A new state law went into effect in May, 2016 making all children under the age of 19 eligible for full scope Medi-Cal benefits regardless of immigration status, as long as they meet the income and other requirements. Income requirements have not changed and are the same for all children. Through this program a child receives: - Medical care, vision exams, dental care, substance abuse treatment, and mental health services that are available under Medi-Cal. - Full scope benefits that are NOT restricted to emergency-only services.
July 2017 Medi-Cal Updates
At this time there are no changes to Medi-Cal, Covered California or any other public health coverage. Despite all the political rhetoric, all of the current health care laws and regulations remain in effect for the foreseeable future.
Medi-Cal and Covered CA:Medi-Cal is still available for all qualified individuals, including undocumented children. Covered California's open enrollment period has ended for 2017. Special Enrollment is always open for people who have a qualifying life event. Download Special Enrollment information slides here. Immigrant Families: Obviously, immigrant families may be somewhat uncertain about the future of their health coverage and eligibility for benefits. This useful link has information to share now with families about whether it is safe to apply for health insurance and seek health care: https://www.nilc.org/issues/health-care/health-insurance-and-care-rights/
We will be monitoring the health coverage situation as it evolves and will keep you informed in the coming months.
6 Facts About Medi-Cal Expansion
All income eligible children up to age 19, including undocumented children, can now enroll in full scope Medi-Cal. This includes Denti-Cal, mental health, and other benefits.
Information is confidential and will not be shared with immigration or other agencies.
The state automatically moved undocumented children who had restricted scope Medi-Cal (also called emergency Medi-Cal) to full scope Medi-Cal in May of 2016. These children do not have to reapply.
The same Medi-Cal enrollment rules apply for the expansion as for traditional Medi-Cal children. Children become members of CenCal Health. CenCal sends parents information about selecting a primary care provider and other member benefits.
Children are income eligible if their family earns below 266% of the federal poverty level (FPL). Families will pay some monthly premiums if their household income is above 160% FPL.
If a child already has a family member enrolled in Medi-Cal, no new application is needed; families can contact the Department of Social Services and get other children in the family added to the case.
CAPSLO Health Services will assist with applications. Enrollment specialist, Karen Florian, can be reached at 544-2478, ext. 28.
Susana Castañeda, Patient Services Representative with SLO Public Health Department can assist with Medi-Cal or the Medically Indigent Services Program (MISP). Susana is also a Certified Enrollment Counselor for Covered California health plans. She can be reached at 805-781-4838.
Parents should know that all enrollment information is confidential - no immigration information will be released to other government agencies. This has been demonstrated to be true with the current restricted scope Medi-Cal coverage. In addition, the receipt of health benefits will not affect an immigrant's ability to change their immigration status or become a citizen. Click here for a fact sheet. Do you want to provide information for parents? Download this easy-to-read booklet in English or Spanish.
For Children: Families with incomes up to 150% of the current year's Federal Poverty Level (FPL) receive Medi-Cal coverage for their children at no cost. Families with incomes between 150% and 250% FPL pay a monthly Medi-Cal premium of $13 per child ages 1-19, up to a cap of $39 per month. If a child is ages 0-1, they are eligible for Medi-Cal with no premium at any income level.
Pregnant Women: There are several public and subsidized insurance options for pregnant women, regardless of immigration status. Download this fact sheet.
Who Provides Coverage and Care?
Coverage (insurance): Medi-Cal members in San Luis Obispo County are enrolled in a managed care plan through CenCal. This means that they can see any doctor with whom CenCal contracts. Dental coverage is provided through Denti-Cal, a state network. Mental health coverage is provided by the San Luis Obispo County Department of Mental Health Services for more severe mental illness and by CenCal, the managed care plan, for mild to moderate mental health issues.
Care (providers): For a list of health care and dental providers, contact CenCal, download the CenCal provider directory, or click here. For more severe mental health issues, call the County Mental Health intake number at (800) 838-1381. For mild mental health issues, referrals to providers can be made by primary care physicians or directly through the Holman Group, CenCal's mental health managed care provider, at (800) 321-2843.
Don't be Shy! Think you may qualify? Give it a try -- go in person to SLO County DSS, apply online at coveredca.com, or call the Covered California number, 1-800-300-1506 and Covered California will transfer you to SLO County DSS if you qualify for Medi-Cal. CAPSLO staff are helping anyone to enroll and Community Health Centers is also enrolling their clients at CHC sites.
Income level near the Medi-Cal limit? For children's coverage, the Medi-Cal limit is now 250% FPL. If a family's income level appears to be over the limit to qualify for Medi-Cal, it is always best to apply anyway. You can also call Pati Garcia, DSS Medi-Cal Program Manager, at 781-1893 if you want more information about determining income limits.
No Open Enrollment Period, Retroactive Coverage There is no open enrollment period for Medi-Cal. Enrollment is ongoing, based on income. When a person applies for Medi-Cal, a question on the form asks whether anyone received medical treatment over the past three months. If the applicant marks "Yes," medical expenses from the prior three months may be covered retroactively. If "No" is marked, then coverage begins with the month in which the application was submitted.
New Enrollees With the large number of people newly qualifying for Medi-Cal, some may get confused about how their Medi-Cal coverage initially works. When a person is enrolled in Medi-Cal, their medical coverage is Fee-For-Service through the State of California for the first month and until they receive their CenCal card.
Once they have their CenCal card, they are on the CenCal managed care plan. Community Health Centers of the Central Coast (CHC) will accept both types of coverage, but some private doctors on the CenCal managed care plan may not accept Fee-For-Service Medi-Cal.
In Case of Emergency: Hospital Presumptive Eligibility (HPE) Program
This program assists families in accessing hospital benefits. Hospital Presumptive Eligibility (HPE) provides an individual or family with immediate temporary access to full-scope Medi-Cal at no cost for up to two months. To apply for HPE benefits, an individual must visit a hospital that is a qualified HPE Provider - all hospitals in SLO are qualified. The HPE provider submits the individual’s information via the HPE Medi-Cal Application online portal and eligibility is determined in real-time. Eligibility is based on household size, income and state residency and is taken on the applicant’s own self-attestation. US citizenship is not required. Those who likely qualify are income eligible, uninsured California residents who are:
Former foster care children 18 to 26 years of age who received foster care on their 18th birthday
Adults 19 to 64 years of age who are not pregnant, not enrolled in Medicare and not eligible for any group described above
For more information about the Hospital Presumptive Eligibility Program check out the California Department of Health Care Services website.