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Medi-CAL Program
Medi-CAL is the State of California's program to provide medical coverage to low-income state residents. It offers medical, dental, vision and mental health care at little or no-cost, or low-cost to eligible families. In other parts of the nation, this program is known as Medicaid.
Services Available
Medi-CAL pays for many kinds of medical expenses. Your medical provider will know what services are available at no cost or with a "co-payment", also known as a “share of cost”.
Pregnancy Services
You may be eligible for Medi-CAL to pay for medical expenses for yourself and the baby if you are pregnant and cannot afford to pay for health care during pregnancy and for the baby's first year of life. Medi-CAL is often available at no cost to the mother even if she has income. Increases in family income will not count after Medi-CAL pregnancy-related services are approved.
Children
Children may get Medi-CAL at no cost if income requirements are met. There are different programs available for infants, for children ages 1 through 6, and for children ages 6 through 19.
Confidential Medical Services for Minors
Confidential medical services are available to unmarried persons under age 21 and living with their parents. Parental consent is currently not needed under the Minor Consent Program. Medical services covered under this program are those which relate to family planning, pregnancy, drug/alcohol abuse, venereal and other sexually transmitted infections, sexual assault, and outpatient mental health services for sexual or child abuse.
Eligibility for Medi-CAL
Families of any size are eligible if they meet eligibility guidelines. 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 qualify if their employer does not provide health insurance; they will have to pay a small share of their medical expenses.
Even if you are working, own a house, or are married, you may be eligible for Medi-CAL programs that help pay medical expenses. Any person has the right to apply. Certain conditions must be met to qualify. It is important for anyone in need of medical assistance to contact the Department of Social Services because so many factors must be considered.
Where to Apply
The Medi-CAL program for Placer County residents is administered by the Placer County Human Services department. If you would like to apply for the Medi-CAL Program you may do so in person, by mail, or by telephone. This program provides eligible applicants with a Medi-CAL Benefits Identification Card (BIC) that may be used for services at participating pharmacies, hospitals, and doctor's offices.
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Location |
Hours |
Auburn at DeWitt Center
Placer County Human Services
11519 B Avenue
Auburn, CA 95603
(530) 889-7610
Fax - (530) 889-7608 |
8:00 a.m. – 5:00 p.m. |
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Roseville
Placer County Human Services
100 Stonehouse Court
Roseville, CA 95678
(916) 784-6000
Fax - (916) 784-6100 |
8:00 a.m. – 5:00 p.m. |
North Lake Tahoe at Carnelian Bay
Placer County Human Services
5225 North Lake Blvd.
Carnelian Bay, CA 96140
(530) 546-1900
Fax - (530) 546-1912 |
8:00 a.m. – 5:00 p.m. |
To apply for Medi-Cal by phone:
(530) 889-7111 |
Anytime |
What to Bring
To expedite your application you may wish to bring with you the following items of verification if applicable:
- A picture identification card
- Social Security card
- Proof of US citizenship
- Non-custodial parent's Social Security number (for child support cases)
- Rent and utility receipts
- Vehicle registration
- Income and property verification such as checking and savings account statements.
- Place of employment
- Home and work address
- Date of birth
- Any prior court order information
- If you are not receiving CalWORKS, your most recent employment information would also be required.
FAQs
| How do I apply for Medi-CAL? |
There are three ways that you can apply for Medi-CAL in Placer County. You can apply by mail, in person at one of the Placer County Human Services office, or by phone. To apply for Medi-CAL by phone call: (530) 889-7111. If you want to apply by mail, please contact one of the offices and request an application be sent to your home. Back |
| How long does the Medi-CAL application process take? |
Forty-five (45) days are allowed to process a Medi-CAL application not involving a disability. If you are applying for Medi-CAL based on a disability, your application process may take up to 60 days or longer depending on how quickly you complete the disability information and how quickly your doctors and hospitals submit your medical records. To avoid delays in the processing of your case, submit all information requested of you as soon as possible. Ask your eligibility worker for help if you are having trouble obtaining information. Back |
| Do I have to pay for Medi-CAL? |
It depends.
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If your income is less than Medi-CAL limits for your family size, you will receive Medi-CAL services at no cost to you. (Refer to All County Welfare Directors Letter (ACWDL) 02-13 to view the Income Limit Chart.)
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If your income is more than Medi-CAL limits for your family size, you will have to pay a certain amount only in the month you have medical expenses. The amount that you pay is called your share of cost (SOC). When you pay or promise to pay that amount, we say that you have met your SOC. Once you have met your SOC, Medi-CAL will pay the rest of your covered medical bills for that month. For example, if your SOC is $50, you must first pay or obligate (obtain your providers agreement to make payments on the SOC) $50. Your provider will enter the amount you paid or obligated into the Department’s database. Your case will certify when the amounts you paid or obligated equal the amount of your share of cost. Once your share of cost is certified; providers checking your eligibility will advised that you are eligible and covered services may now be billed to the Medi-CAL program. Please note, expenses incurred by ineligible members of your family may be used to meet the share of cost of eligible members.
