The People's Guide

36th Edition 2015

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41 The People's Guide 2015 Medi-Cal Medi-Cal The state and federal government fund Medi-Cal. There are many Medi-Cal pro- grams with different rules. Depending on which program you qualify for and how much money you make, Medi-Cal may pay for all your medical expenses or you might have to pay a share of the cost when you access health care services in a particular month. If you have Medi-Cal with a share of cost, you may qualify for lower priced insurance through Covered California. More children are now eligible for free Medi-Cal through the "Optional Targeted Low Income Children's Program", which re- placed the old "Healthy Families" program. Can I Get Medi-Cal? You can get Medi-Cal if you: • Have low income and. • Are a California resident (which means that you intend to stay in California. This rule is not about immigration status To get Medi-Cal you must meet certain income limits, described on page 40. All adults aged 19 to 64 who are U.S. citizens or legal permanent residents and have in- come below 138% of the Federal Poverty Level (see chart on page 40) now qualify for a free Medi-Cal program. Pregnant women and people with a diagnosis of breast or cervical cancer may qualify for Medi-Cal at a higher income level (see page 43). If you get CalWORKs, SSI, foster care, or certain refugee benefits, you get Medi- Cal automatically and don't have to apply separately. Immigration Status Most legal immigrants can get Medi-Cal to cover all their medical and health care needs. Victims of domestic violence or those in the process of adjusting their legal status might also be able to get Medi-Cal. (See page 62 Guide for Non-Citizens). If you have a Deferred Action for Childhood Arrivals (DACA), you can qualify to get full Medi-Cal benefits. If you are undocumented, and a California resident, and meet other Medi-Cal require- ments, you may qualify to get restricted Medi-Cal benefits, Restricted Medi-Cal means that you can get Medi-Cal to pay for emergency services, pregnancy-related care, family planning, kidney dialysis, and long term care services. How Do I Apply? 1. Get an Application Form • You can get an application form mailed to you by calling the DPSS toll-free number at (877) 597-4777. • You can get a Medi-Cal application at a DPSS Office. (See page 70 "Welfare Offices.") • You can also get an application at many hospitals and clinics, whether they are private or county-run. • A few schools in Los Angeles County can have children apply for Medi-Cal at the same time they apply for the Free and Reduced-Cost Lunch program, using the same application. • Visit First 5-funded agencies that have applications and assist people with the application process. See page 47 for a complete list of agencies. • Visit a Certified Enrollment Counselor (CEC). These counselors work for community organizations or insurance brokers and can help you apply on line or by mail. All CECs are certified by Covered California to help consum- ers in person. Visit www.coveredca. com/enrollment-assistance to find an enrollment counselor near you. 2. Apply Online You can apply online using Your Benefits Now!, or Covered California. Your Benefits Now! is a website for Los Angeles County residents to apply for and view their benefits online. Visit: Covered California is a statewide market- place where you can shop onine or over the telephone for insurance coverage. Visit: or call (888) 975- 1142. Medi-Cal is California's program to pay for medical care for many low-income people, including families, children, the elderly, and people with disabilities. Under the new health care law, many adults who could not get Medi-Cal before are now able to get Medi-Cal. 3. CHDP "Gateway" Children who receive a CHDP visit are screened for temporary eligibility for Medi-Cal. If a child is eligible, he/she is pre-enrolled in temporary, full-scope Medi-Cal at no cost for up to 60 days (for the month of the visit and the month after) See pg. 48, "CHDP". 4. Deemed Eligibility for Infants Infants who are born to mothers on Medi- Cal at the time of birth can get Medi-Cal benefits up until the age of one, regardless of any increase in income for their family. At age one, an annual redetermination form must be completed. However, you must contact DPSS when your baby is born or use a "Newborn Referral Form" to start your child's Medi-Cal benefits (see #11 "If you are pregnant", page 42). For questions or problems you may contact MCH Access (213) 749-4261 or the Health Consumer Center of Neighborhood Legal Services at (800) 896-3203. 5. Complete the Form Help is availabe if you need it to complete your application The Medi-Cal office must provide translation services and assistance if you have a disability that makes it hard for you to complete the application. If the worker needs more information, you will be given a list of necessary documents and a due date to mail it back. A "return appointment" is not necessary. If you do not have all the necessary docu- ments, you or someone you know may sign a statement explaining why not. You may be able to receive benefits while you con- tinue to gather the required information. The eligibility worker should help you get some of your missing papers. Give DPSS copies, not originals, of any documents. Make a copy of the application for yourself! Then hand in or mail in the form. Get a receipt if you hand in the form. If you mail the form it is a good idea to send it by certified mail. MEDI-CAL INFORMATION: (877)597-4777

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