Welcome To Tulare County Health and Human Services Agency's Website

Adobe Acrobat and Flash Player required for this site.

MEDI-CAL

What is Medi-Cal?

Medi-Cal is California's Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources. Medi-Cal is supported by federal and state taxes. You can apply for Medi-Cal benefits regardless of sex, race, religion, color, national origin, sexual orientation, marital status, age, disability, or veteran status. If you are found (or determined) eligible, you can continue to get Medi-Cal as long as you continue to meet the eligibility requirements

How can Medi-Cal help me?

Medi-Cal is a large program made up of many separate programs designed to assist Californians in various family and medical situations. When you apply for Medi-Cal, the information you provide on your Medi-Cal Application and any required verification will be used to determine which program(s) you qualify for, and which program is best for you and your family

Who can get Medi-Cal?

People in many different situations qualify for Medi-Cal. They are listed below. If you are not in one of these groups, call the closest TulareWORKs office to determine if you qualify for a County-operated medical assistance program.

You may automatically be eligible for Medi-Cal if you receive cash assistance under one of the following programs:

SSI/SSP (Supplemental Security Income/State Supplemental Program)

CalWORKs (California Work Opportunity and Responsibility to Kids). Previously called Aid to Families with Dependent Children (AFDC).

Refugee Assistance

Foster Care or Adoption Assistance Program.

Even if you don't receive cash assistance, you may be eligible for Medi-Cal if you are one of the following:

65 or older

Blind

Disabled

Under 21

Pregnant

Diagnosed with breast or cervical cancer

In a skilled nursing or intermediate care facility.

Refugee status during a limited period of eligibility. Adult refugees may or may not be eligible depending upon how long they have been in the U.S.

Parent or caretaker relative of a child under 21 and

The child's parent is deceased or doesn't live with the child, or

The child's parent is incapacitated, or

The child's parent who is the primary wage earner is unemployed or underemployed.

Do I have to pay for Medi-Cal?

It depends.

If your income is less than Medi-Cal limits for your family size, you will receive Medi-Cal services at no cost to you. (Please discuss the limits with your worker.)

If your income is more than Medi-Cal limits for your family size, you will have to pay a certain amount only in the month you have medical expenses. The amount that you pay is called your share of cost (SOC). When you pay or promise to pay that amount, we say that you have met your SOC. Once you have met your SOC, Medi-Cal will pay the rest of your covered medical bills for that month. For example, if your SOC is $50, you must first pay or obligate (obtain your providers agreement to make payments on the SOC) $50. Your provider will enter the amount you paid or obligated into the Department's database. Your case will certify when the amounts you paid or obligated are equal the amount of your share of cost. Once your share of cost is certified; providers checking your eligibility will be advised that you are eligible and covered services may now be billed to the Medi-Cal program. Please note, expenses incurred by ineligible members of your family may be used to meet the share of cost of eligible members.

If one spouse lives in a nursing home, Medi-Cal allows the spouse remaining in the home to keep all of the income he/she receives in his/her name regardless of the amount. If that amount is below $2,232 per month, then the spouse in the nursing home can give income to the spouse at home to bring the spouse at home up to $2,232 per month. Be sure to ask your worker for an MC Information Notice 007 for more information on income.

Where can I apply for Medi-Cal?

Clients can apply at any of our District Offices (pdf) and the HHSA Health Care Centers (pdf).

If I apply for Medi-Cal do I have to go to the office for an interview?

For Medi-Cal, you do not have to have an interview in our office , you can call any of our offices and have an application mailed to you.

What if I'm disabled?

If you feel you are disabled, make sure to note this on your application or let your eligibility worker know this when you mail in your application. There are certain criteria you must meet to receive Medi-Cal on the basis of disability. You must have severe physical and/or mental problem(s), which will last at least 12 months and keep you from working during these 12 months, or possibly result in death.

You must prove your disability. Proof may involve obtaining medical records, tests, and other medical findings.

For your child to receive Medi-Cal as a disabled child, he/she must have severe physical and/or mental problem(s) that prevent the child from doing daily activities that a healthy child does.

Disability is looked at in two different ways.

Presumptive Disability allows you to get Medi-Cal as a disabled person while waiting for a final determination of disability. Presumptive Disability covers only certain types of illnesses/diseases and conditions. Ask your eligibility worker if your special situation qualifies you for Presumptive Disability.

If your special situation is not covered under Presumptive Disability, it may take up to 60 days to determine if you meet the Medi-Cal definition of disability and can receive Medi-Cal as a disabled person.

Can I get help from Medi-Cal with Medicare costs?

Medicare is different from Medi-Cal. Medicare is a federal health insurance program run by the Centers for Medicare and Medicaid Services. It is available to most people 65 years of age or older and certain disabled or blind persons, regardless of income. Medicare Part "A" covers hospitalization. Medicare Part "B" covers doctor bills.

If you receive Medicare, you may qualify for the following special Medi-Cal programs:

The Qualified Medicare Beneficiary program pays for the Medicare Part A and B premiums, co-insurance and deductibles. To be eligible you must have income at or below 100% of the Federal Poverty Level.

The Specified Low-Income Beneficiary and Qualifying Individual 1 program pays for the Medicare Part "B" premium. To be eligible you must have income below 135% of the Federal Poverty Level.

The Qualifying Individual 2 program reimburses you for a portion of your Medicare Part "B" premium that you have paid. To be eligible you must have income below 175% of the Federal Poverty Level.

The Qualified Disabled Working Individual program pays the Medicare Part "A" premium. To be eligible you must have income at or below 200% of the Federal Poverty Level, be disabled, be employed and eligible under any other Medi-Cal program.

Even if you don't qualify for the above assistance programs, your Medicare A & B premiums can be used as allowable deductions in the Medi-Cal share of costs calculation.

What if I am disabled and working, can Medi-Cal help me?

Yes. The 250 Percent Working Disabled program allows you to buy into the Medi-Cal program by paying monthly premiums on a sliding scale based on your monthly income. Premiums range from a minimum of $20 to a maximum of $250 per month for an eligible individual, or from $30 to $375 for an eligible couple.

To be eligible for the 250 Percent Working Disabled program, you must:

Continue to meet the federal definition of disability as defined in federal law for Social Security disability programs, although you are able to work,

Pay a monthly premium based on net countable income, and

Meet all other non-financial Medi-Cal eligibility requirements