If one spouse lives in a nursing home, Medi-CAL allows the spouse remaining in the home to keep all of the income he/she receives in his/her name regardless of the amount. If that amount is below $2,232 per month, then the spouse in the nursing home can give income to the spouse at home to bring the spouse at home up to $2,232 per month. Be sure to ask your county social service agency for an MC Information Notice 007 for more information on income.
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| What benefits does Medi-CAL provide? |
Medi-CAL provides medical, vision and dental services for people with full-scope benefits. A person can be eligible for full-scope Medi-CAL benefits is she/he is a U.S. citizen or a legal permanent resident alien and meets other eligibility criteria. Restricted benefits provide emergency services to individuals without satisfactory immigration status. Restricted benefits allow a person to use her/his Medi-CAL for emergency services only. For a pregnant woman with restricted benefits, Medi-CAL will cover pregnancy-related services only. Based on a person's family size and income, a person may have to pay a share of cost (SOC) to the provider each month if Medi-CAL is used. A person with zero SOC pays no portion of the medical expenses whether or not Medi-CAL is used. Back |
| I have Medicare. Can I apply for Medi-CAL also? |
Yes. Individuals who are Medicare beneficiaries may apply for Medi-CAL. If Medi-CAL eligibility is established, the State will begin paying the Part B premium and the Part A and B coinsurance and deductibles. The State will also pay the Part A premium for Medicare beneficiaries who are not qualified for free Part A benefits. Medi-CAL may also provide medical services that are not covered by Medicare. Back |
| Can I get help from Medi-CAL with Medicare costs? |
Yes. Medicare is different from Medi-CAL. Medicare is a federal health insurance program run by the Centers for Medicare and Medicaid Services. It is available to most people 65 years of age or older and certain disabled or blind persons, regardless of income. Medicare Part "A" covers hospitalization. Medicare Part "B" covers doctor bills.
If you receive Medicare, you may qualify for the following special Medi-CAL programs:
- The Qualified Medicare Beneficiary program pays for the Medicare Part A and B premiums, co-insurance and deductibles. To be eligible you must have income at or below 100% of the Federal Poverty Level.
- The Specified Low-Income Beneficiary and Qualifying Individual 1 program pays for the Medicare Part "B" premium. To be eligible you must have income below 135% of the Federal Poverty Level.
- The Qualifying Individual 2 program reimburses you for a portion of your Medicare Part "B" premium that you have paid. To be eligible you must have income below 175% of the Federal Poverty Level.
- The Qualified Disabled Working Individual program pays the Medicare Part "A" premium. To be eligible you must have income at or below 200% of the Federal Poverty Level, be disabled, be employed and eligible under any other Medi-Cal program.
Even if you don’t qualify for the above assistance programs, your Medicare A & B premiums can be used as allowable deductions in the Medi-CAL share of costs calculation. Back |
| What services does Medi-CAL cover? |
For information about the services Medi-CAL covers:
• Call your provider (your doctor, dentist, clinic, hospital, etc.)
• For questions about dental services or Medi-Cal dental programs (Denti_CAL) call 1-(800) 322-6384. Back |
| Is there a special program for children and pregnant women? |
Yes. Pregnant women and children may have more income and property than other people and still qualify for no-cost Medi-CAL services. The income guidelines are different for children under age 1, children 1 to 6, and children 6 to 19. Your family property, such as savings accounts or cars, is not used to determine eligibility if monthly income falls within certain limits. Back |
| What is the Child Health and Disability Prevention (CHDP) Program? |
The Child Health and Disability Prevention (CHDP) Program is a health promotion and prevention program serving California’s infants, children, and teens. The CHDP Program provides periodic preventive health assessments to:
- Children under age 21 with Medi-CAL.
- Non-Medi-CAL eligible children from birth to age 19 with family incomes at or below 200 per cent of the Federal Income Guidelines and no source of health care coverage for preventive health care services.
- Children enrolled in Head Start and state preschool programs.
Children identified with suspected problems after a health assessment are referred for necessary diagnosis and treatment. Many problems can be prevented, corrected, or reduced in severity by prompt diagnosis and treatment.
Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) services are a benefit provided through the CHDP Program for Medi-CAL children not enrolled in a Medi-CAL managed care plans. Call 1 (800) 433-2611 for more information.
For more information about services, call the local Placer County CHDP program at (530) 886-3620. Or, call the California State Medi_CAL program general information line, (800) 675-2229. Back |
| What is the Access for Infants and Mothers (AIM) Program? |
The Access for Infants and Mothers (AIM) program provides health care to uninsured pregnant women whose income is too high to qualify for no-cost Medi-CAL.
To qualify for AIM, you must be less than 30 weeks pregnant when you apply. AIM benefits include:
- Prenatal visits
- Hospital delivery
- Full health care services during the pregnancy and for 60 days following the child’s birth
- Full health care services for the baby from birth to age two.
