Eligibility for Medicaid in California


If you want to know how to qualify for Medi-Cal, Medicaid in California, then you will need to understand about the requirements. Knowing what are the income requirements for Medi-Cal can be confusing, as the threshold varies depending on the size of the household. Medi-Cal eligibility requirements, however, are not exclusive to financial earnings since certain California residents may be entitled to benefits due to a personal factor. Learning about financial and personal eligibility before applying to Medicaid in California can save petitioners time and frustration. California is one of the states that expanded its Medicaid coverage to assist all residents with household incomes below a certain level. As of March 2017, Medicaid covered over 12 million people in the state of California, which is the largest total enrollment of any state.

For comprehensive information about Medi-Cal benefits eligibility, download our guide.

What are the Medi-Cal application guidelines for California applicants?

Who is eligible for Medi-Cal application review? Although the income requirements for Medi-Cal is a considerable factor, so are other personal and medical qualifications. These Medi-Cal eligibility requirements relating to health include having a low household income as well as being pregnant, blind or having a disability. Low-income applicants may also be eligible for Medi-Cal coverage if diagnosed with certain ailments, such as tuberculosis, HIV/AIDS, breast or cervical cancer. All aforementioned conditions extend to members of the household such as minor children and senior adults, older than 65 years of age, who cannot apply to Medi-Cal on their own behalf. Applicants should also keep in mind that not every member of the household may qualify for CA Medicaid, for instance, parents may be ineligible while their child qualify for Medi-Cal kids, which has different rules.

What are the income requirements for Medi-Cal for California applicants?

Eligibility for Medi-Cal benefits concern household income of applicants, as the intended participants of the program are those who are struggling financially. Medi-Cal eligibility for low income individuals and families, however, factor in the household size as well as the age and health status of family members. For instance, income requirements for Medi-Cal applicants who have more family members are much more lenient than those for single adult individuals. Likewise, maximum income thresholds can vary depending on the type of Medi-Cal requested, as the program consists of 21 health plans.

Minors, those younger than 18 years of age, are entitled to health care benefits from the state if their household makes 266 percent or less of the federal poverty level (FPL). For adults to be considered eligible for Medi-Cal they must not have a household income higher than 138 percent of the FPL. While this bracket includes pregnant women, soon-to-be mothers count the expected child(ren) as members of the household. However, there are additional Medicaid programs that target expecting mothers. Pregnant women in California who are not eligible for Medi-Cal based on earnings above 138 percent of the FPL but less than 213 percent can qualify for Medi-Cal for Pregnant Women, which only covers pregnancy related services such as prenatal care. The Breast and Cervical Cancer Treatment Program (BCCTP) of Medi-Cal permits those with either diagnoses with a household income of 200 percent or less of the FPL to receive coverage only if they are otherwise ineligible for other Medi-Cal or Medicare programs. Once applicants know how to qualify for Medi-Cal for the program best suited for their needs, they can find out about the Medicaid cost and coverage available to them, as each specific program will have different provisions.

Download our comprehensive guide to find out more about available Medi-Cal programs.

Who is eligible for Medi-Cal and Medicare in California?

Individuals who meet both Medicare and Medi-Cal eligibility requirements are dual eligible and can enroll in both programs simultaneously. The reasons these individuals exceed Medi-Cal benefits eligibility is because they generally have higher medical needs than the majority of the population. For example, applicants may be qualify for Medi-Cal and Medi-Care if they have more than one chronic disability or health condition, which require numerous health services and care supports.

Dual Medicare and Medi-Cal benefits eligibility applicants enroll in the Cal MediConnect Program, the joint effort to make the two programs work seamlessly in the state. This program helps people remain in their local communities and their homes as much as possible, rather than being placed in care facilities, as many of the enrollees are senior citizens and people with disabilities.

Who does not meet the California Medi-Cal eligibility requirements?

Applicants may not be eligible for Medi-Cal if they are not a U.S. citizen, U.S. national, permanent resident or do not have a do not have satisfactory immigration status. You do not meet the eligibility requirements for Medi-Cal if your household income is greater than the threshold of the program based on the family size and medical status. Likewise, you may lose Medi-Cal benefits eligibility if your income increases after you have submitted your Medi-Cal application.

Find out about Medicaid options for non-citizens and higher earners in our detailed guide here.

What Are the Available Health Services in California?

Low-cost, and even free health benefits are available to a large number of California residents, with some being offered to low-income applicants and others being offered to elderly or disabled individuals. However, before you can access these health services, you need to submit the appropriate application and prove that you meet the necessary qualifications. To learn all about the different health benefits you can receive in California and the application procedures that you must undergo to obtain these benefits, download our free comprehensive guide.

Who Is Eligible to Obtain California Health Benefits?

California’s health programs have various eligibility requirements that applicants must meet in order to successfully enroll. Income, age and other factors are all taken into consideration in the eligibility verification process. Find out which health benefits you qualify for here.