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Message # 640 Information about MediCal

mp3 #640 Information about Medi-Cal (mp3 file)


This SmartLaw message will discuss the following questions:

1--What is Medi-Cal?

2--How poor do you have to be to be eligible for free Medi-Cal?

3--What if you are already receiving welfare payments?

4--What if you no longer receive welfare payments?

5--What if you never received welfare payments?

6--What if you are not a U.S. citizen?

7--What if you disagree with your county's decision in your case?

8--What is the medically indigent adult program?

First, what is Medi-Cal?

You may be eligible for Medi-Cal, which is health care coverage for low-income California residents.

Medi-Cal is California's version of the federal Medicaid program. Eligible persons receive a Medi-Cal card, which they show to doctors and hospitals, to help pay for medical costs.

You may be eligible for Medi-Cal health care if you are disabled, pregnant, under the age of 21, or age 65 or older.

Also, if you are the parent of a child who is deprived of parental support because one or both parents are disabled, or gone from the home, of are unemployed, or are dead, you may be eligible.

You may also qualify if you live in a skilled nursing home, or in an intermediate care facility if you are legally blind.

If you are already getting CALWORKS, SSI, or in-home supportive services, you are automatically eligible for Medi-Cal.

2--How poor do you have to be, to be eligible for free Medi-Cal?

There are limits on the resources and the income that you may have in order to be eligible for free Medi-Cal.

Your resources cannot be more than $2,000 if you are single, or more than $3,000 for a couple. This includes money on hand or in a bank account, certain types of trust account monies, or anything that can be readily changed into money.

The house that you live in, if you are buying or own it, is not considered as a resource.

Your first car is not considered as a resource, no matter what value it has. Additional motor vehicles may be considered as resources, and will be counted toward the personal property limits of $2,000 and $3,000.

If your income is over these limits, you still may qualify for Medi-Cal, but you may be charged a monthly share of cost, that you are responsible for, in order for Medi-Cal to pay the balance of your hospital or medical bills.

The amount that you will pay will be determined by your family size and by the amount of your income after certain deductions are made. However, you don't have to pay any share of cost in months that you have no medical expenses.

If you have past medical or hospital bills, Medi-Cal may help you pay for those bills, if you request Medi-Cal and qualify for it, not later than 3 months after the date that you had those expenses, by asking for retroactive Medi-Cal.

3--What if you are already receiving welfare payments?

If you are already receiving a cash benefit, such as CALWORKS for families with children, or supplemental security income (called SSI) for disabled persons of all ages, or for persons who are age 65 or older, then you are automatically covered by Medi-Cal.

4--What if you no longer receive welfare payments?

Many families who leave the CALWORKS program may still be eligible for Medi-Cal benefits.

If you leave CALWORKS to go back to work, or to work more hours, you may be eligible for transitional Medi-Cal, called TMC. TMC gives you up to two years of Medi-Cal regardless of how much money you make.

If you leave CALWORKS because you start getting more child support or spousal support, you may be eligible for 4 months of continuing Medi-Cal.

5--What if you have never received welfare payments?

Even if you have never received cash aid, you may still be eligible for Medi-Cal.

There is a special Medi-Cal program for pregnant women, and for children under age 19, whose monthly family income is below certain levels. There are no resource limits for pregnant women or children under age 19, however.

There is also a special Medi-Cal program for disabled people, dependent children families, pregnant women, and children under age 21, who have too much countable income or resources to qualify for Medi-Cal any other way. This is called the medically needy program.

There is also a medically indigent program for children in certain circumstances.

In addition, there is a special Medi-Cal program for low income people who have tuberculosis infection.

6--What if you are not a U.S. citizen?

If you are a "qualified alien" living in California (for example, if you are a lawful permanent resident, or if you have a "green card") you are eligible for all Medi-Cal services, if you meet Medi-Cal's income and property limits.

Emergency services are available through Medi-Cal without regard to a person's immigration status. Some of these services are provided by state funds only. Emergency services include labor and delivery for pregnant women, kidney dialysis, and life threatening injuries and medical conditions. In addition, non-emergency care for pregnant women, and long-term care are also provided regardless of a person's immigration status.

7--What if you disagree with your county's decision in your case?

If at anytime you disagree with any action that the county has or has not done in your Medi-Cal case, you may request a state hearing, and have a state hearing officer determine your rights with regard to the problem you are having. You may file a written request, or you may request a hearing from the State Department Of Social Services by calling a toll-free number: 1-800-952-5253.

You must make your request for a state hearing within 90 calendar days of the date the county mails to you its notice of action on your case. If you act fast and request a state hearing before the date that a reduction or ending of your benefits takes effect, then your aid will not be cut while you wait for the state hearing.

8--What is the medically indigent adult program?

If you do not qualify under the Medi-Cal program, you might qualify under your county's "medically indigent adult" program that is available to people who have little or no income and limited resources. This type of medical assistance is available to those who are 21 years of age through 64 years of age.

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