Medi-Cal FAQs

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What is Medi-Cal?
What is the difference between Covered California and Medi-Cal?
How much does Medi-Cal cost enrollees?
What benefits are covered by Medi-Cal?
How do I enroll? Am I qualified?
If the ACA were repealed, would Medi-Cal benefits get cut?
Is California’s budget giving enough to Medi-Cal?


What is Medi-Cal?
Medi-Cal is California’s Medicaid program and offers free or low-cost health coverage for children and adults who meet certain eligibility requirements. Currently, Medi-Cal provides coverage for about 14 million Californians.


What is the difference between Covered California and Medi-Cal?
Covered California is the health insurance marketplace created under the Affordable Care Act (“ACA”) to allow California residents to shop for health plans on the individual market. Policies purchased under Covered California are private health insurance policies. For individuals making between 100% and 400% of the Federal Poverty Level (“FPL”), the federal government will subsidize the cost of plans purchased on the marketplace

However, Medi-Cal is a government-sponsored health insurance plan. It is only available for a low-income individuals and families (138% FPL), adults and children that are disabled, and other populations. For full eligibility requirements, view the California Department of Health Care Services website.


How much does Medi-Cal cost enrollees?
For many individuals that enroll in Medi-Cal, there is no premium, no copayment, and no out-of-pocket costs. Some households, however, are required to pay a low monthly premium.


What benefits are covered by Medi-Cal?
Medi-Cal covers many basic health benefits. These include the ten categories of Essential Health Benefits (EHBs) required under theACA. You can see what specific benefits are covered under each category here.


How do I enroll? Am I qualified?
For all questions about enrollment and whether you are qualified, visit the Covered California website. Covered California’s application will determine whether you qualify for Medi-Cal or if you will need to purchase on the private markets.


If the ACA were repealed, would Medi-Cal benefits get cut?
If the federal government repeals the ACA, or makes significant changes to the way in which Medicaid is funded and operated, it is very likely that many Medi-Cal recipients would experience changes in their benefits. In addition, many individuals who received Medi-Cal under the expansion would likely no longer be eligible for coverage.

Currently the federal government provides about 65% of the funds for Medi-Cal. It is estimated that if the ACA were repealed, California would lose close to $15 billion in federal funding for the expansion. Many of the GOP-led health reform proposals would limit the amount of federal contribution to state Medicaid programs, either by converting the program to block grants or a per capita cap. If federal contributions were limited, the state would be required to either cut benefits or make cuts to other state programs.


Is California’s budget giving enough to Medi-Cal?
Governor Jerry Brown’s proposed budget allots $1.9 billion to the General Fund for Medi-Cal. This is a 2% decrease from the preceding year. However, there is a 22% increase in non-federal spending on Medi-Cal (from state special funds and local Medi-Cal funding). You can read the California Legislative Analyst’s Office Report on the proposed budget and its effect on Medi-Cal here.