Medi-Cal Income
Limits 2024

Medi-Cal Eligibility Criteria

Medi-Cal offers free or low-cost health coverage to eligible Californians, including adults, children, and families. Eligibility is based on residing in California and meeting income requirements. Those above the income limit may still get aid for private healthcare. Eligibility extends to non-U.S. citizens or nationals in certain cases.

Medi-Cal logo with a poppy flower, symbolizing Medi-Cal income limits for eligibility.

What Are Medi-Cal Income Limits?

Medi-Cal
Qualifications
Medi-Cal for Adults
up to 138% FPL
Medi-Cal for Children
up to 266% FPL
Medi-Cal for Pregnant Women
up to 213% FPL
Medi-Cal Access Program for Pregnant Women
over 213% - 322% FPL
CCHIP (for Children in San Mateo, San Francisco)
over 266 - 322% FPL
CCHIP (Santa Clara counties)
over 266 - 322% FPL

Federal Poverty Level Chart for Medi-Cal Eligibility Programs (2024)

Household Size
138% FPL
213% FPL
266% FPL
322% FPL
400% FPL
1
$20,121
$31,056
$38,783
$46,948
58,320
2
$27,214
$42,004
$52,456
$63,499
78,880
3
$34,307
$52,952
$66,128
$80,050
99,440
4
$41,400
$63,900
$79,800
$96,600
120,000
5
$48,494
$74,849
$93,473
$113,151
140,560
6
$55,587
$85,797
$107,145
$129,702
161,120
7
$62,680
$96,745
$120,818
$146,253
181,680
8
$69,773
$107,693
$134,490
$162,804
202,240
Chart showing Covered California eligibility based on Federal Poverty Level.

Asset Eligibility For Medi-Cal

Effective January 1, 2024, eligibility for Medi-Cal will no longer consider assets. This means that when assessing if you qualify for Medi-Cal, the following will not be taken into account:

  • Bank accounts
  • Cash
  • Property
  • Vehicles

This change simplifies the eligibility process, focusing primarily on income and other criteria.

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Required Documents for Application

Identity Verification:

  • Birth certificate, Driver’s license, U.S. Passport, U.S. Military ID, or other government IDs
  • Social Security numbers
  • School records, paycheck, Medicare card

Immigration Status:

  • Immigration documents
  • Naturalization certificate
  • T or U visa application or receipt

Residency in California:

  • Driver’s license, rent/mortgage receipt, utility bill, or other proof of California address

Income Proof:

  • Recent check stubs, employer statements, tax returns, or bank statements

Additional Resources:

  • Bank statements, mortgage, life insurance, stocks/bonds, vehicle registration

Health Coverage Details:

  • Information on any job-related health insurance, policy numbers for current health insurance

Application Processing Time

  • Standard Applications: Decided within 45 days.
  • Disability Applications: May take up to 90 days. Submit documents promptly to avoid delays.

Urgent Medical Needs

Inform us immediately if you have an urgent medical or dental need, such as a serious illness or pregnancy, to expedite the process.

How We Can Help

Medi-Cal stands as a cornerstone in California’s healthcare system, providing vital medical coverage to millions, particularly children. This program plays a critical role in ensuring that the health needs of our younger generation are met, regardless of their family’s financial situation. By offering comprehensive medical benefits, Medi-Cal safeguards not only the health of children but also the peace of mind of their families.

Conversely, Covered California offers a complimentary service that links Californians with reputable health insurance brands. Established to aid citizens and legal residents in applying for marketplace coverage, Covered California stands as the exclusive platform where you can receive financial assistance when purchasing health insurance from established companies. This implies that during your application process, you might be eligible for a subsidy on a health plan through Covered California, or you may qualify for health insurance under the state’s Medi-Cal program.

Focused Expertise: Navigating Children’s Medi-Cal Enrollment through Covered California

Our Enrollment Center expertise is in providing specialized assistance for enrolling children in Medi-Cal as part of a family’s Covered California application. It’s crucial to understand that, although we offer this dedicated service, our Enrollment Centers are independent and not directly affiliated with Medi-Cal. Our role is specifically to facilitate the submission of the household application to Medi-Cal on behalf of the applicant, streamlining the process for your family’s convenience.

Clear Distinction of Services:

  • For Adults: We do not provide direct Medi-Cal services. Adults with household incomes below 138% FPL can apply through their local Medi-Cal office or complete an online application.
  • For Children: We do not provide direct Medi-Cal services. When submitting a family application for a Covered California health plan, we can facilitate the enrollment of eligible children into Medi-Cal.

Guidance, Not Management: While we guide the process for including children in Medi-Cal through the family’s Covered California application, any inquiries or services specific to Medi-Cal itself, particularly post-enrollment questions or management, should be directed to the local Medi-Cal office. Our role is to ensure that children’s enrollment into Medi-Cal is a seamless part of your family’s healthcare plan application, but ongoing Medi-Cal management and queries are beyond our scope.

