Medi-Cal is California’s healthcare insurer for low-income residents and persons with disabilities. Medi-Cal is short for the California Medical Assistance Program. Due to the state’s dire fiscal situation this year, eligibility rules could change if funds for the program are cut, so stay up to date with changes by checking in periodically at the state’s Department of Medical Care Services website.
Talk with medi-cal eligibility for rules for eligibility and enrollment. The Medi-Cal website has several pages committed to Medi-Cal and its broad mandate. You may be enrolled should you already collect Social Security benefits, food stamps, adoption assistance, foster care or in-home support services supplied by their state.
Look further to find out if you qualify, even if you are not already collecting government benefits. If you are 65 or older, blind or else disabled, in a elderly care facility, you could qualify. Women that are undergoing treatment for breast or cervical cancer may also qualify if their income is less than 200 percent in the federal poverty level.
Call your neighborhood County Welfare Office. Medi-Cal lists the state’s 58 county welfare offices on its website. The office can answer questions you have and can present you with some idea whether you are going to qualify, before you fill in the applying.
Apply for assistance. The straightforward application can be found in 11 different languages and it is available on the web. The application form ask you for the identifying information, marital status, the members of your household and their ages, and whether you have a house in a choice of California or in another state. You are also needed to list all of your sources of income in addition to expenses relating to health insurance, alimony and other factors that matter in your overall household budget.
Be completely honest on your application. The penalties for fraud and abuse are severe, and include losing your benefits and potential prosecution both for recipients and providers. The state’s Health Department reports on its website that since 1999 it offers poured a huge quantity of resources into combating Medi-Cal fraud.
At the time of January 2018, 2.5 million people were signed up for Medi-Cal fee-for-service, representing about 19% of all enrollees. In the fee-for-service arrangement, health care providers submit claims to the Medi-Cal program for services rendered. Medi-Cal managed care. Most beneficiaries receive Medi-Cal advantages from contracted Medicaid managed care organizations. Since January 2018, 10.8 million people were enrolled in a Medi-Cal managed care plan, representing about 81% of all enrollees.
California has several models of managed care which can be designated in the county level: County Organized Health System (COHS) model, with one health plan per county, “two plan model” with one community health plan and something commercial health plan inside the county, a geographic managed care model with multiple plans per county, a regional managed care model with 1-2 commercial health plans in numerous counties, and different one-county models in San Benito and Imperial counties.
In Denti-Cal, nearly all beneficiaries are covered through fee-for-service arrangements, where the state pays dentists directly for services, instead of the managed care model. However, greater than 879,000 Denti-Cal enrollees do receive dental care through managed care plans started as experimental alternatives within the 1990s: in Los Angeles County where managed care plans are optional for beneficiaries, as well as in Sacramento County where these are mandatory.
Eleven counties had no Denti-Cal providers or no providers willing to accept new child patients included in Denti-Cal: Del Norte, Tehama, Yuba, Sierra, Nevada, Amador, Calaveras, Alpine, Mariposa, Mono ifepbh Inyo counties. Delta Dental, operating within the same building as DHCS’ Denti-Cal division, enrolls dentists into DentiCal, processes claims by dentists, pays dentists and authorizes treatments, as well as handles customer service operations and outreach.
Medi-Cal is jointly administered through the Centers for Medicare and Medicaid Services (CMS) and the California Department of Healthcare Services (DHCS), while the county welfare department in all the 58 counties accounts for local administration in the Medi-Cal program.