Millions of Californians receive health care coverage through the Medi-Cal program. Learn more about the program and its recent changes. Medi-Cal is the state implementation of federal Medicaid. It provides health coverage to low-income families with children, seniors and people with disabilities. It also covers some long-term services and support.

What is Medi-Cal?

Medi-Cal is California’s free or low-cost healthcare program for people with very low incomes. It offers healthcare, dental, and vision coverage for eligible adults and kids. Various providers serve enrollees, including doctors, hospitals, and community-based organizations. It’s the country’s largest public health care program and is funded equally by state and federal funds. The Riverside County Medi-Cal services have undergone a bold transformation to improve outcomes for our enrollees and their families. This transformation aligns all aspects of the Medi-Cal program into a standardized and simplified system for all our enrollees. We are also enhancing the role of our on-the-ground partners, such as county agencies, local organizations, community-based organizations and tribes, to support them better as they deliver services. Most Medi-Cal students get medical and dental care through managed care plans. Managed care plans are groups of doctors and hospitals that work together to provide quality health care for Medi-Cal people. The plan that you join depends on where you live and your income level. 

How do I get my Medi-Cal card?

You will receive a letter with valuable information regarding your new coverage when you are approved for Medi-Cal. You will also receive a card that you need to present when you see a doctor or hospital for care. It is your new Medi-Cal Benefits Identification Card (BIC). The BIC has the State of California with pictures of poppy flowers and contains important information for doctors and hospitals to know Medi-Cal covers you. If you have a managed care plan, your BIC will also include the name of your health plan and the phone number of the company that collects your health care needs. Most managed care program members have a primary care physician who can refer them to other healthcare professionals and medical experts.  It is very common for a family to be eligible for more than one health coverage program. For example, the parents may be eligible for premium assistance tax credits through Covered California. At the same time, their children can get free or low-cost health insurance through Medi-Cal. If this is the case, you must inform your county office to avoid a coverage gap.

How do I choose a health plan?

The first step in selecting a health plan is to evaluate your healthcare needs. It includes identifying the types of doctor and hospital visits you regularly make and what medications you take. You should also note any health conditions you or your family members have. Next, check out the plans available online or from your employer’s benefits administrator. Each program should have a summary of benefits, outlining its costs and coverages. Look for a provider directory on each plan that lists the doctors and clinics that take the program. Then, eliminate any plans that don’t have local in-network doctors.

Another factor to consider is the type of network the plan uses. Some plans use narrower networks of “preferred” providers with special contracts with insurance companies. These are often cheaper but need more flexibility in choosing doctors and hospitals. Other plans have wider networks, such as preferred provider organizations (PPOs) and point of service (POS) plans. These typically have higher monthly premiums but offer more freedom in choosing providers, with referrals required only for specialist care. Finally, it would help to look at the deductibles and out-of-pocket maximums on each plan to see how much you would have to pay before the insurance kicks in. If you have a lot of medical expenses to cover, a plan with lower deductibles or out-of-pocket maximums can save you money in the long run.

How do I use my Medi-Cal coverage?

For children with disabilities, Medi-Cal can be used as secondary insurance to pay for items like medical supplies, specialized equipment, therapy services (including occupational, physical, speech and ABA), and copayments. Suppose your child has a primary private insurance plan that covers more than 138% of the federal poverty level. In that case, it is important to make sure that provider knows you have Medi-Cal as well and that they only bill your child for services covered by Medi-Cal after the other insurance pays their portion.

Some providers can bill your child for the remaining balance of services up to the contracted Medi-Cal rate, but you should always ask. You may also have other types of coverage besides Medi-Cal, such as employer-sponsored insurance or Medicare. The rules about how these different types of coverage work together are complicated, but it is important to know what you do and do not have to pay for to avoid a gap in health care coverage.