This distinction ensures that while we are here to help integrate Medi-Cal coverage for children into your family’s overall health plan, the direct management and specific queries related to Medi-Cal are expertly handled by the local Medi-Cal offices, equipped with resources and knowledge tailored to Medi-Cal services.

Who Qualifies? Understanding Children’s Eligibility for Medi-Cal

Eligibility for children’s Medi-Cal coverage is determined by several factors, including household income, age, and residency status. Generally, children under 19 years of age from low- to moderate-income families qualify for Medi-Cal. Here are a few scenarios that commonly arise:

  • Scenario 1: A single parent with two children, earning below 266% of the Federal Poverty Level.
  • Scenario 2: A family of four, with both parents working, but their combined income falls short of the threshold for affordable private insurance.
  • Scenario 3: A child with special healthcare needs, requiring services that are best covered under Medi-Cal.

In each of these cases, and many others, Medi-Cal offers a pathway to essential healthcare services, ensuring that children’s health needs are not sidelined due to financial constraints. Our role is to guide families through the application process, ensuring they understand the eligibility criteria and helping them secure the coverage their children need.

Understanding Adult’s Eligibility for Medi-Cal

Adults with incomes up to 138% of the Federal Poverty Level typically qualify. Additionally, factors such as age, pregnancy, disability status, and family size are also considered in the eligibility criteria. Medi-Cal aims to ensure that all qualifying Californians have access to necessary healthcare services, ranging from preventive care to more specialized treatments. Navigating these criteria can be complex, but knowing these key qualifications is the first step towards securing essential health coverage through Medi-Cal.

Enrollment Steps for Split Families: Navigating Covered California for Parents and Medi-Cal for Children

A Step-by-Step Guide to Securing Health Coverage

Applying for Medi-Cal for children can seem challenging, but with the right guidance, it’s a straightforward process. Here’s how we assist you at every step:

  1. Determine Eligibility: We start by helping you understand if you are eligible for Covered California and if your child is eligible for Medi-Cal based on age, household income, and other factors.
  2. Gather Necessary Documents: We guide you in collecting all required documentation, such as proof of income, identity, and California residency.
  3. Complete the Application: Our team assists you in filling out the Covered California application, which includes the option to apply for Medi-Cal for your children.
  4. Submit the Application: We ensure that your application is complete and submit it on your behalf.
  5. Follow-Up and Confirmation: Once your application is submitted, our team will assist with any subsequent inquiries or requests from Covered California to ensure a smooth process. Additionally, should Medi-Cal require any further information, you will be promptly notified by mail.

 

How to apply for Medi-Cal

Here’s a step-by-step approach to help you navigate the enrollment process:

  1. Determine Your Eligibility: First, assess if you meet the eligibility criteria for Medi-Cal. This includes factors like income level, age, family size, and residency in California. Use our chart below to estimate your eligibility.
  2. Gather Required Documentation: Prepare necessary documents such as proof of income (like pay stubs or tax returns), identification (state ID or driver’s license), proof of California residency, and any other relevant documents like immigration status, if applicable.
  3. Choose How to Apply: You have multiple options to apply for Medi-Cal:
  4. Complete and Submit the Application: Fill out the application with accurate information. Double-check for any errors before submitting to avoid delays in processing.
  5. Wait for Approval: After submission, there will be a processing period during which your eligibility is determined. You may receive a request for additional information or documentation.
  6. Receive Your Medi-Cal Card: Once approved, you will receive your Medi-Cal card and benefits information. This card is your gateway to accessing healthcare services under Medi-Cal.
  7. Select a Health Plan: Depending on your county, you may need to choose a Medi-Cal managed care health plan. This plan will determine your network of doctors and healthcare providers.

Remember: Medi-Cal is designed to provide health coverage to those who need it most. If you encounter any challenges or have questions during the application process, don’t hesitate to seek assistance from local resources or Medi-Cal offices.

Frequently Asked Questions (FAQs)

Your Concerns Addressed with Clarity

  • Q: Can I apply for Medi-Cal for my child if I have private insurance?
    • A: Yes, children can be eligible for Medi-Cal even if parents have private insurance.
  • Q: What if my child needs special medical services?
    • A: Medi-Cal covers a wide range of services, including special medical needs. We can help clarify these benefits as you apply.

Benefits and Coverage Details

Comprehensive Care for Your Child’s Needs

Medi-Cal provides extensive coverage for children, including but not limited to:

  • Doctor visits
  • Hospital care
  • Dental and vision care
  • Mental health services
  • Specialized care for chronic conditions

While adult Medi-Cal coverage has some differences, particularly in dental and vision care, children enrolled in Medi-Cal receive a comprehensive package designed to ensure their holistic health and well-being.

Resources and Useful Links

Dept of Healtcare Services

Covered California Website

BenefitsCal

Couple researching Medi-Cal resources online, analyzing documents for clarity
Medi-Cal's poppy logo, epitomizing California's healthcare expertise and county services.

Expert Guidance on Medi-Cal

California Department of Healthcare Services

(855) 832-8082