Undivided Resources
Article
Medi-Cal 101

Medi-Cal 101


Published: Jun. 14, 2021Updated: Jan. 9, 2024

Featured image

Medi-Cal is California’s Medicaid program, which provides health care coverage to many Californians based on a variety of factors including income, adoption/foster care status, and disability. Medi-Cal will always be secondary coverage for children with private primary insurance, but it can help fill some of the funding gaps by eliminating copays and many other out-of-pocket expenses when your child sees Medi-Cal-contracted providers. Medi-Cal may also fund medical supplies (such as diapers and feeding-tube formula) and durable medical equipment.

Medi-Cal for children is administered through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Some services that are not available to adults with Medi-Cal may be available under EPSDT.

To help you understand the various Medi-Cal programs and how your child might benefit, also check out our handy guide Making the Most of Medi-Cal and our glossary of Medi-Cal terms and services.

What services does Medi-Cal provide?

Common Medi-Cal services include (but are not limited to):

Who is eligible for Medi-Cal?

Eligibility for Medi-Cal is usually based on household income. However, California offers several programs that allow people with disabilities to obtain Medi-Cal if their income is too high to qualify based solely on financial need. (These include, among others, the Medically Needy Share of Cost Program, the Aged and Disabled Federal Poverty Level program, and the 250% Working Disabled Program, which may be useful for young adults with disabilities whose monthly income is too high for the other programs.)

The program most often utilized by the families of children with developmental disabilities is the institutional deeming waiver for individuals with developmental disabilities. This program allows many children who are Regional Center clients to receive Medi-Cal without regard to family income. For children with private health coverage, Medi-Cal coverage will be considered secondary insurance, and may cover out-of-pocket expenses when you see a provider who accepts Medi-Cal.

Medi-Cal waiver eligibility infographic

Other programs include the Aged, Blind and Disabled - Medically Needy program (which requires a monthly Share of Cost), the Aged & Disabled Federal Poverty Level program, and the 250% Working Disabled program, which may be useful for young adults with disabilities whose monthly income is too high for the other programs.

Types of Medi-Cal

Medi-Cal as a Primary Provider:

  • Most children with Medi-Cal as primary coverage will be enrolled in a Medi-Cal managed care plan. For Los Angeles County, those managed care plans include HealthNet and LA Care or a contracted plan under LA Care, such as Anthem Blue Cross, Blue Shield of California Promise Health Plan, and, under limited circumstances, Kaiser Permanente (usually for existing or recent Kaiser members).

    • These plans operate like any other managed care plan. You will receive an enrollment packet and both a Benefits Identification Card (BIC) and a managed care health plan card, along with instructions for finding in-network providers. New Medi-Cal recipients are encouraged to call Health Care Options and select a plan. If they fail to do so, one will be chosen for them.

    • NOTE: Effective January 1, 2024, Kaiser Permanente will have its own contract with the state and will no longer be contracted under LA Care. Current Kaiser Medi-Cal patients should be transferred to the Kaiser state plan and should not need to take further action. New recipients will be permitted to select Kaiser Medi-Cal coverage if they are current Kaiser members, have been a Kaiser member in the past 12 months, or have a Kaiser member in their immediate family. Current and former foster youth and recipients eligible for both Medicare and Medi-Cal will also be able to choose Kaiser.

Medi-Cal as a Secondary Provider

If a child has multiple insurance plans, Medi-Cal is always the last provider to be billed. For most beneficiaries, this means Medi-Cal will be your secondary insurance. You can read all about using Medi-Cal as secondary health coverage in this article.

Until recently, families with secondary Medi-Cal coverage were exempt from enrolling in a Medi-Cal managed care plan. This changed effective January 1, 2023. See our article on how to choose a managed care plan and communicate with your providers about your coverage.

Treatment Authorization Requests (TARs)

Some services and medications require prior authorization by Medi-Cal. The provider will submit the TAR and check its status. If the TAR is denied and you disagree with the decision, you may be able to request a fair hearing or state hearing.

Do you have more questions about how your child can benefit from Medi-Cal? Be sure to read our breakdown in Making the Most of Medi-Cal. You may also wish to read How Do We Pay For It All? Undivided’s Guide to Funding Resources.

If you're looking for your local Medi-Cal office, you can find office listings by county on the DHCS website. For checking benefits status, most counties are using BenefitsCal or will be by the end of 2023.

Contents


Overview

What services does Medi-Cal provide?

Who is eligible for Medi-Cal?

Types of Medi-Cal

Join the Undivided Community to get more resources like this in your inbox

Tags:

Author

Undivided Editorial TeamStaff
Reviewed by Undivided Editorial Team

Promise Image
Each piece of content has been rigorously researched, edited, and vetted to bring you the latest and most up-to-date information. Learn more about our content and research process here.
A Navigator is your Partner at each turn
Every Undivided Navigator has years of experience supporting families raising kids with disabilities or parenting their own. Partner with an Undivided Navigator for a free Kickstart to learn first hand what support feels like!
tick-icon
Expert-driven content, guidance, and solutions.
tick-icon
Member events and office hours with real answers, plus access to our private parents' group.
tick-icon
Priority to begin a free Kickstart of the Undivided Support System with a dedicated Navigator.
“It’s so helpful to have one place that you can go to get many answers.”–Leeza Woodbury, with Navigator Kelly since 2020
*Currently offering Navigator Kickstarts to residents of California