Medi-Cal is California’s medical care insurer for low-income residents and persons with disabilities. Medi-Cal is short for the California Medical Assistance Program. Due to the state’s dire fiscal situation this year, eligibility rules could change if funds for the program are cut, so stay up to date with changes by checking in periodically at the state’s Department of Health Care Services website.
Talk with electronic eligibility verification for rules for eligibility and enrollment. The Medi-Cal website has several pages focused on Medi-Cal as well as its broad mandate. You can be enrolled should you already collect Social Security benefits, food stamps, adoption assistance, foster care or perhaps in-home support services provided by their state.
Look further to find out if you qualify, even if you are not already collecting government benefits. In case you are 65 or older, blind or otherwise disabled, in a elderly care facility, you might qualify. Women that are undergoing treatment for breast or cervical cancer might also qualify if their income is less than 200 percent of the federal poverty level.
Call your neighborhood County Welfare Office. Medi-Cal lists the state’s 58 county welfare offices on its website. The office can answer any questions you have and can give you an idea whether you will qualify, even before you fill out the application.
Submit an application for assistance. The straightforward application is available in 11 different languages and is also available on the web. The application asks you for the identifying information, marital status, the individuals your family along with their ages, and whether you have a property in a choice of California or even in another state. You happen to be also necessary to list all your sources of income along with expenses associated with medical insurance, alimony as well as other factors that matter inside your overall household budget.
Be completely honest on your own application. The penalties for fraud and abuse are severe, and may include losing your benefits and potential prosecution for both recipients and providers. The state’s Health Department reports on its website that since 1999 it has poured a huge number of resources into combating Medi-Cal fraud.
As of January 2018, 2.5 million everyone was enrolled in Medi-Cal fee-for-service, representing about 19% of enrollees. Within the fee-for-service arrangement, medical service providers submit states to the Medi-Cal program for services rendered. Medi-Cal managed care. Most beneficiaries receive Medi-Cal advantages from contracted Medicaid managed care organizations. Since January 2018, 10.8 million people were enrolled in a Medi-Cal managed care plan, representing about 81% of enrollees.
California has several kinds of managed care which can be designated in the county level: County Organized Health System (COHS) model, with one health plan per county, “two plan model” with one community health plan and something commercial health plan within the county, a geographic managed care model with multiple plans per county, a regional managed care model with 1-2 commercial health plans in many counties, and different one-county models in San Benito and Imperial counties.
In Denti-Cal, the majority of beneficiaries are covered through fee-for-service arrangements, where the state pays dentists directly for services, rather than the managed care model. However, a lot more than 879,000 Denti-Cal enrollees do receive dental hygiene through managed care plans started as experimental alternatives in the 1990s: in L . A . County where managed care plans are optional for beneficiaries, and in Sacramento County where these are mandatory.
Eleven counties had no Denti-Cal providers or no providers ready to accept new child patients covered by Denti-Cal: Del Norte, Tehama, Yuba, Sierra, Nevada, Amador, Calaveras, Alpine, Mariposa, Mono ifepbh Inyo counties. Delta Dental, operating inside the same building as DHCS’ Denti-Cal division, enrolls dentists into DentiCal, processes claims by dentists, pays dentists and authorizes treatments, and in addition handles customer service operations and outreach.
Medi-Cal is jointly administered through the Centers for Medicare and Medicaid Services (CMS) and also the California Department of Healthcare Services (DHCS), while the county welfare department in each one of the 58 counties is responsible for local administration of the Medi-Cal program.