Tanja Barnes

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The Basics of Medi-Cal and Covered California for 2014

This is a follow-up to yesterday’s blog post “Finding Affordable Health Insurance Through Covered California“.  Today I continue to provide information on options for obtaining affordable health insurance and health care in California, specifically as it pertains to Medi-Cal.

If you get nothing more out of this topic at least take this with you: you maybe able to find the exact same health insurance coverage (for those of you who are already insured) but what’s more: you may qualify for tax credits or assistance with your premiums ONLY if you go through Covered California.

If you are currently insured or choose to purchase coverage directly through an insurer, you may not know about these tax credits or premium assistance as your current insurer is under no obligation to inform you and that could cost you money.

Medi-Cal Basics

In addition to Premium Assistance there is also Medi-Cal which is free health coverage for those who qualify including people with disabilities and those that meet certain income criteria. See my Medi-Cal eligibility chart below.

You may be eligible for Medi-Cal in 2014
Note: if you already have affordable insurance from your employer or government program like 
Medicare or Medicaid, you will not be eligible for financial assistance through Medi-Cal.

What Services Will Medi-Cal Provide?

Medi-Cal covers doctor visits, hospital care, and pregnancy-related services, as well as nursing home care for individuals age 21 or older. The ACA ensures all Medi-Cal health plans what is called as essential health benefits. Essential health benefits must include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental Health and Substance Use Disorder Services including Behavioral Health Treatment
  • Prescription Drugs
  • Rehabilitative and Habilitative Services and devices
  • Laboratory services
  • Preventive and wellness services & chronic disease management
  • Pediatric services (including oral and vision care)

Effective 2014, mental health and substance use disorder services will expand to better meet the needs of individuals eligible for Medi-Cal.

This expansion also allows coverage for parents who would lose coverage under current rules if their income slightly exceeds the federal poverty level (refer to my above chart).

All Medi-Cal beneficiaries who qualify will be able to receive the following mental health benefits through Medi-Cal Managed Care Plans and Medi-Cal Fee-For-Service:

  • Individual and group mental health evaluation and treatment (psychotherapy)
  • Psychological testing when clinically indicated to evaluate a mental health condition
  • Outpatient services for the purposes of monitoring drug therapy
  • Outpatient laboratory, drugs, supplies and supplements
  • Psychiatric consultation
  • Specialty mental health services currently provided by County Mental Health Plans will continue to be available.
  • Substance Use Disorder Services Benefits:
  • Voluntary Inpatient Detoxification
  • Intensive Outpatient Treatment Services
  • Residential Treatment Services
  • Outpatient Drug Free Services
  • Narcotic Treatment Services
  • Dental care, vision services and speech therapy are generally available only to children and youths under age 21, but certain adults and pregnant women are also eligible for these services. Dental services will be available to all adults starting May, 2014.

FAQ’s about Medi-Cal and Covered California

► If I already have Medi-Cal benefits, do I need to reapply? 

No.  If you already have Medi-Cal coverage, your Medi-Cal benefits will continue until your next regularly scheduled annual redetermination date.

► If I currently receive Medi-Cal benefits, will my benefits change in 2014? 

No.  Medi-Cal will continue to provide the same benefits under the ACA as it provides you today. At your annual redetermination, Medi-Cal will determine what health insurance program you and your family are best suited for.

► Is Medi-Cal changing its criteria to receive benefits?

Yes.  Medi-Cal eligibility is now simpler than ever.  For most individuals, Medi-Cal eligibility will be based on your household size and your income.  Medi-Cal will also attempt to verify your information electronically so you may be found eligible for benefits without ever having to provide paper verifications.

► How does Covered California work with Medi-Cal?

Covered California will act as a “one-stop shop” for health insurance.  Through Covered California, you will be able to apply for Medi-Cal benefits electronically and receive a real-time eligibility results.  You will also be able to report changes online and receive real-time customer support 24 hours a day. 

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If you have any additional questions regarding the Affordable Care Act and how it expands health care coverage, including Medi-Cal in 2014,  visit California’s Department of Health Care Services website at www.dhcs.ca.gov

This series of blog posts including Finding Affordable Health Insurance Through Covered CaliforniaThe Basics of Medi-Cal and Covered California for 2014 and Facts About Covered California’s Small Business Health Options Program (SHOP) is dedicated in loving memory to Martin Bosworth.