Medi-Cal – Most Asked Questions & Useful Links
Most Asked Questions
1. What is Medi-Cal?
Medi-Cal offers free or low-cost health coverage for California residents who meet eligibility requirements. Most applicants who apply through Covered California and enroll in Medi-Cal will receive care through managed health plans.
Medi-Cal has always covered low-income children, pregnant women, and families. On January 1, 2014, California expanded Medi-Cal eligibility to include low-income adults. When you complete a Covered California application, your eligibility for Medi-Cal will automatically be determined. You can apply for Medi-Cal benefits regardless of your sex, race, religion, color, national origin, sexual orientation, marital status, age, disability, or veteran status.
- Doctors Accepting Medi-Cal
- Dentists Accepting Denti-Cal
- Vision Care Providers Accepting Medi-Cal – Once you click on the link and create an account, you will receive a list of vision care providers to choose from who accept Medi-Cal
- Pharmacies Accepting Medi-Cal
- Medi-Cal Benefits Frequently Asked Questions
- Long-Term Care Alternatives
- COBRA Information
- Prescription Discount Card
- Helpful Links & Information for Community Resources
- Covered California
- Timely Access to Care English
- Timely Access to Care Spanish
2. What are the requirements to be eligible for Medi-Cal?
Medi-Cal has several different programs, so each person’s circumstances are unique, but in general, anyone can apply. You must also be a resident of Ventura County, and willing to provide your Social Security number, immigration/citizenship status, and have verification of identity. Your caseworker will let you know what other information needs to be provided, depending on the program(s) you are eligible for.
3. How do I apply?
Learn more here.
4. Where are your offices located and what are your hours of operation
- Community Service Center offices are open from 8:00 am to 5:00 pm Monday through Friday.
- East County Community Service Center 2900 N. Madera Road, Simi Valley, CA 93065 (805) 584-4842
- Fillmore Community Service Center 828 Ventura Street, 2nd Floor, Fillmore, CA 93015 (805) 524-8666
- Moorpark Community Service Center 612B (Building B) Spring Road, Suite 301, Moorpark, CA 93021 (805) 523-5444
- Oxnard Community Service Center 1400 Vanguard Drive, Oxnard, CA 93033 (805) 385-9363
- Santa Clara Valley Community Service Center 725 E. Main Street, Santa Paula, CA 93060 (805) 933-8300
- Ventura Community Service Center 4651 Telephone Road, Ventura, CA 93003(805) 658-4100
- Thousand Oaks Community Service Center 80 E. Hillcrest Drive, Suite 200, Thousand Oaks, CA 91360 (805) 449-73205.
- For After Hours “Help” – click here
5. What verifications are necessary when applying for Medi-Cal?
Individuals applying for Medi-Cal must provide proof of:
- Social Security Number
- California Residency
- Citizenship/legal resident status*
- Number of people in your household and tax filing status
- Other Health Coverage
- If you have a child with an absent parent, you may be asked to co-operate with the Dept. of Child Support Services for Medical support.
- Property Disability
- *Individuals who are unable to provide proof of citizenship/legal resident status may be eligible for restricted Medi-Cal to cover:
- Emergency services
SB 75 – Full-Scope Medi-Cal for All Children — Under a new California law, that was implemented in May 2016, children under 19 years of age are eligible for full-scope Medi-Cal benefits regardless of immigration status, as long as they meet all other eligibility requirements.
6. Who qualifies for Medi-Cal?
Individuals who are potentially eligible for Zero Share of Cost Medi-Cal include those who are:
- A United States Citizen or Legal Resident, or a child under 19 years of age regardless of immigration status, and
- A California Resident, and
- In a household with Modified Adjusted Gross Income (MAGI) below 138% of the Federal Poverty Level (FPL) for adults and 160% FPL for children.
Note: Income levels are different for pregnant women and disabled or elderly populations.
7. Do I have to be a U.S. citizen to be eligible?
No, but you have to be an eligible non-citizen (have the legal right to be in the U.S.) or a child under 19 years of age to get full scope benefits. If you are an undocumented non-citizen, you may still be eligible for emergency only services.
8. What are the income standards for Medi-Cal?
You can get Medi-Cal regardless of how much money you get. However, the more income you have, the more you may have to pay as a Share of Cost (SOC) before Medi-Cal helps pay for your medical bills. If your income is too high to qualify for Medi-Cal, then you may be eligible for tax credits that are applied immediately to your monthly premium when you enroll in a health plan through other health insurance programs through Covered California
9. What are the property standards for Medi-Cal?
The Affordable Care Act simplified financial eligibility requirements for Medi-Cal program eligibility. Under these simplifications, “property” such as a car, is no longer counted. For other Medi-Cal programs where the simplification rules do not apply, the “property” limits vary depending on the number of individuals in your household starting at $2,000 for one person and $3,000 for a couple.
Some property is exempt, such as one vehicle, furniture, other personal items, burial plots, and the home you live in. A person in Long-Term Care may allocate income and property to the spouse at home. You should apply and let the caseworker determine if you are property eligible.
10. What if I have an immediate medical need?
If you have an immediate medical need, apply in person at one of our offices. A caseworker will assess your situation and determine your eligibility. You may be eligible for temporary approval of Medi-Cal benefits while your application is being processed.
11. I am homeless could I still be eligible for benefits?
Yes, if you meet all the other criteria for Medi-Cal benefits. You will be asked to provide a contact address/phone number, or you may use the Community Service Center address if you cannot provide an alternate contact.
12. If I receive Supplemental Security Income/State Supplemental Payment (SSI/SSP) am I eligible for Medi-Cal?
Yes, the State of California automatically provides Medi-Cal for SSI/SSP recipients. You know you receive SSI/SSP benefits if you receive your Social Security benefits on the first of the month. You do not need to apply for Medi-Cal separately. If you receive regular Social Security and receive your benefits on the third of the month or after, you must apply for Medi-Cal separately. See #3 above.
13. If I am approved to receive benefits, how do I access them?
Medi-Cal benefits are accessed through a Benefit Identification Card (BIC). The BIC works much like any other insurance card. The medical provider will be able to tell whether you are eligible if you have other insurance that must be billed first and how much your Share of Cost (SOC) is if any. You should show your BIC anytime you receive medical services or prescriptions, even if you have a SOC. Always find out if the medical provider takes Medi-Cal patients before you go for treatment.
14. What happens if my BIC card is not working?
The BIC may not work for various reasons, such as the card may not be active, or the requested services aren’t a Medi-Cal covered benefit. You may call (888) 472-4463 for assistance.
15. What if I have lost my BIC card?
Request a benefit replacement card through MyBenefitsCalWIN.org please allow about seven days to receive a new card in the mail, or go into your local office. If you have an urgent need, you may call (888) 472-4463.
16. What if I don’t think I am eligible can I still apply?
Yes, you may apply for Medi-Cal at any time.
17. I have questions about my Medi-Cal eligibility, who do I contact?
- Get information online 24/7 at www.mybenefitscalwin.org
- Call 1-888-472-4463, 8 am to 5 pm, Monday through Friday to speak with a Client Benefit Specialist.
18. How much does Medi-Cal cost?
For many individuals who enroll in Medi-Cal, there is no premium, no co-payment, and no out of pocket cost. Some households will see affordable costs, such as a low monthly premium. For some Medi-Cal children, the monthly premiums are $13 per child up to a family maximum of $39 per month. In general, individuals in Medi-Cal will get the same health benefits available through Covered California at a lower cost.