Children’s Health Care
Medi-Cal For Families
1. Am I Eligible?
Children aged birth to 19 whose family income is too high for the family based Medi-Cal program will be enrolled in Medi-Cal’s Targeted Low-Income Children’s Program (TLICP) which is now called Medi-Cal for Families. The program offers health, dental, mental health, and vision services. Families must meet certain income requirements, but the value of things you own (“resources”) are not counted against you.
The child must be without employer-based or private health insurance for at least three months before the application, with some exceptions. The child can obtain three months of retroactive Medi-Cal prior to becoming eligible for Medi-Cal for Families, or can be on “Share of Cost” Medi-Cal. Nineteen-year-olds can apply on their own. The child stays eligible for 12 months continuously once it is decided that he or she is eligible, even if the income changes. The cost of the items you own (“resources”) does not count against you.
2. Residency Requirements
You must sign a statement that each person who is applying for Medi-Cal for Families intends to stay in California with no plans to leave. Children who are U.S. citizens will be asked to provide a copy of their birth certificate.
3. What Does It Cost?
Depending on your income, you could pay monthly premiums ranging from $13 per child (no more than $39 per month). If you fall in the higher income group, you will receive a report in the middle of the year to see if your income has dropped, which would mean you would pay less.
Any time your income drops or increases you should report it to the local county the within 10 days at to see if you can pay less. Also, if you pay three months of premiums in
advance, you will get a fourth month of coverage for free. If you pay 9 months in advance, you get 12 months of coverage. Except for the first month, you can pay your premiums at some Western Union Convenience Pay locations.
4. How Do I Apply?
You may get an application form at any DHA Office, at many health clinics or call 800-560-0976 . If your child is found to be ineligible for Medi-Cal for Families at the annual redetermination (e.g. because your family income goes down) your child should be given temporary full-scope Medi-Cal while the information is sent to the county (with your permission) to determine if your child is eligible for regular no-cost Medi-Cal. This is called the “Presumptive Eligibility Program.” You should not be required to apply separately for Medi-Cal or to provide any information again, unless the county needs more information from you to determine eligibility.