Steps to Medi-Cal
medi-cal is california’s medicaid program. This is a public health insurance program that provides free or low-cost medical services to children and adults with limited income and resources. Visit each topic below to learn more about the medical process:
are you eligible?
Pregnant women, children, and the disabled may have income higher than the federal poverty level and are encouraged to apply.
how to apply
- in person
- by mail
- by phone
on the phone:
If you need additional help applying or have additional questions, you can contact a trained Certified Enrollment Counselor (CEC) free of charge.
Find a list of local cecs or call 1-800-300-1506. If you have already submitted an online application and have not yet been contacted, please do not submit a duplicate application.
verify your eligibility
Due to the high volume of new applications, the process is taking longer than normal and the steps below may be performed out of order if this helps expedite coverage.
The process to verify your Medi-Cal eligibility, from the time your completed application is received to the time you receive your Benefits Identification Card (BIC), normally takes 45 days. the general verification process is as follows:
- apply: Complete the application and submit it in person, by mail, by phone, or online
- receive notification of possible eligibility by mail
- Your county social services office may contact you by mail or phone to request paper verification if income, citizenship, and other criteria cannot be verified electronically
- receive a final notice of action notifying you whether or not you can get medi-cal
- receive your bic: When you receive your bic in the mail, you can use the many medi-cal benefits available to you.
sign up for a plan
when you first qualify for medi-cal and receive your bic, you are covered by fee-for-service (also called regular medi-cal). Within 45 days of receiving your bic, information explaining your health plan options will be mailed to you.
However, you must choose a health plan within 30 days of receiving your health plan information. If you do not choose a plan within 30 days, cal will choose a plan for you. the health plans available to you depend on the county you live in.
- go to the medi-cal managed care health plan directory to find your county
- for those medi-cal members who are already enrolled and need to choose a health plan, they can do so on the health care options website.
- If you see only one health plan on the list, the county has chosen this plan for you. wait for information from your health plan in the mail.
- If you see multiple health plans listed, explore each plan and choose the one that best fits you and your family’s needs. Remember, if you don’t choose a plan within 30 days of receiving your health plan information, Medi-Cal will choose a plan for you.
- if you live in san benito county, there is only one health plan available and you can enroll in this health plan. however, you can choose to stay with fee-for-service medi-cal.
start using your benefits
medi-cal currently provides a basic set of health benefits, including doctor visits, hospital care, immunizations, pregnancy-related services, and nursing home care. The Affordable Care Act ensures that all Medi-Cal health plans offer what are known as Essential Health Benefits (EHBs). These ten comprehensive services include the following categories:
- ambulatory (ambulatory) services
- emergency services
- maternity and newborn care
- mental health and substance use disorder (sud) services, including behavioral health treatment
- prescription drugs
- programs such as physical and occupational therapy (known as rehabilitation and habilitation services) and devices
- laboratory services
- preventive and wellness services and chronic disease management
- Children’s (pediatric) services, including oral and vision care.
Review the Medi-Cal Health Benefits Chart for more information about the services in each category. the federal healthcare.gov glossary provides definitions for all terms used.
dental benefits are available starting May 1, 2014
dental benefits for adults age 21 and older have been reinstated by the center for medicare and medicaid services.** you can find a medi-cal dentist in the medi-cal dental provider directory. For more information on dental services for children, visit the Medi-Cal Dental website.
The following benefits have now been restored:
- exams and x-rays
- fluoride treatments
- anterior root canals (front teeth)
- prefabricated crowns
- full dentures
- other medically necessary dental services
- individual and group mental health assessment and treatment (psychotherapy)
- psychological testing, when clinically indicated, to assess a mental health condition
- outpatient service in order to monitor drug therapy
- outpatient laboratory, drugs, supplies and supplements
- psychiatric consultation
- All specialty mental health services currently provided by county mental health care plans will continue to be available.
- voluntary inpatient detoxification
- intensive outpatient treatment services
- residential treatment services
- non-drug outpatient services
- narcotic treatment services
The following substance use disorder services are now available through medi-cal: