The California Medical Assistance Program (Medi-Cal or MediCal) is California’s Medicaid program serving low-income individuals, including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of federal poverty level. Benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental (Denti-Cal), vision, and long term care and supports. Approximately 12.5 million people were enrolled in Medi-Cal as of May 2015, or about 32.4% of California’s population; in Tulare County and Merced County, more than 50% of county residents were enrolled as of September 2015.
Medi-Cal provides health coverage for people with low income and limited ability to pay for health coverage, including the aged, blind, disabled, young adults and children, pregnant women, persons in a skilled nursing or intermediate care home, and persons in the Breast and Cervical Cancer Treatment Program (BCCTP). People receiving federally funded cash assistance programs, such as CalWORKs (a state implementation of the federal Temporary Assistance for Needy Families (TANF) program), the State Supplementation Program (SSP) (a state supplement to the federal Supplemental Security Income (SSI) program), foster care, adoption assistance, certain refugee assistance programs, or In-Home Supportive Services (IHSS) are also eligible.
As a means-tested program, Medi-Cal imposes asset limits on prospective enrollees. This limit depends on the number of individuals being considered for coverage; for one enrollee, this limit is $2,000, while for two enrollees, the limit is $3,000. Each additional individual being considered results in an additional $150 of permitted assets, up to a total of ten individuals covered. If applicants possess property whose total value exceeds the allowed amount, they are required to reduce (“sell down”) their assets through activities such as purchasing clothes, purchasing home furnishings, paying medical bills, paying a home mortgage, paying home loans, and paying off other debts.
Beginning in 2014 under the Patient Protection and Affordable Care Act (PPACA), those with family incomes up to 138% of the federal poverty level became eligible for Medi-Cal (pursuant to 42 U.S.C. § 1396a(a)(10)(A)(i)(VIII)), and individuals with higher incomes and some small businesses may choose a plan in Covered California, California’s health insurance marketplace, with potential federal subsidies.
Medi-Cal health benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental (Denti-Cal), vision, and long term care and supports.
California is one of a few US states that provide Medicaid dental benefits to adults. But given Denti-Cal’s bare-bones coverage and the widespread absence of participating dentists in the program, a patchwork of supplemental programs has grown up to fill in some of the gaps, including Federally Qualified Health Centers (FQHC), a designation that refers to hundreds of health clinics and systems that operate in underserved, low-income and uninsured communities that private-practice dentists tend to avoid, and the state’s First 5 county commissions, which are funded by tobacco sales taxes, as well as a sprinkling of county-funded dental care.