Medi-Cal is simply the name California uses for the federal Medicaid program. Medicaid is a joint federal and state program providing health coverage to millions of Americans, primarily those with low incomes and limited resources. Every state operates its own version of this program under federal guidelines, and California chose to brand its implementation as Medi-Cal. This difference in name does not reflect a difference in the fundamental nature of the program, but rather a distinction in state administration.
Medicaid vs. Medi-Cal: Understanding the Name Difference
Medicaid is the overarching health care program established by the federal government, but its daily operations are managed by individual states. This joint structure allows each state to tailor the program to its local population and administrative needs, which often includes adopting a unique, state-specific name. California’s choice to call its program Medi-Cal is a prime example of this state branding initiative.
This practice is widespread for states to localize a federally established program. For instance, Massachusetts administers its version of Medicaid under the name MassHealth, while Tennessee calls its program TennCare. Other states use names like Apple Health in Washington or KanCare in Kansas. Beneath the different titles, the core program remains the same federally authorized structure.
The Federal Baseline: Mandatory Requirements of Medicaid
The foundation for every state’s Medicaid program, including Medi-Cal, is established by federal law, specifically Title XIX of the Social Security Act. This legislation sets a mandatory floor, or minimum requirement, that all participating state programs must meet to receive federal funding. The federal government mandates that states cover certain populations who fall into specific eligibility categories.
These mandatory groups include low-income pregnant women, children up to age 19, and certain disabled individuals who are receiving Supplemental Security Income (SSI). States must also provide coverage for low-income seniors and some parents or caretaker relatives with dependent children. By setting these baseline requirements, the federal government ensures a minimum level of health care access across the country.
State Implementation: Eligibility and Enrollment
While the federal law sets the minimum populations that must be covered, each state retains considerable flexibility in setting the specific financial requirements for enrollment. Following the Affordable Care Act (ACA), many states, including California, expanded their eligibility criteria to cover nearly all non-elderly adults with incomes up to 138% of the Federal Poverty Level (FPL). This expansion uses a calculation method known as Modified Adjusted Gross Income (MAGI) to determine eligibility for most children, pregnant women, and adults under age 65.
The MAGI methodology simplifies the application process by relying on an individual’s taxable income and household size, rather than counting assets like bank accounts or property for most groups. However, for certain beneficiaries, such as those aged 65 and older or those in long-term care, eligibility is determined using non-MAGI rules, which may still consider both income and resources. The enrollment process typically involves applying through a state-run online portal, such as Covered California, which determines if an applicant is eligible for Medi-Cal or for subsidized private insurance.
Scope of Coverage: Required Services vs. State Additions
All state Medicaid programs must cover a set of federally mandated health care services to ensure beneficiaries have access to necessary medical treatment. Nursing facility services for adults are also a required component of the benefit package.
Mandatory Services
- Inpatient and outpatient hospital services
- Physician services
- Laboratory and X-ray services
- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for children under 21
Beyond the federal minimum, states have the option to include a wide array of additional services, and many, like California, utilize this flexibility to enhance their coverage. These optional benefits often include prescription drug coverage, dental care for adults, vision services, physical therapy, and specific mental health treatments. This variation in state-selected services is where the practical experience of being enrolled in Medicaid can differ most dramatically across state lines.