Medi-Cal is California’s version of Medicaid, the government health insurance program that provides free or low-cost coverage to residents with limited income. If you qualify, the state pays for your doctor visits, hospital stays, prescriptions, dental care, vision, mental health services, and more. Here’s how the entire system works, from qualifying to using your benefits.
Who Qualifies for Medi-Cal
Eligibility is based primarily on your household income measured against the Federal Poverty Level (FPL). Most adults and families qualify if their income falls below 138% of the FPL. For a single person, that means earning up to $21,597 per year. For a family of four, the cutoff is $44,367. Each additional household member adds roughly $7,590 to the limit.
Certain groups qualify through different pathways: pregnant individuals, children, seniors, and people with disabilities each have their own eligibility rules that can be more generous than the standard income threshold. California also extends Medi-Cal to all income-eligible residents regardless of immigration status.
Medi-Cal does look at assets (things you own, like savings accounts or property) for some programs. The current limit is $130,000 for one person, with an additional $65,000 for each extra family member up to ten. Transfers of assets made before January 1, 2026, won’t count against you, but transfers on or after that date could trigger a penalty that delays your coverage.
How to Apply and How Long It Takes
You can apply online through Covered California or BenefitsCal, by phone, by mail, or in person at your county human services office. The state has up to 45 days to review your application and may contact you for additional information during that time. Once a decision is made, you’ll receive a letter called a Notice of Action telling you whether you’ve been approved.
If approved, you’ll get a Benefits Identification Card (BIC) in the mail, and you can start using Medi-Cal right away. In most cases, you’ll also need to choose a Medi-Cal managed care health plan. The state will send you information about the plans available in your county and instructions for signing up.
Managed Care vs. Fee-for-Service
Medi-Cal delivers healthcare through two models, and most members end up in managed care.
With managed care, you enroll in a specific health plan that coordinates your benefits. The plan contracts with a network of doctors, hospitals, and specialists in your area. Your plan helps manage and coordinate your care, and it offers additional services called Community Supports (things like housing transition assistance or medically tailored meals) that aren’t available in the other model.
With fee-for-service (sometimes called “regular” Medi-Cal), you can see any provider who accepts Medi-Cal, but nobody coordinates your care for you. You’re responsible for finding your own providers and managing referrals. Most counties have moved primarily to managed care, so fee-for-service is less common than it used to be.
What Medi-Cal Covers
Medi-Cal covers a broad range of services. Doctor visits, emergency care, hospital stays, lab work, and prescriptions are all included. Beyond the basics, the program also covers several categories that many people don’t realize are included.
- Dental: Exams, X-rays, cleanings, fillings, crowns, root canals, extractions, dentures, and orthodontics for children who qualify.
- Vision: A routine eye exam once every 24 months, plus eyeglasses or contact lenses.
- Mental health: Outpatient therapy, specialty mental health services, inpatient psychiatric care, substance use disorder treatment, residential treatment, and inpatient detoxification.
- Pediatric care: Children under 21 get expanded benefits through a program called EPSDT, which covers periodic health screenings and any medically necessary services beyond the standard Medi-Cal benefit package, including preventive dental and vision care.
Peer support services are also available in select counties for people recovering from mental health or substance use challenges.
How Providers Get Paid
In managed care, the state pays each health plan a set monthly amount per enrolled member, regardless of how much care that person actually uses. This is called a capitation payment. The health plan then uses that money to pay its network of doctors and hospitals. A portion of the payment is withheld and tied to quality measures, so plans have a financial incentive to deliver good care and hit performance benchmarks.
In fee-for-service, providers bill the state directly for each visit, test, or procedure at rates set by California’s Medi-Cal fee schedule. These rates have historically been lower than what private insurance pays, which is one reason some providers limit how many Medi-Cal patients they accept.
Share of Cost for Higher-Income Members
Some people qualify for Medi-Cal but have income above the standard limits, particularly seniors and people with disabilities in certain eligibility categories. Instead of being denied, they’re assigned a monthly “share of cost.” This works like a deductible: you pay for your own medical expenses up to a set amount each month, and Medi-Cal picks up anything beyond that. The share of cost is calculated by taking your monthly income and subtracting your “maintenance need” level, which is the amount the state considers necessary for basic living expenses. Whatever is left over becomes your share of cost.
How Renewals Work
Medi-Cal isn’t a one-time approval. Your eligibility is reviewed once a year through a process called redetermination. In many cases, your county office can verify your eligibility automatically by checking government databases for income and household information. If everything checks out, you’re renewed without lifting a finger, and you’ll receive a notice confirming your coverage continues.
If your county can’t confirm your eligibility automatically, you’ll receive a renewal form in a bright yellow envelope. This form comes pre-filled with the information the county already has. Your job is to review it, correct anything that’s wrong, and provide any requested proof of income (pay stubs, tax returns, or similar documents). If you don’t return the form, you risk losing your Medi-Cal coverage. Keeping your contact information current with your county office is the single most important thing you can do to avoid gaps in coverage.