county social services office and ask for a Medi-Cal application.
  • If you need help filling out the forms, call the county social services agency. Mail or take your application with the required verifications (proof) to the nearest social services agency in your county. If you don’t have all your verifications, or are not sure of what you need, please send what you have. You can send the rest later. The sooner the social services agency receives your application, the sooner your case may be processed and your Medi-Cal benefits can begin.
  • If you get SSI/SSP payments, your Social Security administration office automatically sets up Medi-Cal for you. No separate application for Medi-Cal is needed. You will get your Medi-Cal card (BIC) in the mail.

If you get CalWORKs payments, the county social services agency automatically sets up Medi-Cal for you. No separate Medi-Cal application is needed. You will get your Medi-Cal card (BIC) in the mail.

How Is My Application Processed?

  • When the county receives your application, it will be given to an eligibility worker. The worker will review your application and determine if additional information is needed. The worker may ask you for information by mail or by phone. If you want to meet with your worker to discuss your application, call your worker to set up an appointment.
  • Once the eligibility worker has all of the necessary information, he or she will determine if you are eligible for Medi-Cal. You will get a letter in the mail telling you if your Medi-Cal application is approved or denied. If you do not understand this letter or do not agree with the information in this letter, contact the eligibility worker at the county social services agency. If you still disagree with the county’s action, you may file for a State Hearing by completing the back of the Notice of Action the county sends you or by calling the toll free number.
  • If your child(ren) is not eligible for free Medi-Cal, they may be able to get health coverage through the low-cost Healthy Families Program (HFP). Make sure you indicate on your application that we can send your information to the HFP if your child(ren) is found ineligible for free Medi-Cal.

Anyone can help you with the application process — a family member, friend, or anyone else of your choice. 

How Long Does It Take?

Forty-five (45) days are allowed to process a Medi-Cal application not involving a disability. If you are applying for Medi-Cal based on a disability, your application process may take up to 60 days or longer depending on how quickly you complete the disability information and how quickly your doctors and hospitals submit your medical records. To avoid delays in the processing of your case, submit all information requested of you as soon as possible. Ask your eligibility worker for help if you are having trouble obtaining information. If you have an immediate medical need, such as pregnancy, indicate this need on your application and your application may be processed more quickly.

 

Do I Have To Pay For Medi-Cal?

It depends.

  • If your income is less than Medi-Cal limits for your family size, you will receive Medi-Cal services at no cost to you. (Refer to All County Welfare Directors Letter (ACWDL) 02-13 to view the Income Limit Chart.)
  • If your income is more than Medi-Cal limits for your family size, you will have to pay a certain amount only in the month you have medical expenses. The amount that you pay is called your share of cost (SOC). When you pay or promise to pay that amount, we say that you have met your SOC. Once you have met your SOC, Medi-Cal will pay the rest of your covered medical bills for that month. For example, if your SOC is $50, you must first pay or obligate (obtain your providers agreement to make payments on the SOC) $50. Your provider will enter the amount you paid or obligated into the Department’s database. Your case will certify when the amounts you paid or obligated equal the amount of your share of cost. Once your share of cost is certified; providers checking your eligibility will advised that you are eligible and covered services may now be billed to the Medi-Cal program. Please note, expenses incurred by ineligible members of your family may be used to meet the share of cost of eligible members.

    If one spouse lives in a nursing home, Medi-Cal allows the spouse remaining in the home to keep all of the income he/she receives in his/her name regardless of the amount. If that amount is below $2,232 per month, then the spouse in the nursing home can give income to the spouse at home to bring the spouse at home up to $2,232 per month. Be sure to ask your county social service agency for an     MC Information Notice 007 for more information on income.

What If I'm Disabled?

If you feel you are disabled, make sure to note this on your application or let your eligibility worker know this when you mail in your application. There are certain criteria you must meet to receive Medi-Cal on the basis of disability. You must have severe physical and/or mental problem(s), which will last at least 12 months and keep you from working during these 12 months, or possibly result in death.

You must prove your disability. Proof may involve obtaining medical records, tests, and other medical findings.

For your child to receive Medi-Cal as a disabled child, he/she must have severe physical and/or mental problem(s) that prevent the child from doing daily activities that a healthy child does.

Disability is looked at in two different ways.

  • Presumptive Disability allows you to get Medi-Cal as a disabled person while waiting for a final determination of disability. Presumptive Disability covers only certain types of illnesses/diseases and conditions. Ask your eligibility worker if your special situation qualifies you for Presumptive Disability.
  • If your special situation is not covered under Presumptive Disability, it may take up to 60 days to determine if you meet the Medi-Cal definition of disability and can receive Medi-Cal as a disabled person.

 

Are There Special Treatment Programs?

Yes. There are programs to assist you if you need dialysis treatment or parenteral hyperalimentation (feeding tube) services.

Can I Get Help from Medi-Cal with Medicare Costs?

Yes. Medicare is different from Medi-Cal. Medicare is a federal health insurance program run by the Centers for Medicare and Medicaid Services. It is available to most people 65 years of age or older and certain disabled or blind persons, regardless of income. Medicare Part "A" covers hospitalization. Medicare Part "B" covers doctor bills.

If you receive Medicare, you may qualify for the following special Medi-Cal programs:

  • The Qualified Medicare Beneficiary program pays for the Medicare Part A and B premiums, co-insurance and deductibles. To be eligible you must have income at or below 100% of the Federal Poverty Level.
  • The Specified Low-Income Beneficiary and Qualifying Individual 1 program pays for the Medicare Part "B" premium. To be eligible you must have income below 135% of the Federal Poverty Level.
  • The Qualifying Individual 2 program reimburses you for a portion of your Medicare Part "B" premium that you have paid. To be eligible you must have income below 175% of the Federal Poverty Level.
  • The Qualified Disabled Working Individual program pays the Medicare Part "A" premium. To be eligible you must have income at or below 200% of the Federal Poverty Level, be disabled, be employed and eligible under any other Medi-Cal program.

Even if you don’t qualify for the above assistance programs, your Medicare A & B premiums can be used as allowable deductions in the Medi-Cal share of costs calculation.

I am Disabled and Working: Can Medi-Cal Help Me?

Yes. The 250 Percent Working Disabled program allows you to buy into the Medi-Cal program by paying monthly premiums on a sliding scale based on your monthly income. Premiums range from a minimum of $20 to a maximum of $250 per month for an eligible individual, or from $30 to $375 for an eligible couple.

To be eligible for the 250 Percent Working Disabled program, you must:

  • Continue to meet the federal definition of disability as defined in federal law for Social Security disability programs, although you are able to work,
  • Pay a monthly premium based on net countable income, and

Meet all other non-financial Medi-Cal eligibility requirements

Are There Special Programs for Parents Who Lose Medi-Cal Becasue of Full-Time Employment or Receipt of Child Support Payments?
Yes. Transitional Medi-Cal provides no costs Medi-Cal for up to 2 years for families who are no longer eligible for CalWORKs or Section 1931(b) Medi-Cal because of increased earnings from employment.

Families who are no longer eligible for CalWORKs or Section 1931(b) Medi-Cal due to the collection or increased collection of child support payments may receive up to four months of no cost Medi-Cal.