If you live in California and you need health insurance but cannot afford it, the state has a program to help you. It is called Medi-Cal. Medi-Cal is California’s version of the federal Medicaid program. It provides free or very low-cost health coverage to millions of Californians, paying for doctor visits, hospital stays, medicine, and dental care.
When you apply, you do not have to wait for a special time of year. You can sign up for Medi-Cal at any time. If you qualify, your coverage can begin almost right away. This guide will explain exactly what Medi-Cal is, the rules for who can get it, what kinds of care it pays for, and how to apply for it today.
Medicaid is a massive government program. It is the largest source of health coverage in the United States. According to the federal government’s official website, medicaid.gov, the program pays for medical and health-related services for millions of people with low incomes.
The federal government in Washington, D.C., helps pay for the program and sets basic rules. However, every state runs its own Medicaid program. Because of this, the program works a little differently depending on where you live.
In California, the state decided to name its Medicaid program Medi-Cal. Whenever you hear someone in California talking about Medi-Cal, they are talking about Medicaid. They are the exact same thing.
Medi-Cal is managed by a state agency named the California Department of Health Care Services (DHCS). Over one-third of all the people who live in California get their health insurance through Medi-Cal. Because it is funded by tax dollars, the goal of the program is to make sure that no one has to go without basic medical care just because they do not have a lot of money.
To understand why Medi-Cal is so helpful, it is good to know a few basic words about health insurance. When people buy private health insurance, they usually have to pay money out of their own pockets. They pay:
Medi-Cal works differently. For the vast majority of people who get Medi-Cal, there is no premium, no deductible, and no copay. You do not pay a monthly bill. When you show your Medi-Cal card at a doctor who accepts it, the visit is usually completely free. The state and federal government pay the doctor for you.
Medi-Cal is for people who do not make a lot of money. The main rule to get Medi-Cal is based on your household income. Your household means you, your spouse if you are married, and any children who live with you and are claimed on your taxes.
See if you fit into one of the main groups that can get Medi-Cal coverage.
| Group | Basic Income Rule |
|---|---|
| Adults (Ages 19 to 64) | Household income at or below 138% of the federal poverty level. |
| Children (Under 19) | Can qualify even if the family makes more than 138% of the poverty level. |
| Pregnant People | Can qualify with higher income limits to ensure healthy babies. |
For most adults between the ages of 19 and 64, the income limit to get Medi-Cal is 138% of the Federal Poverty Level.
The federal poverty level is a number the government uses to measure how much money it takes to live. Because prices go up, the government changes this number a little bit every year. If you look at all the money you make in a year before taxes are taken out, and that amount is at or below 138% of the poverty level for your family size, you will likely get Medi-Cal.
If you make slightly more money than the limit, you might not get Medi-Cal. However, you can still get massive discounts on private health insurance through the state.
California is very generous compared to many other states when it comes to Medicaid. The state has recently made big changes so that even more people can get health care.
If you get Medi-Cal, you get complete health coverage. By law, Medicaid programs must cover a list of things called “Essential Health Benefits.” This means the state cannot give you a fake or weak insurance plan. It has to pay for the real care you need to stay healthy.
Here is a plain-language look at what Medi-Cal pays for:
You can go to the doctor for a yearly checkup. If you get sick with a cold, the flu, or an infection, you can go to the doctor to get looked at.
If you get badly hurt, break a bone, or have a sudden heart problem, you can go to the emergency room. If you are so sick that you have to sleep at the hospital for a few days, Medi-Cal pays the massive hospital bills.
When your doctor writes a note for medicine (a prescription) and you take it to the pharmacy, Medi-Cal pays for it. You will usually pay absolutely nothing at the pharmacy counter.
Having a baby in a hospital can cost thousands and thousands of dollars. Medi-Cal covers care while you are pregnant, the cost of giving birth in the hospital, and care for both you and the baby after the birth.
Health is not just about your body; it is also about your mind. Medi-Cal covers visits to therapists, counselors, and psychiatrists. If you are feeling deeply sad, anxious, or dealing with addiction to alcohol or drugs, the program pays for treatment to help you recover.
Medi-Cal includes a dental program known as Denti-Cal (or Smile California). It pays for you to go to the dentist to get your teeth cleaned, get x-rays, get cavities filled, and even have teeth pulled if they are causing you pain. Children on Medi-Cal can also get braces if a doctor says it is medically required, not just to look nice.
Medi-Cal pays for a routine eye exam once every two years. If the eye doctor says you need glasses to see clearly, Medi-Cal will pay for a standard pair of glasses.
If you do not have a car and you cannot take a bus, you might struggle to get to your doctor’s appointments. Medi-Cal offers a service to give you a free ride to and from your medical appointments.
For seniors and people with serious disabilities, living alone can be very hard. Medi-Cal has a program called In-Home Supportive Services (IHSS). It helps pay for someone to come to your home to help you cook, clean, bathe, and get dressed so you can stay in your own house safely instead of moving to a nursing home.
Once you are approved for Medi-Cal, you do not just walk into any hospital in the country. The program is carefully managed.
When you get approved, the state will mail you a plastic card called a Benefits Identification Card (BIC). It looks a little bit like a credit card with the state seal on it. Keep this card safe in your wallet.