For more information and an application, call 1 (800) 433-2611. Back |
| What is the BabyCal? |
BabyCal encourages pregnant women and their families to get early and ongoing prenatal care and to practice healthy behaviors throughout the pregnancy (no smoking, drinking or drugs).
For information about BabyCal call 1 (800) BABY-999 (1 (800) 222-9999) or click here. Back |
| What is the Women, Infants & Children Supplement Nutritional Program (WIC)? |
The WIC program is for pregnant women, breast-feeding women, infants and children under five (5) years of age who have a medical/nutritional risk and are low-income. Due to limited federal funds, not everyone eligible for the WIC program will always receive services.
The WIC program provides:
- Coupons for food
- Nutritional counseling
- Nutrition education classes
- Breast feeding help.
For more information in Placer County, call WIC Nutrition Program, 1 (530) 889-7187, or 1-800-829-7199. Or, call your local county health department, or look under "WIC" in the white pages of your phone book. Back |
| What is the Family Planning Services Program? |
With Family Planning Services you will:
- Receive information and education on your options for birth control
- Discuss with your provider the birth control method that is best for you
- Receive Family Planning Services at low or no cost.
With Family Planning Services you can:
- Receive continued follow-up care
- Prevent unplanned pregnancies
- Plan when to have your next child.
Family Planning Services can give you:
- Birth control supplies for men and women
- Pregnancy tests
- Breast and cervical cancer screening
- Tests and treatment for sexually transmitted infections (STI)
- Education, testing, and counseling for HIV, the virus known to cause AIDS.
If you are low-income or are receiving Medi-CAL, Family Planning Services are available at no cost. You can get Family Planning Services from:
- Your regular Medi-CAL health care plan, doctor, or community clinic.
- Or, any other doctors or clinics that accept Medi-CAL.
- Health care providers who participate in Family Planning, Access, Care & Treatment (PACT).
To contact the California Office Family Planning Services, call 1 (800) 942-1054. Back |
| Are there county-operated health care programs? |
Yes. Individuals who are not eligible for Medi-CAL may qualify for a health care program offered by the county in which they live. Call your county social services office for more information.
Click here for information on Placer County’s Medical Care Services Program (MCSP). Back |
| What is California Children Services (CCS)? |
California Children Services (CCS) financially assists low-income families who are unable to afford necessary medical care for children with serious medical problems. CCS arranges and pays for diagnostic evaluations, if required, without regard to the family’s income and resources. The CCS program covers almost all serious medical conditions that can be improved or stabilized, including:
- Birth defects
- Chronic illness
- Genetic disease
- Handicaps which are present at birth or develop later
- Injuries due to accidents or violence.
To apply for this program, contact your county health department. Click here to find information about CCS in Placer County. Back |
| What is In-Home Supportive Services? |
The In-Home Supportive Services (IHSS) program helps pay for services which enable individuals to remain safely in their own homes instead of entering a nursing home or board and care facility. To be eligible, you must be over 65 years of age, disabled, or blind. Disabled children are also eligible for IHSS.
The types of services IHSS can help pay for include:
- Housecleaning
- Meal preparation
- Laundry
- Grocery shopping
- Personal care services (such as bowel and bladder care, bathing, grooming and paramedical services)
- Accompaniment to medical appointments
- Protective supervision for the mentally impaired.
To apply for IHSS in Placer County, contact the IHSS office at (530) 889-7240 or (916) 787-8800, or click here for more information. Back |
| More program information telephone numbers. |
1. Prepaid Health Plans/Managed Care:
• To Enroll/Dis enroll Call MAXIMUS, the State’s Health Care Options Contractor: 1 (800) 430-4263
• To File A "Plan Specific" Complaint Call your specific Health Plan
• If You Are Not Satisfied, Call The State Office Of The Ombudsman: 1 (888) 452-8609
2. Medi-Cal Billing Problems:
• For Problems Or Questions Regarding Medical Bills, Call Electronic Data Systems: (916) 636-1980
3. Medi-Cal State Hearing:
• To file a request for a Medi-Cal State Hearing: Call the Public Inquiry and Response Unit at 1 (800) 952-5253; For Hearing Impaired: TDD 1 (800) 952-8349
4. Third Party Liability:
• Health Insurance Billing and Coding, Premium Payment, Medicare Buy-in: 1 (800) 952-5294
• Casualty, Personal Injury, Probate, Estate, Liens, Workers’ Compensation, Overpayment Recovery: 1 (800) 952-5294.
5. Medi-Cal Beneficiary Fraud and Abuse: 1 (800) 822-6222
6. Provider Fraud and Elder Abuse complaint line: 1 (800) 722-0432
7. SSA or SSI/SSP Information: 1 (800) 772-1213
(For hearing impaired: TTY 1 (800) 325-0778
8. Other Health Program Numbers:
For Healthy Families/Medi-Cal for Children application and/or information: 1 (888) 747-1222. Back |
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