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Learn About Requirements for Medicaid in California

UPDATE: In 2020, Medicaid will not undergo any significant changes.

Learning how to qualify for Medicaid in California is crucial if you are interested in obtaining free or inexpensive medical assistance from the state’s medical insurance program, Medi-Cal. Only petitioners who meet the Medicaid eligibility requirements will be accepted into the program. Note that different types of criteria must be met by all applicants.

To gain CA Medicaid benefits eligibility, you must meet requirements in income-related and non-income related aspects that have been established by the state.

What Are the Income Requirements for Medicaid in California?

For those asking, “Who is eligible for Medicaid in California?” the simple answer is often: Americans with low incomes. However, to obtain Medicaid benefits eligibility, defining the necessary income is essential. The income required to meet Medicaid eligibility requirements in California is based on the number of members in an applicant’s household. This is standard in every state within the nation that offers the Medicaid assistance program.

Regarding how to qualify for Medicaid in CA based on income, your household income (based on your family’s size) must not exceed 138 percent of the Federal Poverty Level. Furthermore, families can obtain Medicaid benefits eligibility in California if their family size and household income line up as follows:

  • 3 members: $27,821
  • 4 members: $33,534
  • 5 members: $39,248
  • 6 members: $44,961
  • 7 members: $50,688
  • 8 members: $56,429
  • 9 members: $62,169
  • 10 members: $67,910
  • 11 members: $73,651
  • 12 members: $79,392

To gauge the maximum income you are allowed to earn if your household has more than 12 members, simply add a specific amount for each additional member of your household. The total will determine how much income you are allowed to earn and still receive benefits from the Medi-Cal program.

What are the requirements for Medicaid in California Which Are Not Income-related?

Beyond the California Medicaid eligibility requirements that are related to household income, the Medi-Cal program also requires prospective beneficiaries to meet various other qualifying criteria. Namely, Medicaid benefits eligibility can only be obtained by U.S. citizens or legal residents who are state residents in CA. Moreover, applicants must be considered in need of medical insurance assistance or health care, and (as mentioned above) they must be considered low-income or very low-income.

Beyond the income, residency/citizenship and medical need requirements for CA Medicaid eligibility, certain groups of individuals are granted access to medical assistance benefits in California. Applicants who are 65 years of age or older, for instance, can get medical assistance from the Medi-Cal program. In addition to the elderly, Medicaid benefits eligibility is also granted to the blind and the disabled of the state.

If you are pregnant or in an intermediate care home/nursing facility, you can get Medicaid. Additionally, if you are younger than 21 years of age, you also qualify.

In the event that you have a limited duration of time as a refugee in the United States, you can receive medical assistance, too. Plus, Breast and Cervical Cancer Treatment Program participants are eligible for benefits via the medical aid program.

Furthermore, parents or caretakers of children younger than 21 can also be accepted as beneficiaries of Medicaid if the child’s parent is:

  • Deceased.
  • Unemployed.
  • Underemployed.
  • Not living with the child.

So long as you can provide proof of your income, and your other eligibility qualifications when you apply for medical assistance benefits, you will be accepted into the program. Explore the different Medicaid requirements by downloading our informative guide.

Learn About California Medicaid Through Other Program Enrollment

Multiple methods are available for how to qualify for Medicaid in CA, as proved by the information provided in the sections above. However, another way to determine who is eligible for Medicaid in CA is by seeing if applicants are already members of another accepted state program. Members of all of the following programs may also receive medical assistance from Medi-Cal: CalFresh, CalWorks, Foster Care or Adoption Assistance Program, SSI, Refugee Assistance Program.

In the event you receive benefits from any of these other programs within the state, you can apply for Medicaid assistance as well. You will get the medical help required to maintain your health and that of every member of your household.

In the event that your application is denied due to non-eligibility, you may appeal the decision within 90 days of the action. Once it receives your appeal request, the California Department of Health Care Services will make a ruling regarding your application within 45 days of its receipt.

If your application is approved after the DHCS’ reconsideration, you and your household will begin to receive medical assistance benefits through the Medi-Cal program. Download our helpful guide to learn about the different eligibility qualifications for Medicaid.