In most counties in California, you will be asked to pick a “Managed Care Plan.” This is a private insurance company that the state pays to handle your health care. Examples of these plans might be L.A. Care, Anthem Blue Cross, Health Net, or Molina. The plans offered depend on which county you live in.
If you do not pick a plan yourself, the state will choose one for you and mail you a packet.
Once you have a health plan, you must choose a main doctor. This doctor is called your Primary Care Provider (PCP). This doctor is your home base. Whenever you feel sick, you call this doctor first. You go to them for your checkups.
If you need a special doctor—like a doctor who only looks at hearts, or a doctor who only treats skin problems—your main doctor will give you a “referral.” A referral is a permission slip. Once your main doctor gives you the referral, your Medi-Cal plan will pay for you to see the specialist.
Not every doctor in California takes Medi-Cal. When you call a doctor’s office for the first time, you must ask a very clear question: “Do you accept my Medi-Cal managed care plan?”
If they say no, you cannot go to that doctor (unless you want to pay the full bill yourself). You must look in your health plan’s booklet or look on their website to find a doctor who is part of their group.
The state of California wants to make it as easy as possible for people to apply. There is no test to take, and it is completely free to apply. You should never pay someone money to help you fill out a Medi-Cal application.
Here are the step-by-step ways you can apply.
The easiest and fastest way to apply is on a computer or a smartphone. California has a website called Covered California. This is the state’s main marketplace for health insurance. When you go there and fill out an application, the computer checks your income. If your income is low enough, it automatically sends your information to Medi-Cal.
Action Step: Go to your state’s official marketplace or search for the California Department of Health Care Services website.
If you do not like using computers, you can apply over the phone. You can call the Covered California help center, or you can call your local county social services office. A worker will ask you questions over the phone and type in the answers for you.
You can print out a paper application, fill it out with a pen, and mail it to your local county office. This is slower, but it works perfectly fine.
Every county in California has an office for social services or human services. You can walk into the building, ask for a Medi-Cal application, fill it out in the waiting room, and hand it to a clerk.
When you apply, the state needs to make sure you are telling the truth about who you are and how much money you make. To prove this, they might ask you for:
If you get approved for Medi-Cal, you get to keep it for a full year.
However, Medi-Cal does not last forever automatically. Once a year, the state has to check to see if you still qualify. They need to see if you got a new job, if you make more money now, or if you moved away. This check is called Redetermination or Renewal.
Here is what you need to know about renewal:
Always make sure the county has your current mailing address. If you move to a new apartment or house, call your county office right away to change your address so you do not miss your renewal letter.
Sometimes it can be confusing to know which government program is which. Here is a simple comparison between Medi-Cal and the other common insurance choices in California.
| Program Name | Who It Is For | Est. Monthly Cost | Notes |
|---|---|---|---|
| Medi-Cal | People with very low incomes. | Usually $0 | Free comprehensive health care all year. |
| Covered California (ACA) | People with low-to-middle incomes who make too much for Medi-Cal. | Depends on income (Often very low) | The state helps pay the monthly bill through tax credits (APTC). |
| Medicare | People aged 65 and older, and some people with serious disabilities. | Varies (Usually around $170+) | A federal program. You can have both Medicare and Medi-Cal. |
| Employer Insurance | People who get coverage offered through their job. | Deducted from paycheck | If your job insurance is too expensive, your children might still get Medi-Cal. |
If you are 65 or older, you usually have Medicare. Medicare is good, but it is not totally free. It has copays, deductibles, and a monthly bill you have to pay.
If you are a senior and your income is very low, you can apply for Medi-Cal as well. If you get both, you are called “Dual Eligible.” This is a huge benefit because Medi-Cal will act as a backup. Medicare pays the doctor first, and then Medi-Cal steps in to pay the extra bills and copays that Medicare left behind. Medi-Cal can even pay your monthly Medicare bill for you.
Life changes fast. Here are a few common life events and how they involve Medi-Cal.
If you lose your job and you no longer have an income, you should apply for Medi-Cal immediately. Do not wait. You can apply the exact same day you lose your job. If you have zero income for the month, you will qualify.
If you are pregnant, the income limits to get Medi-Cal are higher. This means even if you make a little too much money for regular Medi-Cal, you might still get it while you are pregnant. Furthermore, when your baby is born to a mother on Medi-Cal, the baby is automatically covered for their first year of life.
By law, young adults can stay on their parents’ private health insurance plan until they turn 26. When they hit 26, they are kicked off the parents’ plan. If you turn 26 and you do not make a lot of money on your own, you should apply for Medi-Cal for yourself as a single adult.
Sometimes, government workers make mistakes. If you apply for Medi-Cal and the county sends you a letter saying you are denied, you do not have to just accept it if you think they are wrong.
You have the right to ask for a Fair Hearing. This means an independent judge will look at your application and your pay stubs. If the county made a math error and you actually do qualify, the judge will order the county to give you your Medi-Cal coverage. The letter that denies you will always have instructions on the back explaining how to ask for this hearing.
Health insurance is a shield that protects you from medical debt and keeps you healthy. If you do not have health insurance right now and you think your income is low, there is no reason to wait.
If you qualify for Medi-Cal, it will cover you and protect your family for the whole year.