Medi-Cal is California’s healthcare 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 in 2011, eligibility rules could change if funds for the program are cut, so stay up to date with changes by checking in periodically at the state’s Department of Healthcare Services website.
Consult with medi-cal eligibility verification system for rules for eligibility and enrollment. The Medi-Cal website has several pages committed to Medi-Cal as well as its broad mandate. You can be enrolled in the event you already collect Social Security benefits, food stamps, adoption assistance, foster care or in-home support services offered by the state.
Look further to see if you qualify, even if you are not already collecting government benefits. In case you are 65 or older, blind or otherwise disabled, in a an elderly care facility, you could qualify. Women that are undergoing treatment for breast or cervical cancer might also qualify if their income is less than 200 percent from the federal poverty level.
Call your local County Welfare Office. Medi-Cal lists the state’s 58 county welfare offices on its website. Work can answer any questions you may have and can present you with an idea whether you will qualify, just before you complete the applying.
Make an application for assistance. The straightforward application can be found in 11 different languages and is available online. The application form asks you for the identifying information, marital status, the members of your household along with their ages, and whether you own a house in a choice of California or in another state. You are also required to list your sources of income along with expenses relating to medical insurance, alimony and other factors that matter inside your overall household budget.
Be completely honest on the application. The penalties for fraud and abuse are severe, and may 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 tremendous variety of resources into combating Medi-Cal fraud.
As of January 2018, 2.5 million individuals were enrolled in Medi-Cal fee-for-service, representing about 19% of all enrollees. Inside the fee-for-service arrangement, health care providers submit states the Medi-Cal program for services rendered. Medi-Cal managed care. Most beneficiaries receive Medi-Cal benefits from 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 enrollees.
California has several kinds of managed care which are designated at the county level: County Organized Health System (COHS) model, with one health plan per county, “two plan model” with one community health plan and one commercial health plan within the county, a geographic managed care model with multiple plans per county, a regional managed care model with 1-2 commercial health plans in many counties, and different one-county models in San Benito and Imperial counties.
In Denti-Cal, the vast majority of beneficiaries are covered through fee-for-service arrangements, where the state pays dentists directly for services, rather than the managed care model. However, a lot more than 879,000 Denti-Cal enrollees do receive dental treatments through managed care plans started as experimental alternatives within the 1990s: in Los Angeles County where managed care plans are optional for beneficiaries, as well as in Sacramento County where they may be mandatory.
Eleven counties had no Denti-Cal providers or no providers willing to accept new child patients covered by Denti-Cal: Del Norte, Tehama, Yuba, Sierra, Nevada, Amador, Calaveras, Alpine, Mariposa, Mono ifepbh Inyo counties. Delta Dental, operating within the same building as DHCS’ Denti-Cal division, enrolls dentists into DentiCal, processes claims by dentists, pays dentists and authorizes treatments, and in addition handles customer service operations and outreach.
Medi-Cal is jointly administered through the Centers for Medicare and Medicaid Services (CMS) and the California Department of Healthcare Services (DHCS), whilst the county welfare department in each one of the 58 counties is responsible for local administration of the Medi-Cal program.