HOW DO I APPLY FOR MEDI-CAL?
1. Submit an Application You can submit an application online, in-person or through the telephone. If you are visiting a hospital or clinic, they can also supply you with an application and often assist with the submission. You can submit the application online at benefitscal.com.
2. Children Under Age 19 You may apply for Medi-Cal for your children. Children who receive a CHDP visit are screened for temporary eligibility for Medi-Cal. If a child is eligible, he/she is pre-enrolled in temporary, full-scope Medi-Cal at no cost for up to 60 days (for the month of the visit and the month after). Infants who were born to a woman receiving Medi-Cal at the time of birth should receive Medi-Cal ongoing until the age of one.
3. Filling Out the Application You can get help filling out the application by calling (800) 560-0976. A Medi-Cal worker will go over the application you filled out. If you are asked for more information, you will be given a list of what is needed and a specific date by which the information must be mailed to the Medi-Cal office. A “return appointment” is not necessary. You can also get application assistance in the community from trusted providers like Community HealthWorks (916)448-3333.
4. Provide Needed Papers
• Identification with your name and current address on it. For example, a birth certificate, driver’s license, or California ID card. If you lack ID, you can fill out a form called “PA 853” and swear that you are who you say you are, or documents to verify income or disability status may also serve as proof of identity.
• Social Security Number or Card (or proof of application for the card) only for those requesting “full-scope” benefits.
• Proof of income (like check stubs, a copy of your tax return, or a statement of income under penalty of perjury if you are paid in cash or do not have any other way to prove income)
• Proof that you live in Sacramento County (a document that has your name and an address on it, such as an ID, a bill mailed to your house, school attendance records, pay stubs, etc.) for each adult on the application.
• Proof of U.S. citizenship and identity or acceptable immigration status for each person on the application who has declared acceptable immigration status. If you are a parent applying for children only, you do not need to give proof of your immigration status.
• Verified child or dependent care, educational expenses and/or health insurance premiums, or court ordered child support payments can be used as deductions, but are not needed to determine eligibility.
5. Cooperate With Child Support Services If one parent is absent, most people will have to cooperate with DHA and a county agency called the Department of Child Support Services (DCSS.) You must provide information you have about the other parent such as an address or social security number, to show who your child’s absent father or mother is and whether that parent can give the child with medical insurance. You do not have to supply this information if you are a survivor of domestic violence and the release of this information would put you or your family in danger.
6. Wait for Approval Normally, the Medi-Cal office will approve or deny your application within 45 days of receiving it, except for the faster ways for children, described above. If the state must evaluate a disability, the approval or denial can be delayed up to 90 days. If Medi-Cal denies your benefits, you can appeal. See the Hearings and Complaints link.
7. The Medi-Cal Card Once you have been “approved,” you may ask your worker for a written verification of your eligibility status from the Medi-Cal Eligibility Data Systems (MEDS) or your medical provider may be able to use your Social Security Number to verify your eligibility status through their Point of Service system. Your permanent white plastic Medi-Cal card, called a “Benefit Identification Card” or BIC, is mailed to your address. Each person listed on your application will get one, even if they aren’t eligible for Medi-Cal, because if the family must pay a monthly Share of Cost, the medical expenses of every person listed on the application can be used to meet the Share of Cost. If you don’t get your plastic card by the end of the month, or lose it, contact your worker. Keep the BIC even if your Medi-Cal stops. If you need Medi-Cal again, you can use the same BIC.
8. Managed Care. Most Medi-Cal recipients will need to select a health plan. When your Medi-Cal is approved, you will get information about how to select a health plan. If you do not choose a plan, the state will choose one for you. If you later want to change your health plan, you must call Health Care Options at 1-800-430-4263.
9. If You Are Pregnant If you are pregnant, you may be eligible for a program called AIM (Access for Infants and Mothers). Call AIM at (800) 433-2611. You can also get AIM even if you have medical insurance, if your insurance does not cover pregnancy or if you have a $500 or more “deductible”. Many pregnant women can get a temporary Medi-Cal card called “Presumptive Eligibility” immediately, without showing proof of pregnancy or providing information on property, car, or resources. This will help you get early prenatal care, lab tests and medication. You still have to turn in a regular Medi-Cal application and provide proof of income by the end of the next month if you still need Medi-Cal. As soon as the baby is born, call your worker to report the name and date to add the new baby to your family case record. The baby needs his or her own card by the end of the new Medi-Cal application for your baby. If you have trouble reaching your worker to tell the worker about the birth of your baby, some WIC offices and clinics have “Newborn Referral Forms” you can mail to DHA. Or you can get one yourself on the internet at
https://www.dhcs.ca.gov/formsandpubs/forms/Forms/MCED/MC_Forms/MC330_ENG.pdf
10. Retroactive Benefits If you had medical or pharmacy services from a Medi-Cal provider in the 3 months before you applied for Medi-Cal, ask your worker for a form to apply for “retroactive benefits.” The mail-in application also asks if you want this. If you were eligible for Medi-Cal during those 3 months, Medi-Cal may pay those bills. If you’ve already paid the bills and Medi-Cal covers the services, your clinic, doctor, dentist, or pharmacist should provide the refund to you. If you have trouble getting a refund, call Legal Services at (916) 551-2150.