Medi-Cal, otherwise known as Medicaid, is a government health insurance program that helps people in California with low income get health care services at a lower cost. There are several different Medi-Cal programs, each serving a different group of people. The Medi-Cal program serving people who are older, blind, or living with a disability with low income is called the Aged, Blind, and Disabled (ABD) Federal Poverty Level (FPL) Program, or A&D FPL Medi-Cal.

What does A&D FPL Medi-Cal cover?

A&D FPL Medi-Cal pays for routine and acute health care services. This includes:

• Visits to health care providers (including physicians and nurse practitioners)
• Inpatient and outpatient hospital services
• Early and periodic screening, diagnostic, and treatment services
• Preventive care (e.g., vaccinations)
• Lab tests and X-rays
• Dialysis services
• Mental health services
• Substance use treatment
• Rural health clinic services
• Medical transportation
• Long-term care (e.g., nursing facility care, home health services)

Medi-Cal may also cover services such as:

• Physical, respiratory, and occupational therapy
• Home- and community-based care
• Case management
• Prescription drugs
• Dental and vision care

Since the program serves those with limited income, people with A&D FPL Medi-Cal pay few to no out-of-pocket costs. To get coverage once you are enrolled, you must go to health care providers that take part in the Medi-Cal program.

Medi-Cal is administered by the California Department of Health Care Services (DHCS). Call DHCS at 1-855-832-8082 to learn more about the coverages provided.

How do I know if I qualify for A&D FPL Medi-Cal?

A&D FPL Medi-Cal covers people who are age 65+, blind, or living with a disability who also have limited income. In general, to be eligible, you must:

• Be a California resident
• Be a U.S. citizen or a qualified non-citizen
• Have income under 138% of the FPL

Also, if you receive Supplemental Security Income (SSI), you should automatically qualify for Medi-Cal without having to file a separate application.

If you need help with your health care coverage and costs, you should apply for Medi-Cal even if you think you are over the income limit. This is because:

• Not all types of income are counted toward the income limit.
• You may qualify for a different form of health care assistance.
• If you are over the income limit, but you have very high medical costs, you may be able to qualify for Medi-Cal through the Medically Needy Program.

What is Medically Needy Medi-Cal?

If your income is too high to qualify for A&D FPL Medi-Cal, but you have high medical expenses, you may qualify for Medi-Cal under the Medically Needy program. This program allows you to get coverage from Medi-Cal while spending some of your own income on medical expenses (called a “spend down”). This is called a Share of Cost.

To get Medi-Cal benefits, you must submit current paid or unpaid medical bills equal to or greater than your Share of Cost. Once your medical bills reach this amount, you will get coverage for the rest of the spend-down period.

Some examples of medical expenses you can use to meet your Share of Cost include:

• Unpaid medical bills that have not been used to meet the share of cost before
• Health insurance premiums
• Medical bills you paid within the last three months
• Medical bills that will not be paid by health insurance (or any other source)
• Co-pays for medical bills
• Medical services prescribed by your doctor
• Transportation by ambulance, bus, or taxi to get health care services

How do Medicare and Medi-Cal work together?

Medi-Cal pays for some services not covered by Medicare. If you get Medicare, you may also be able to get help from A&D FPL Medi-Cal (Medicaid). Millions of Americans have both Medicare and Medicaid coverage. This is called being "dual eligible."

If you have Medicare and qualify for full A&D FPL Medi-Cal coverage, the state will pay your Medicare Part B (Medical Insurance) monthly premiums. Depending on the level of Medi-Cal you qualify for, the state might also pay for:

• Your share of Medicare costs, like deductibles, coinsurance, and copayments
• Part A (Hospital Insurance) premiums, if you have to pay a premium for that coverage

If you have both Medicare and Medi-Cal, you should show both cards to your health care provider each time you receive services. In addition, if you are dual-eligible for Medicare and Medi-Cal:

• You will automatically be signed up for the Low-Income Subsidy (LIS)/Extra Help program through Medicare Part D (prescription drug coverage). This program helps people with low income pay for their medicines.
• You can get your coverage through a Medicare Advantage Special Needs Plan (SNP) instead of having original Medicare with separate Medicaid coverage. This plan can help you manage the health care services you need. SNPs may also offer more benefits than what you already get from original Medicare. In some cases, you may have no monthly premiums and/or you may pay lower co-payments. All SNP plans are different, so check with the plans to see what they cover and if you can enroll.

Note: SNPs are not available in every community. To find out if there is an SNP in your area, visit the Medicare website or call 1-800-633-4227 or 1-877-486-2048 (TTY).

How do I prepare to apply for A&D FPL Medi-Cal?

When you apply, you’ll be asked for important information to help determine if you qualify for benefits. Before you start, gather some basic information to make your application process easier: 

• A document that shows your age, such as your birth certificate or driver’s license
• A Social Security card
• Pay stubs for anyone in your household who has earned income
• Documentation that shows any other form of income, such as letters from Veterans Affairs (VA) or the Social Security Administration (SSA)
• Documentation of medical expenses

How do I apply for Medi-Cal (Medicaid) in California?

There are a few different ways you can apply for A&D FPL Medi-Cal. Read below to learn more about which option might be right for you.

The quickest and easiest way to apply for A&D FPL Medi-Cal is online through the BenefitsCal portal . When you apply through this portal, your personal information is kept 100% confidential and protected by special security technology.

Apply On BenefitsCal Portal

To apply online, start by clicking the button above or by going to the BenefitsCal homepage. 

• Once you click on the button above, you will be taken straight to the online benefits application.
• If you go to their homepage, you will click "Apply for Benefits". It will then ask Ready to Apply? and you will click on a second "Apply for Benefits" button. This will also take you to the online benefits application. 

1. Before beginning the application, you will  be presented with drop-down sections that go over what to expect, how to upload documents, and interview tips. After scrolling down to the bottom, you will be asked which county in California you live in. Once you select your county, you will click on the button that says "Begin". 

2. You will then be shown tips on completing the application and asked to provide as much information as you can. You may scroll down toward the bottom of the page and select "Next". The next page displays the Diversity, Equity, and Inclusion statement. After reading the statement, click "Next".

3. You will then be asked how you are feeling about the application process. Select the smiley face that best represents how you feel. After selecting a smiley face, you will be taken to the main page of the benefits application. Next to "Your Information" you will click "Start". You will then be prompted to complete each section of the application and submit. 

Note: If you wish to change the language to something other than English while completing the application, go to the top of the screen and click on the button that says "English". This will open up a drop down where you can select your preferred language. 

If you want to apply by mail or in-person, you will need a paper application. You can download and print a paper Medi-Cal application in your primary language, complete it, and mail it to:

Covered California
P.O. Box 989725
West Sacramento, CA 95798-9725

You can also mail your application to, or drop it off in person at, your local county office. In some situations, you may be able to apply over the phone or have someone else apply for you.

How can I get help with my application?

• Contact a Certified Enrollment Counselor (CEC). Call 1-800-300-1506 to find a local CEC.
• Visit a Benefits Enrollment Center (BEC), if there’s one near you. See if there’s one in your area.
• NCOA also has a HelpLine you can call to get free support. To get started today, call 1-800-794-6559