Medi-Cal is California’s health care insurer for low-income residents and persons with disabilities. Medi-Cal is short for the California Medical Assistance Program. As a result of state’s dire fiscal situation this year, eligibility rules could change if funds for the program are cut, so stay abreast of changes by checking in periodically at the state’s Department of Health Care Services website.
Check with medi-cal eligibility for rules for eligibility and enrollment. The Medi-Cal website has several pages dedicated to Medi-Cal along with its broad mandate. You can be enrolled if you already collect Social Security benefits, food stamps, adoption assistance, foster care or in-home support services provided by the state.
Look further to find out if you qualify, even if you are not already collecting government benefits. If you are 65 or older, blind or otherwise disabled, in a nursing home, you may qualify. Ladies who are undergoing solution for breast or cervical cancer could also qualify if their income is lower than 200 percent in the federal poverty level.
Call the local County Welfare Office. Medi-Cal lists the state’s 58 county welfare offices on its website. The workplace can answer any queries you have and can present you with an idea whether you will qualify, just before you complete the application.
Apply for assistance. The straightforward application can be found in 11 different languages and is available online. The application asks you for the identifying information, marital status, the people in your family along with their ages, and whether you possess a home in both California or in another state. You might be also needed to list your sources of income as well as expenses associated with health insurance, alimony as well as other factors that matter inside your overall household budget.
Be completely honest on the application. The penalties for fraud and abuse are severe, and can include losing your benefits and potential prosecution both for recipients and providers. The state’s Health Department reports on its website that since 1999 it offers poured a huge quantity of resources into combating Medi-Cal fraud.
Since January 2018, 2.5 million everyone was enrolled in Medi-Cal fee-for-service, representing about 19% of enrollees. In the fee-for-service arrangement, medical service providers submit states the Medi-Cal program for services rendered. Medi-Cal managed care. Most beneficiaries receive Medi-Cal advantages of contracted Medicaid managed care organizations. As of January 2018, 10.8 million people were enrolled in a Medi-Cal managed care plan, representing about 81% of all enrollees.
California has several models of managed care which are designated in the county level: County Organized Health System (COHS) model, with one health plan per county, “two plan model” with one community health plan then one commercial health plan in the county, a geographic managed care model with multiple plans per county, a regional managed care model with 1-2 commercial health plans in numerous counties, and unique one-county models in San Benito and Imperial counties.
In Denti-Cal, nearly all beneficiaries are covered through fee-for-service arrangements, where the state pays dentists directly for services, rather than the managed care model. However, more than 879,000 Denti-Cal enrollees do receive dental hygiene through managed care plans started as experimental alternatives inside the 1990s: in La County where managed care plans are optional for beneficiaries, and in Sacramento County where they may be mandatory.
Eleven counties had no Denti-Cal providers or no providers prepared to accept new child patients protected by Denti-Cal: Del Norte, Tehama, Yuba, Sierra, Nevada, Amador, Calaveras, Alpine, Mariposa, Mono ifepbh Inyo counties. Delta Dental, operating in the same building as DHCS’ Denti-Cal division, enrolls dentists into DentiCal, processes claims by dentists, pays dentists and authorizes treatments, and also handles customer service operations and outreach.
Medi-Cal is jointly administered by the Centers for Medicare and Medicaid Services (CMS) as well as the California Department of Medical Care Services (DHCS), while the county welfare department in each of the 58 counties is mainly responsible for local administration in the Medi-Cal program.