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. The program most often used by families of children with developmental disabilities is the institutional deeming waiver for individuals with developmental disabilities. This program allows 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. To qualify for Medi-Cal under the institutional deeming waiver for people with developmental disabilities, the Regional Center consumer must:

• live at home with their family;

• have a valid Social Security number;

• be ineligible for Medi-Cal due to family income;

• be diagnosed with a developmental disability;

• have two or more qualifying conditions in the areas of self-help, motor functioning, social/emotional functioning, special health care conditions, or extensive medical needs, such that the child meets the criteria for an intermediate care facility for individuals with developmental disabilities (ICF-DD); and

• receive at least one funded Regional Center service and utilize that service at least once per year. Many families fulfill this requirement via respite hours.

For more information, see our Medi-Cal 101 article.