Medi-Cal is California's state Medicaid program, providing health care coverage for low-income families and individuals who lack other health insurance and who meet specific income and family status requirements. Historically, Medi-Cal has not covered all low-income individuals but has required additional eligibility criteria such as being a child, a senior, disabled, pregnant or diagnosed with other conditions, at differing financial eligibility levels depending on the program. Note that under health reform, Medi-Cal will be expanded to include all adults under 138% of the federal poverty level who are citizens or legally resident for 5 or more years. In the interim, if you are not eligible for Medi-Cal, you may be eligible for the Low Income Health Program.
At a Glance
Medi-Cal is a program that provides health insurance for low-income families. It offers medical, dental, vision and mental health care at little or no-cost to eligible families. In other parts of the nation, this program is known as Medicaid. See below for more information on the following:
How to Apply
There are a number of ways to apply for coverage:
- On-line at Benefits Calwin. Benefits CalWIN is a State website where you can find out about eligibility for Medi-Cal benefits, CalFresh (formerly Food Stamps) and CalWORKS (cash assistance). You can begin the application process by completing an easy online application and submitting electronic copies of your verifications. Simply select the Start Here button on Benefits Calwin to begin the process.
- Contact the County of San Diego’s ACCESS Customer Service Center
- Toll-Free: 1-(866) 262-9881
- TDD (hearing impaired): (858) 514-6889
- Fax: (858) 467-9088
- Walk-in or call for an appointment at any Family Resource Center.
Who is Eligible to Apply
Families and individuals may be eligible for Medi-Cal depending on income, assets and family size. The following persons may be eligible:
- Children under 21 years of age
- Persons 65 years of age and older
- Disabled and blind persons
- Pregnant women
- Families where at least one child is under 21 and at least one parent is absent, disabled, unemployed or working (depending on hours worked and income earned)
- Anyone who is eligible for CalWORKS; Supplemental Security Income and State Supplemental Program (SSI/SSP); Entrant or Refugee Cash Assistance (ECA or RCA); or In-Home Supportive Services (IHSS)
- Families with working parents may also qualify. They may have to pay a share of their medical expenses.
Residency and Financial Requirements
In order to apply for full-scope Medi-Cal, an applicant(s) must be a citizen or legal resident. Undocumented individuals may be eligible for a very limited set of benefits in the case of an emergency or pregnancy (known as Emergency Only Medi-Cal).
Income eligibility varies according to a number of factors including the Medi-Cal category for which you are eligible, and your age and family size. In general, you will be asked to provide documentation about income, assets and income deductions affecting eligibility.
- Income Deductions: Examples are Dependent care costs, court-ordered child support or alimony paid or received, education, or self-employed business expenses
- Assets: Examples are your home (living in), one car, clothing, college grants or scholarships, earned income tax credits
For more detailed information on eligibility and the application process for Medi-Cal, go to Benefits Calwin and click on the button marked Medical Services.
For more detailed information about the different Medi-Cal programs, go to the Medi-Cal eligibility chart.
Note: If you feel that you have been denied coverage or services inappropriately, the San Diego Consumer Center for Health Education and Advocacy (CCHEA) is available to help you resolve your problem. Call 1-877-734-3258 for assistance.