Medi-cal – California’s Medicaid System

Medi-cal is a California state Medicaid system providing medical services for children and adults with limited income and assets. Under the Affordable Care Act (ACA) eligibility criteria for Medi-cal has been expanded to include 1 to 2 million new subscribers as of January 1st, 2014. Eligibility primarily considers ones income for single subscribers under the age of 65 with income at or below 138% of the federal poverty level (in 2014 that would mean an individual who earns $16,105 or less).

Find out if you qualify for Medi-cal based on your income

The Medi-cal program is required to provide minimum essential health benefits as mandated by the ACA:

  • Ambulatory patient services.
  • Emergency services.
  • Hospitalization.
  • Maternity and newborn care.
  • Mental health and substance use disorder services, including behavioral health treatment.
  • Prescription drugs.
  • Rehabilitative and habilitative services and devices.
  • Laboratory services.
  • Preventive and wellness services and chronic disease management.
  • Pediatric services (including oral and vision care).

Starting January 1st, 2014 Medi-cal expansion includes more comprehensive benefits for mental health and substance use disorders:

  • Individual and group mental health evaluation and treatment (psychotherapy).
  • Psychological testing when clinically indicated to evaluate a mental health condition.
  • Outpatient services for the purposes of monitoring drug therapy.
  • Outpatient laboratory, drugs, supplies and supplements.
  • Psychiatric consultation.
  • Specialty mental health services currently provided by county mental health plans will continue to be available.
  • Substance use disorder services benefits.
  • Voluntary inpatient detoxification.
  • Intensive outpatient treatment services.
  • Residential treatment services.
  • Outpatient drug-free services.
  • Narcotic treatment services.

Effective May 1st, 2014 Medi-cal has been expanded to include dental services for adults. Generally vision care and speech therapy services are only reserved for children and youths under the of 21. Adults may be eligible for these services under certain circumstances.

How do I apply for Medi-cal coverage?

J.C. Lewis Insurance will gladly take your enrollments via phone or by paper application. Fill out the Covered California/Medi-cal application and fax to 707-800-7456 or email to [email protected] We’ll process your application in the order in which it was received.

Can J.C. Lewis Insurance Services handle the Medi-cal enrollment for me?

Yes! All that we request is that you fill out the Appointment of Representative form and fax or email to us at 707-800-7456 or [email protected] This will allow us to gather information from your county social service office and provide real time updates on the status of your application.

How long does it take to process my application?

With the expansion of the Medi-cal system most California counties are backlogged with applications. It could take anywhere between 1 and 6 months for your application to be processed. We recommend applying with us as soon as possible to give yourself the best change of receiving coverage in a timely manner.

How do I know if I’m eligible for Medi-cal?

Call us at 707-978-2359 and we’ll tell you. Otherwise we recommend viewing the 2015 federal poverty guidelines.

What if I have an emergency before my application is processed?

If you are on your way to the emergency room and you do not have a Medi-cal ID card yet it is recommended that you call your county social service office and request an expedited enrollment.