California Medicaid Eligibility and Enrollment
- California Medicaid provides medically necessary services for children and adults with limited income. Find out if you qualify for California Medicaid.
California Medicaid is a joint federal and state government medical program designed to pay for health care services for 12 million low-income participants with disabilities, people 65 years and older and pregnant women who need medically necessary treatment and meet the program’s financial requirements. The program also helps provide medical coverage to financially needy people with specific diseases such as breast cancer, HIV/AIDS or tuberculosis. The Department of Health Care Services administers and manages California’s Medicaid health care program, which is financed equally by the state and federal government.
What Does California Medicaid Cover?
In California, Medicaid provides a wide range of services, some of which are considered the “core set of health benefits” by the state. These benefits include hospital care, immunization, pregnancy-related services and nursing home care. Due to the Affordable Care Act, all California Medicaid participants receive Essential Health Benefits (EHB). These include the following:
- Ambulatory services
- Emergency care
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative services (physical and occupational therapy)
- Labs and X-rays
- Well-check exams
- Chronic disease management
- Children’s pediatric, oral and vision services
California Medicaid also offers comprehensive dental benefits to children and adult participants. The state’s medicaid program also provides a variety of mental health and substance use disorder services such as outpatient care, narcotic treatment and partial hospitalization.
Who Is Eligible for Medicaid in California?
Like all Medicaid programs, Medi-Cal has several eligibility requirements applicants must meet to qualify for services, including income and asset limits that are adjusted annually based on the federal poverty limit. To be eligible, participants must be a U.S. citizen, state resident, or legal alien in need of health care or insurance coverage and be in a financial situation considered as low income or very low income. People in the following groups may qualify for California Medicaid:
- Pregnant women
- Parents and caretakers with dependent children 21 years of age or younger
- Blind and disabled individuals
- Adults who are 65 years of age and older
The income limit for California Medicaid depends on the applicant’s age, household size and family status. For example, pregnant women and parents and caretakers with children 21 years old and younger have higher income limits than adults without dependent children. To qualify for Medicaid in California, adult applicants between the ages of 19 and 64 must earn less than 133% of the federal poverty level, which is $12,800 a year for individual adults and $26,500 for a family of four in 2021. The maximum qualifying incomes in California are $16,971 and $34,846, respectively. Children in California are eligible for Medicaid through a program called the Children’s Medical Services (CMS) Branch, which offers a comprehensive system of health care for children through well-check exams, rehabilitation treatments and follow-up services.
How Do I Enroll in Medicaid in California?
Eligible participants can apply for Medi-Cal by printing an application and mailing it in to the Department of Health Care Services. You can also apply in person at your local county office or online at the Covered California website. To print an application, visit the Department of Health Care Services website and download the application and mail your completed form to the following address:
Medi-Cal Eligibility Divisions
P.O. Box 997417
Sacramento, CA 95899-7417
Applicants may also call the DHCS at (800) 300-1506 and apply over the phone. Applicants who want to learn more about Medi-Cal and whether they qualify for benefits can use the online screening tools to determine if they are eligible for coverage.
Contact Information for California Medicaid
Department of Health Care Services
Medi-Cal Eligibility Division
1501 Capitol Avenue
Sacramento, CA 95814
You may also contact Children’s Medical Services by mail at:
Children’s Medical Services
P.O. Box 997413
Sacramento, CA 95899-7413
Children’s Medical Services Branch Office: (916) 327-1400
Website: Children’s Medical Services (CMS) Branch Office