Medi-Cal and Medicaid: Looking for a health insurance can feel overwhelming, especially if you have a very limited budget. For people who struggle to afford coverage, understanding the difference between Medi-Cal and Medicaid insurance can add to the confusion.
There is not much difference between the both, Medi-Cal is simply California’s version of the Medicaid program. It is funded by both the federal government and the state of California to provide healthcare to those with limited financial resources.
Who Can Qualify for Medi-Cal?
Medi-Cal is available to California residents who meet certain income and eligibility requirements. The main factors for qualifying are income levels, participation in other assistance programs, and special circumstances like age, disability, or family status.
IRMAA brackets for 2025 Medicare Part D and Part B: What you need to know
As per Freeway Insurance for adults, Medi-Cal is available if their income is up to 138% of the Federal Poverty Level (FPL). Children, however, can qualify if their family income is up to 266% of the FPL.
Additionally, people who are already enrolled in programs like CalFresh (California’s food assistance program), Supplemental Security Income (SSI/SSP), or CalWorks (California’s welfare-to-work program) may automatically qualify for Medi-Cal. Other groups that may qualify include individuals who are aged 65 or older, under 21 years of age, pregnant, or living in skilled nursing facilities. Parents or caregivers of children under 21, and individuals diagnosed with specific conditions such as breast or cervical cancer, may also be eligible.
What Does Medi-Cal Cover?
Medi-Cal provides the same essential health benefits required by the Affordable Care Act. These benefits include a wide range of health services like:
Immigrants who meet other eligibility criteria but do not have satisfactory immigration status may still qualify for emergency services, pregnancy-related services, and state-funded long-term care.
How the $2,000 Out-of-Pocket Limit for Medicare Prescription Drugs Will Work Starting in 2025
Income Requirements for Medi-Cal
For those with lawful residency, Medi-Cal eligibility is based on income levels. Your family’s income, after deductions for things like child care and work-related expenses, must be at or below the specified limit for your family size. The limits differ depending on your family size, and it’s important to understand these thresholds to see if you qualify for no-cost or low-cost Medi-Cal health insurance.
How is Medicaid Different?
Medicaid is a program available across the U.S. to help low-income individuals and families pay for healthcare. While Medicaid operates nationwide, each state has its own rules and requirements for eligibility. The basic criteria for Medicaid are similar to Medi-Cal, focusing on income, family size, and health status. In most states, you must be a U.S. citizen or a legal resident to qualify. Your age and health may also influence your eligibility, especially if you are a child, pregnant woman, senior, or have serious health conditions.
Medicaid eligibility depends on your state, so itis best to check with your local Medicaid office to understand the specific rules in your area.
How to Apply for Medi-Cal
Applying for Medi-Cal is a straightforward process. There are several ways you can apply based on your preferences. You can apply in person at your county’s social services office, online through the Covered California website, or by phone at your local office. You can also apply by mail by completing the Single Streamlined Application and sending it to your county’s social services office.
Once you submit your application, it typically takes about 45 days for the process to be completed, and you will receive a Benefits Identification Card (BIC), which lets you start using your Medi-Cal benefits. If you need help with the application process, Certified Enrollment Counselors are available to guide you through the steps for free.
This website uses cookies.